The last fifteen years have seen remarkable advances in the treatment of benign prostatic hyperplasia. new medications continue to be developed along with high-tech procedures to relieve urinary problems this condition causes.
By the age of sixty, about 50 percent of American men will have developed benign prostatic hyperplasia (BPH). This enlargement of the prostate is a natural part of aging. Some men will not experience any notable symptoms from BPH, while others will have urinary problems of varying severity. As the prostate enlarges, the gland begins to press against the urethra—the tube that transports urine out of the body—like a clamp on a garden hose.
As a result of the pressure, the bladder wall becomes thicker and irritable and, eventually, the bladder begins to contract even when it contains only small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to fully empty itself. Over time, severe BPH may cause additional problems, with urine retention and strain on the bladder leading to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence.
The goal and the approach
The goal oftreatment for BPH, whether medical or surgical, is reducing the size of the prostate and opening the urethra for easy passage of urine. When the use of medicine alone is unsuccessful or undesirable to the patient, we often turn to two forms of minimally invasive surgery, transurethral needle ablation (TUNA) or laser prostatectomy.
“The ideal candidate for TUNA is someone with a moderately enlarged prostate and moderate post-void residuals who hasn’t responded to drug treatment,” says Dr. Scott Kahn of Premier’s Urology Division. “On the other hand, a patient with a greatly-enlarged prostate, severe symptoms, and large post-void residual might better benefit from a laser prostatectomy. We review the pros and cons of each approach with our patients and, together, choose the one that’s right for them,” he says.
The TUNA procedure was approved for clinical use by the FDA in 1996. The patient is sedated and instruments reach the prostate via the urethra. “We’re able to precisely treat just the enlarged portion of the prostate with this procedure,” says Dr. Kahn. “Using a pair of needles inserted directly into the prostate, we apply low level radiofrequency energy, which heats the tissue to 110 degrees Celsius, effectively destroying it.”
Most patient are able to return to work in two to three days after the procedure and they experience few side effects. There is no incontinence associated with the TUNA procedure and erectile difficulties are rare.
An even newer procedure, called photoselective vaporization of the prostate (PVP) was FDA approved in 2001. “Basically, as the name suggests, this procedure vaporizes the benign enlarged nodules of the prostate. There is very little bleeding involved, which makes it useful for patients who are on blood thinners,” says Dr. Kahn.
Using fiber optics, the surgeon directs laser light at the prostate. The intense pulses of light are absorbed by the blood and, within moments, the temperature of the blood rises enough to cause the nearby prostate cells to vaporize. Delivery of the laser pulse is so precise that there is no damage to surrounding tissues and vessels. Recovery is quick and side effects are few.
“We have other procedures available when a patient’s BPH or general health condition requires them,” says Kahn. “Refinements continue to be made, but at this point these two procedures fill the bill for most men.”