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Enlarged prostate: Treating an age-old men’s health problem

October 12, 2017 | UC Irvine Health
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Dr. Faysal Yafi, above, treated Paul Bonney's enlarged prostate with a new treatment option: the UroLift® system.

After about four years of worsening symptoms — urinary urgency, frequency and irregular flow — Paul Bonney decided it was time to take action.

Bonney, 70, was suffering from an enlarged prostate, or benign prostate hyperplasia (BPH).

He was among good company:

  • By age 60, 50 percent of men will have signs of BPH.
  • By age 85, the number jumps to 90 percent.
  • Of those 90 percent, about one-third will develop BPH symptoms that need treatment.

If left untreated, BPH can lead to urinary tract infections, kidney damage, and/or the complete inability to urinate.

New treatment for enlarged prostate

BPH is a non-cancerous condition. As men age, the prostate — a walnut size gland that surrounds the urethra — can grow larger. This can reduce the flow of urine and the bladder’s ability to empty.

Men's Health Q&A
To learn more about the prevention, symptoms and treatment for BPH and common men’s health conditions in aging, check out Yafi’s free lecture, “A Frank Discussion About Men’s Health Issues” at 7 p.m., Monday, Oct. 23, 2017, at the Newport Beach Central Library.
Bonney specifically sought out a UC Irvine Health doctor for his BPH treatment because he was so impressed with the UC Irvine Health ophthalmologists who successfully treated his macular pucker and cataracts. His search led him to Dr. Faysal Yafi, chief of andrology and director of men’s health at UC Irvine Health.

Bonney’s treatment path started with a couple of different BPH medications, tadalafil and alfuzosin, which helped, but not enough to have a normal lifestyle. That prompted Yafi to suggest a new-technology treatment option for BPH called the UroLift® system.

The UroLift system is a minimally invasive outpatient procedure that uses tiny implants to lift and hold the enlarged prostate away from the urethra. This allows urine to easily flow again without cutting, heating or removing parts of the prostate.

It was about a 10-minute procedure and then Bonney was sent home to recover. He experienced some discomfort for a couple of days but recovered quickly.

Preserving sexual function

“The results were really, really, really terrific. It was as if the enlarged prostate had just gone away,” Bonney said. “I was a normal, healthy male again.”

Results like these are what attracted Yafi to the UroLift procedure.

“The most exciting part is that we’re preserving sexual function as well as offering something that’s less invasive with fewer side effects,” Yafi said. “Patients love getting something done that changes their lives and allows them to walk out the same day.”

Are you a candidate for UroLift?

The UroLift procedure isn’t for everyone, though.

To test if a person is a strong candidate, Yafi performs a cystoscopy, also known as a bladder scope. During this in-office process, a tiny camera is inserted through the tip of the penis into the urethra to assess the prostate’s size and the bladder’s level of obstruction. If the patient tolerates this well and his anatomy is favorable, then he is a good candidate for the procedure.

After the UroLift procedure, patients have two-week, two-month and six-month follow-up appointments to assess how they’re doing. On average, patients will see about a 60 percent improvement in their urinary symptoms compared to before the procedure, Yafi said. The five-year follow-up studies on the UroLift procedure show that the outcome success rates are sustainable.

Other BPH treatments

For those who aren’t ideal Urolift candidates, there are plenty of other treatment options, Yafi explained:

Watch and wait. This surveillance of the prostate is usually the first line of defense, especially for men with an enlarged prostate who do not experience distressing symptoms.

For those who have mild symptoms, this is an optimal time to implement lifestyle changes, such as reducing or eliminating cigarette smoking, coffee, tea and alcohol because they can irritate the bladder. Men with mild BPH symptoms may also want to stop drinking fluids in the late afternoon or early evening so they don’t wake up to urinate at night as often.

Medications. In addition to the ones Bonney tried, other medications for BPH include alpha blockers (tamsulosin, terazosin, doxazosin, silodosin) and 5 alpha reductase inhibitors (finasteride, dutasteride). However, medications may include side effects, such as loss of libido, problems with ejaculation, or lower blood pressure. For men on multiple medications, cognitive impairment is another risk factor to weigh when considering BPH medications.

 Other minimally invasive procedures

  • Besides the UroLift system, there’s also transurethral microwave therapy. This procedure uses a microwave antenna attached to a tube that is inserted into the bladder. The microwave heat destroys extra prostate tissue.
  • Another alternative is transurethral needle ablation. In this procedure, a heated needle is inserted in the urethra to kill excess prostate tissue.
  • Another option is the Rezum® system, another in-office minimally invasive procedure that uses thermal therapy via water vapor to get rid of extra prostate tissue.

Surgeries. The most common BPH surgery is transurethral resection of the prostate. The doctor removes the parts of the prostate that affect urinary flow. Retrograde ejaculation, which is when semen is ejaculated into the bladder instead of through the urethra, is a harmless but often quite bothersome sexual side effect that can sometimes occur with this surgery.

Others may opt for laser surgery to remove parts of the prostate or open or robotic surgery to remove the whole prostate.

What’s next in BPH treatment

Aquablation, an ultrasound-guided, robot-assisted technique which uses water jets for the targeted removal of prostate tissue, is currently undergoing further investigation.

Of course, preventing BPH in the first place would be ideal.

“The data suggests it’s associated with the metabolic syndrome, so a diet that is free of processed foods may help,” Yafi said. “Although we still don’t know any preventive measures that definitely avoid enlargement of the prostate.”

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