Most of us are familiar with Benjamin Franklin's quote from 1789; "nothing is certain except death and taxes." To the men reading this column, we will add a third certainty: PROSTATE ENLARGEMENT! As men grow older and wiser, the prostate tends to follow. That doesn't mean that every man will develop voiding symptoms.
The prostate is a small gland located at the bottom of the bladder. It makes up the beginning of the tube that drains the bladder (urethra). Its primary function is to produce fluids important for the viability of the sperm.
To better understand the anatomy, imagine a doughnut under a water-filled balloon. The doughnut represents the prostate, and the balloon represents the full bladder. The only outlet for the fluid in the balloon is through the hole of the doughnut (prostate). A large doughnut with a generous hole should not affect the fluid leaving the balloon. If you grasp this concept, you'll understand why the opening of the prostate is far more important than its overall size.
Urinary symptoms from prostate blockage often include weak urinary stream, dribbling, difficulty starting a stream, starting and stopping, incomplete bladder emptying, urgency and frequent nighttime trips to the bathroom. Occasionally symptoms worsen to the point that men develop urge-incontinence (when a desire to urinate is so intense and sudden that once you have it, you can't reach the bathroom on time resulting in an embarrassing accident). Over time, the continued blockage can even result in permanent bladder weakness.
The treatment for the blockage of the prostate can be medical or surgical.
Medical treatment should be tried first in most cases. There are several over-the-counter remedies with "catchy names." But, these quick fixes are typically well-marketed herbs that have undergone no verifiable process of evaluation beyond the claims of their makers. In our practice, we see many patients who have derived little to no benefits from these over-hyped therapies. We routinely caution men about these "too good to be true" remedies.
There are also FDA-approved prescription medications that specifically target the prostate to enlarge the doughnut hole—thus relieving the symptoms. Their risks have been rigorously studied, and their benefits are scientifically proven.
There are some patients who don't achieve improvement with any oral medication and others who can't tolerate the medication due to side effects. Some men will also experience sexual dysfunction as a result. The cost of medication can be prohibitive for some patients, and finally, some simply don't want to be taking medications on a daily basis. In these situations, we consider surgical options.
The most common surgical treatments have been either a traditional resection (also called "roto-rooter") or laser vaporization of the prostate tissue. Both have the goal of enlarging the doughnut hole and are effective, but these surgeries routinely require an overnight hospital stay with a catheter draining the bladder for 1-2 days and can affect certain sexual functions.
A new innovative technique is now being performed at Blanchard Valley Hospital; UROLIFT - an FDA-approved minimally invasive procedure for the prostate. This is recommended for select patients with benign enlargement of the prostate who don't want to be on medication or undergo traditional prostate surgery. Small implants are placed in the prostate, which lift and hold the prostate tissue out of the way, increasing the opening of the prostate (doughnut hole). There are no incisions. It is done with light anesthesia (not requiring hospital admission), and you can go home the same day. Also important is that most patients go home urinating spontaneously, without a catheter (this has been a very appealing point to many men contemplating a prostate procedure). It also does not cause sexual or ejaculatory dysfunction. Improvement is readily noticeable and patients can quickly return to their normal activities.
Undoubtedly by now, your desire to run out for a delicious doughnut is at an all-time high... but we sincerely hope to have convinced you of the importance of paying attention to your prostate health!
Andre Gilbert, MD & Joshua Ebel, MD
Blanchard Valley Urology Associates
