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Relatively new treatment offers alternative for men with BPH

David Aslan was looking forward to hitting the beaches at his new Longboat Key address when he moved from New York to Florida last December. But trips to the beach and beyond soon became a source of worry for the retired firefighter when he developed BPH, a benign form of prostate enlargement that leaves men always looking for the next restroom. While not cancerous, it's certainly annoying and often embarrassing because of the frequent, urgent need to urinate.

Benign prostatic hyperplasia, as BPH is technically known, can be so disruptive that men withdraw from life, family and friends, preferring to stay at home where they know there's an available bathroom. When Aslan did venture out, "I had to think ahead and avoided any places where there was a chance I wouldn't have immediate access to the bathroom," he said.

Aslan, 53, also was getting up several times each night to go the bathroom, disturbing his and his wife's sleep. BPH often becomes a couples problem.

"Everything revolved around having a bathroom near," said Cari Ferreiro-Aslan, 55, Aslan's wife and a retired New York state prosecutor. "It made even car rides difficult. Day-to-day living was a hardship."

As men age, the prostate becomes larger. It can become so large that it squeezes the urethra, the tubelike structure that channels urine out of the body and lies between the two lobes of the prostate. When the urethra is squeezed, men are unable to completely empty their bladder, so they feel like they always have to go.

The American Urological Association estimates that half of all men between ages 51 and 60 have BPH. But the condition can start as early as the 40s. By the time men reach their 80s, 90 percent have BPH.

"Usually the symptoms hit a certain threshold before men will seek out medical attention," said Dr. Matt Ercolani, a urologist with Gulf Urology in the Sarasota area, who treated Aslan. "Most men will grin and bear it for years thinking there's nothing that can be done, it's just a natural part of getting older."

Ercolani and his partners spend a good deal of their time and marketing dollars educating the public about treatment options for BPH.

"Of the 13 million guys who have BPH, only about 400,000 get treatment annually. That's a shame," Ercolani said. "It's an undertreated problem because we can't get men to come in and because a lot of family doctors aren't aware that we now have many good treatment options."

Aslan tried oral medication, the usual first line of treatment for BPH, but the side effects — chief among them dry mouth and difficulty swallowing — were intolerable. The drugs may also cause dizziness, fatigue, difficulty ejaculating, erectile dysfunction or reduced sex drive; they may relieve BPH symptoms in some men and not in others.

Aslan's care was complicated because he also has Parkinson's disease.

"The oral (BPH) medication did give me some relief," Aslan said, "but the doctors didn't think it was safe to combine it with my Parkinson's medications for very long."

After reviewing all his options with Ercolani, Aslan decided to try a relatively new treatment known as the UroLift, an outpatient procedure that takes less than an hour and can have a man back on the golf course in a week.

The UroLift system involves placing two to six fine implants that look like fishing line from right to left, across each lobe of the prostate. Those sutures are then drawn aside, like drapes on a window, pulling the prostate away from the urethra, opening the obstructed area so urine flows out of the body normally. Most other treatments for BPH may affect sexual function; UroLift does not.

"With every other procedure we do we're cutting, removing, burning or remodeling the tissue. That requires time for healing. Recovery can be as long as six weeks," Ercolani said. "With this, all we're doing is pulling two sides of the prostate apart. Symptoms improve almost immediately. Strenuous activity is limited for about a week versus three to six weeks with other procedures."

Aslan went in for treatment about noon one day in May and was home in time for dinner. Some doctors offer the procedure in their offices under local anesthesia; others perform it in an outpatient surgery center using the same type of anesthesia that's given for colonoscopies. Aslan went to an outpatient surgery center in Englewood.

"I had a little discomfort the day of treatment and the first day after, but by the third day I felt back to normal and was no longer rushing to the bathroom," he said. Some insurance companies, including Medicare, cover the procedure.

Research shows the benefits of UroLift last for at least five years. More research is needed to know if it lasts longer than that.

"Many urologists are waiting for more data to come in before giving it a try," said Dr. Scott Klavans, a urologist with Morton Plant Hospital in Clearwater. "It's so new that they want to wait and see the long-term results and if there are any problems with it."

Klavans doesn't perform the procedure, but one of the doctors in his medical practice has been doing it for several months with good results. Klavans plans to take the special training so he can begin offering the procedure too, by the end of the year. He likes having another option to offer his BPH patients.

"Whether it's better than the other treatment options available, that remains to be seen,'' he said. "But, for the patient who doesn't want surgery, doesn't want to take pills, this is an alternative that seems to help."

Contact Irene Maher at imaher@earthlink.net.

Symptoms of BPH

• Need to urinate often, for example, every one to two hours, especially at night

• Feeling that bladder is full after urinating

• Feeling that urinating can't wait

• Weak urine flow

• Dribbling of urine

• Need to stop, start urinating several times

• Trouble starting to urinate

• Need to push or strain to urinate

• Unable to urinate at all — an emergency that should be treated right away

Source: Urology Care Foundation of the American Urological Association (urologyhealth.org)

BPH treatment

Options include:

Watchful waiting: symptoms not severe; treat if they worsen, but waiting too long may make it more difficult to reduce symptoms later.

Medication: relaxes prostate, bladder and/or shrinks prostate; includes Cadura, Flomax, Proscar, Advodart, Jalyn, Hytrin, RapaFlo.

UroLift: separates prostate, takes squeeze off urethra.

TUNA: transurethral needle ablation; uses high-frequency radio waves to heat needles placed in prostate that kill tissue and shrink prostate.

TUMT: transurethral microwave thermotherapy; microwave heat destroys enlarged prostate tissue.

TURP: transurethral resection of prostate; 70-year history; uses electric current or laser to remove obstructing tissue.

TUVP: transurethral electroevaporation of prostate; electrical current vaporizes prostate tissue.

REZUM: outpatient procedure, uses heat and steam to shrink prostate.

ILC: interstitial laser coagulation; laser burns prostate tissue away, usually reserved for men with larger prostates.

PVP: photoselective vaporization; laser vaporizes obstructing prostate tissue.

Source: Urology Care Foundation of the American Urological Association (urologyhealth.org)

Relatively new treatment offers alternative for men with BPH 07/21/17 [Last modified: Thursday, July 20, 2017 6:09pm]
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