Category: Enlarged Prostate

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Enlarged Prostate

TURP: The Procedure and The Recovery

For around 100 years, transurethral resection of the prostate was the main treatment method for benign prostate hyperplasia.

Did you know that for around 100 years, transurethral resection of the prostate was the main treatment method for benign prostate hyperplasia?

That’s a long time. And, this procedure is still rather common today.

So what exactly is a transurethral resection of the prostate?

What does it entail?

And what does the recovery look like?

These are all great questions, so let’s get started answering them.

A transurethral resection of the prostate, also known as TURP is a surgery used to treat urinary problems that are caused by an enlarged prostate.

The TURP procedure begins with the use of general anesthesia, followed by the insertion of a resectoscope – a tool that we covered the history and development of in previous articles.

A resectoscope is a thin metal tube that is about 12 inches long and .5 inches in diameter that is inserted into the end of the penis where it is guided into the urethra.

The instrument contains a light, a camera, and a wire loop which is then heated with an electric current. The electrical current running through the wire loops is used to cut tissue and seal blood vessels, while the surgeon removes the tissue that is blocking the urethra one piece at a time.

Once the tissue is removed, a catheter is then inserted into the urethra to pump fluid into the bladder and flush away pieces of the prostate that have been cut.

Following a TURP procedure, most men need to stay in the hospital for one or two days or until there is no significant amount of post-op blood in their urine or other post-op issues.

TURP remains a very common surgery for BPH, with some estimations pointing at upwards of 150,000 men in the United States having TURP each year.

Transurethral resection of the prostate is a treatment that in the past, many men have opted for because it does not remove the entire prostate, and it doesn’t involve any incisions. It is also well-known to have long-term outcomes, with the effects of treatment sometimes lasting 15 years or more.

However, this method of treating BPH is not without its own set of side effects and risks. Therefore more and more men are opting for a non-invasive prostate procedure called Prostate Artery Embolization.

In our next article, we will take a look at the side effects and risks of TURP and compare them to that of Prostate Artery Embolization.

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What is TURP?

Transurethral resection of the prostate (TURP) was the main treatment method for benign prostate hyperplasia for almost 100 years.

Over the past few weeks, we have taken a look at the history regarding the diagnosis and treatment of an enlarged prostate.

We started the series by covering the doctors and anatomists of the late 16th century who contributed to the identification of the prostate itself and the condition of an enlarged prostate.

We also took a look at some of the early attempts at treating the enlarged prostate, which involved a lot of trial and error- and there was a lot of error.

However, as we covered throughout the series, through continued research, medical advancements, and time, treatment methods for an enlarged prostate were greatly improved. This is all thanks to the many physicians that paved the way for successful prostate treatment through medical innovations in not only the methods of surgical procedures, but the tools used as well.

These tools, some of which are still used today, led to safer and more effective ways to treat an enlarged prostate.

All of this research and development, trial and error, invention, and innovation, led to a prostate procedure that became the gold standard for treating an enlarged prostate for many years. This procedure, which is still done today, is known as Transurethral Resection of the Prostate, also known by the acronym TURP.

Transurethral resection of the prostate was the main treatment method for benign prostate hyperplasia from the early 1900s, to the late 1990s.

In our next article, we will take a further look at the Transurethral Resection of the Prostate.

We will cover what it is, how it’s performed, and its effect on relieving the symptoms of an enlarged prostate.

We will also look at the side effects and risks of this procedure, and compare it to that of the non-invasive and increasingly popular treatment for BPH called Prostate Artery Embolization.

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Development of Surgical Tools

Technology led to the creation of non-invasive BPH procedures such as prostate artery embolization. But before that, there were new tools.

Long before the development of the technology that led to the creation of non-invasive procedures to treat benign prostate hyperplasia, the major medical advancements were the creation of new surgical tools. And, a real game changer was the creation of the resectoscope.

The resectoscope was introduced in the late 1920s by Maximilian Stern. Stern was able to utilize the direct vision made available by inserting the tool, which had a tungsten wire loop on one end into the cystoscope. He then used an electrical cutting current in order to use the loop to successfully cut away excess prostate tissue.

As with all great inventions, the resectoscope left room for further innovation, such as a modified version by Theodore Davis, which had a larger viewing area and a wider loop, as well as a foot pedal attached to it that allowed him to switch between currents that cut and currents that cauterized.

Further improvements included that of Joseph McCarthy who combined Davis’s improved resectoscope with the phonendoscope- which had an even better viewing system.

By combining these two advancements, McCarthey created what would become known as the Stern-McCarthy resectoscope.

Though it arguably should have been called the Stern-Davis-McCarthy resectoscope, the Stern-McCarthy resectoscope is credited with being the first practical cutting-loop resectoscope, and as a result, transurethral prostatectomy emerged as the dominant method used to treat enlarged prostate for the next 70 years

This method, also known as TURP (Transurethral resection of the prostate ), which is still done today- would not have been possible without all of this innovation.

In fact, it wouldn’t have been possible without many inventions that preceded it. Such as Dr. Young’s cystoscope, as well as the first practical incandescent light bulb, the fenestrated tube, and the application of high-frequency electrical current underwater.

These inventions and surgical procedures led the way to more advanced methods which use fiber optics, video cameras, laser energy, and others.

Though TURP is still used as a treatment procedure for an enlarged prostate, more and more, it is being replaced by newer medical therapies and less invasive procedures such as genicular artery embolization.

In our next article, we will begin to look at the most common present-day surgical and non-invasive surgical procedures to treat an enlarged prostate.

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Improving Prostate Treatment with Innovation

One of the turning points in the treatment of benign prostate hyperplasia was the invention of the irrigating cystoscope.

One of the turning points in the treatment of benign prostate hyperplasia was the invention of the irrigating cystoscope, and the many improvements made to it by Dr. Hampton Young, of Johns Hopkins University Hospital.

Following the development of the irrigated cystoscope and other critical tools, physicians continued to experiment with all sorts of other methods for treating an enlarged prostate. This included high-frequency currents to treat bladder tumors.

In roughly 1926, a physician by the name of Maximilian Stern introduced another innovative instrument to be used in prostatic procedures called the resectoscope.

A resectoscope is a tool that is inserted through the cystoscope sheath and has a tungsten wire loop on one end. Under direct vision by way of the cystoscope, Dr. Stern was able to cut slivers of prostate tissue with the loop, through which flowed an electrical cutting current.

Unlike cautery heat, these high-frequency currents did not penetrate and damage the surrounding tissue nearly as much. As a result, patients reported having fewer side effects and a lower risk of complications such as hemorrhage.

Though the electric current cut well, some physicians took issue with it not coagulating deep enough. Thus making it, in some cases, just as effective as using a knife.

This led to the invention of a modified resectoscope by a South Carolina urologist, with a background in electrical engineering, named Theodore Davis.

Not only did Davis use a larger instrument with a larger viewing window and a wider loop, but he also is credited with incorporating a current that cuts and coagulates. Davis even went so far as to invent a foot pedal, which allowed him to switch between the two during surgery.

Around the same time that Davis was improving the resectoscope, another doctor by the name of Joseph McCarthy was busy making further improvements.

Dr. McCarthy was able to successfully combine the improved resectoscope with the phonendoscope, which had a greatly improved viewing system.

By combining these two advancements, McCarthey created what would become known as the Stern-McCarthy resectoscope.

In our next article, we will take a look at the Stern-McCarthy resectoscope and its use in the treatment of an enlarged prostate, and also begin to look at the dominant treatment methods that emerged, some of which are still performed today.

 

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Inventions to Treat BPH

It is estimated that at some point in their lives, 8 out of 10 men will experience the uncomfortable symptoms caused by an enlarged prostate.

It is estimated that at some point in their lives, 8 out of 10 men will experience the uncomfortable symptoms caused by an enlarged prostate. However, this occurrence isn’t anything new.

Doctors have been working to find cures and develop treatments for this very common condition for centuries.

In fact, in our last few articles, we took a deeper look at the origin of the diagnosis of an enlarged prostate, and when it was first documented. And, we looked at some of the many attempts to treat or even cure the condition- Some of which actually made things worse.

Fortunately, as time went on, and medical advancements continued to be made, medical experts and physicians were able to find newer and better ways to treat men with this prostate condition.

A real turning point in the development of treatment procedures for an enlarged prostate, occurred in 1904 when Dr. Hampton Young perfected the surgical procedure known as a “radical perineal prostatectomy”.

By perfecting the perineal approach and developing specialized instruments for the procedure, Dr. Young was able to lower the mortality rate for those undergoing prostate surgery.

While open surgeries for treating an enlarged prostate continued to develop, another method was emerging called the transurethral method.

The transurethral method is a treatment based on the idea of increasing the lumen of the prostatic urethra by destroying or damaging the prostatic tissue so that it would contract.

Several instruments for transurethral removal of bladder neck obstruction by ‘valves’, were created, however, the procedure was done blindly, and though effective at times, it also came with the high risk of hemorrhage, and many patients were left with urinary incontinence.

Fortunately, physicians continued to develop better and better techniques for transurethral procedures, including using a wire loop cautery. As well as treatments that included a thermogalvanic destruction, which is when cautery is introduced through the urethra, requiring a cautery plate and a cautery knife.

However, one of the biggest issues with these methods was that,  just like with the previous procedures, all of them were done blindly. That is until various new instruments were invented and came into use, such as the irrigating cystoscope, which allowed for visual control during these procedures.

The irrigating cystoscope was a real game changer, even more so, as Dr. Young worked to modify it, making it better and bed.

Young is credited with adding illumination to the external end of the tube, by way of a small electric bulb. And then, just a few years later, Young replaced the cutting tube with an electrically heated cautery tube and made the outer tube double-walled so that water could circulate to cool it. Young’s basic design was the forerunner of a great variety of subsequent operations.

In our last article of this series on the history of diagnosing and treating an enlarged prostate, we will take a look at some of the procedures that emerged after Dr. Young’s irrigating cystoscope, and begin to explore the modifications and improvements that have been made to these techniques.

 

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Advances in Prostate Care

In the early 20th century, a young doctor developed a procedure that would revolutionize the way prostate conditions are treated.

In the early 20th century, located right here in our neck of the woods, a young doctor was developing a prostate procedure that would revolutionize the way prostate conditions are treated and open the door to the many other treatments that would follow.

This man was urologist Dr. Hugh Hampton Young, who due to his position as the chief of surgery in the Genitourinary Surgery Division at Johns Hopkins Hospital became known as the “Father of American Urology.”

Among his many contributions to male prostate health, Dr. Young is best known for his development and perfection of radical perineal prostatectomy, while working at The Johns Hopkins Hospital in 1904.

This procedure, which to this day, remains the oldest continuously employed treatment for prostate cancer, was developed at a critical time when previous open prostatectomy surgeries had a 20-percent mortality rate.

Fortunately, by perfecting the perineal approach and developing specialized instruments for the procedure, Dr. Young was able to reduce the mortality rate to 2 percent.

During his many years working at Johns Hopkins, Dr. Hampton Young developed a number of innovative instruments and techniques.

The first known instrument he created was known as the “punch,” which was used for the resection of an obstructing bladder neck, and prostatic tissue.

This then led to the development of numerous other punches, particularly at the Mayo Clinic where several of his students perfected the instrument.

In 1912, Dr. Young, using this instrument, successfully relieved railroad entrepreneur James Buchanan Brady’s prostate condition brought on by an obstructing bladder neck, and prostate tissue.

Upon doing so, Brady went on to fund the construction and creation of the Brady Urological Institute.

While there, Dr. Young went on to do much more, including establishing a new design for a urological operating table and developing a detailed approach to performing radical perineal prostatectomy which became the standard for prostate cancer surgery.

Dr. Young went on to found The Journal of Urology which he edited until his death in 1945. However, one of his biggest contributions was the creation of a detailed plan for the training of young urologists, which went on to become the model for all other training programs in the United States.

In our next article, we will continue our series on the history of treating benign prostate hyperplasia, by looking at some of the early surgeries, some of which are still performed today.

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Early Treatment Methods

By the late 1800s, physicians found a link between prostate size and a man's age, as well as between prostate growth and testosterone.

By the late 1800s, physicians had found a link between prostate size and a man’s age, as well as between prostate growth and testosterone.

This discovery set the foundation for developing various treatment methods in order to relieve the uncomfortable symptoms caused by an enlarged prostate.

Though it wasn’t until centuries later that the more effective treatments that we use today, such as transurethral resection of the prostate, medications, and prostate artery embolization, became available- These procedures owe a debt of gratitude to the many physicians that came before, who opened the path to finding the best treatment for what would later be known as benign prostate hyperplasia.

Unfortunately part of this journey involved making mistakes along the way.

One notable example is a procedure performed by some physicians in the 1800s who thought that the condition of an enlarged prostate could be cured by removing the testicles. Yikes.

Fortunately, this method fell out of practice shortly thereafter. And, fortunately, many other physicians did not use this technique, and instead, continued to study the enlarged prostate and the impact that it can have on a man’s health. All in an attempt to find the most effective and efficient way to treat the condition.

One of the turning points in the development of prostate procedures to treat an enlarged prostate, took place in 1891.

A physician in Arizona had found a way to treat the prostate condition by removing prostate tissue through an incision made in the perineum—the area between the scrotum and rectum. This would later be called a perineal prostatectomy.

Following this breakthrough procedure, all sorts of other prostate surgeries began to pop up.

Eugene Fuller, a New York City Physician, developed the  “suprapubic procedure.”

The suprapubic procedure is the surgical removal of the prostate through an incision made in the lower abdomen and bladder.

The suprapubic procedure showed promising results and opened the door for another physician, Hampton Young to get even better results by using the same perineal incision to remove the prostatic mass.

Dr. Young, a urologist at Johns Hopkins Hospital also discovered that if he pushed the gland upward from the rectum, it could ease and complete the excision, making the removal more complete.

Hampton Young went on to become known as the “Father of American Urology,” and continued to refine and perfect his technique for treating an enlarged prostate.

In our next article, we will continue looking at the history of treating benign prostate hyperplasia, by diving deeper into the impact that Dr. Hampton Young had on the treatment of it, as well as take a look at the advancements made by the many physicians that followed.

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Early Physicians and BPH

There are many physicians to which we owe a debt of gratitude for their contributions to the treatment of benign prostate hyperplasia.

There are many physicians to which we owe a debt of gratitude for their contributions to the treatment of benign prostate hyperplasia.

Most historians agree that the prostate was first anatomically described in the mid-1500s by the Italian doctor and anatomist Nicolo Massa.

In his book, “Anatomiae libri introductorius,” which translates to “Introduction to Anatomy,” Massa noted that the bladder rested on a “fleshy gland”, the gland of course being, the prostate.

Although it is debated that the fleshy gland wasn’t called a prostate until, around the same time in history, when the French anatomist Andre du Laurens used the name “prostate”, or “prostatae”- In more recent years, historians have discovered that the French anatomist did indeed call the fleshy gland a prostate, but it was actually the French surgeon Ambroise Paré in his anatomy book, who years prior had referred to this part of the male reproductive system as the prostate.

So what’s the point of all of this? Why should we care who named the prostate gland?

The point is, the male prostate gland has been an area of the male body that has been extensively studied and examined for centuries.

Why is this?

Well for starters, it affects a lot of men.

The enlargement of the prostate gland and the connection that it has with urinary retention and other symptoms in men prompted extensive research and development on finding the cause and figuring out how to treat it.

In our next article, we will dive deeper into the history of treating an enlarged prostate, and the

 

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BPH Medications and Sexual Dysfunction: Something to Consider

Some treatment methods for an enlarged prostate can increase problems with sexual dysfunction, and in some cases, even cause them.

Some treatment methods for an enlarged prostate can increase problems with sexual dysfunction, and in some cases, even cause them.

Though prescription drugs are often very good at improving the symptoms of Benign Prostate Hyperplasia- such as urinary issues, they can come with their own set of problems. Because of this, some men may resort to surgery, however, that too comes with its risks regarding sexual function.

Some surgical procedures for men with an enlarged prostate can increase the risk of inadvertently damaging structures around the penis which can lead to erectile dysfunction and other problems.

But before we get to that, let’s take a look at some of the common BPH medications and the effect they can have on sexual health.

We’ll start with the commonly prescribed 5-Alpha reductase inhibitors and the impact these medications that are used to shrink the prostate and reduce BPH symptoms can have on sexual health.

5-Alpha reductase inhibitors show promising results in their ability to shrink the prostate and reduce benign prostate hyperplasia symptoms.

These medications work by inhibiting the 5-alpha reductase enzyme from converting some of the body’s testosterone into dihydrotestosterone- which can cause further prostate growth. Unfortunately, one of the most common side effects of 5-alpha reductase inhibitors is sexual problems.

Several clinical trials have looked at the problem of side effects caused by the 5-alpha inhibitor finasteride, also known by the brand name Proscar.

These studies found that sexual adverse effects occur at the rates of 2.1% to 3.8%, erectile dysfunction (ED) being the most common, followed by ejaculatory dysfunction and loss of libido.

Another common 5-alpha reductase inhibitor, dutasteride (Avodart), has neem known to cause a multitude of adverse effects concerning sexual function. 3.4 to 15.8% of men treated with dutasteride experience erection problems, loss of libido, and reduced semen volume.

Most of these sexual issues caused by 5-alpha inhibitors are believed to be due to their effect on decreasing levels of dihydrotestosterone which is a natural sex hormone and is essential for normal sexual function.

Another type of medication that is commonly prescribed to treat the symptoms of an enlarged prostate is alpha-blockers.

Alpha-blockers, such as tamsulosin ( Flomax) doxazosin (Cardura), and terazosin (Hytrin) work by relaxing the bladder neck, and prostate muscles. Unfortunately, they can also cause erectile issues such as decreased ejaculation. Men who take these medications may also experience lower sperm count, decreased sperm volume, and lower sperm movement.

According to a 2008, Cochrane systematic review that looked at the sexual side effects of Flomax for BPH, 63% of users reported some form of side effect from the medication. The side effects of tamsulosin that were reported the most included erectile dysfunction, reduced libido, and something called retrograde ejaculation or a dry orgasm- where the semen exits into the bladder rather than out of the penis.

Combination medication therapies, such as dutasteride and tamsulosin ( brand name Jalyn), can also cause sexual problems.

Clinical trials found that the most common adverse reactions reported were impotence, decreased libido, breast disorders (including breast enlargement and tenderness), ejaculation disorders, and dizziness.

In fact, studies have found that ejaculation disorders occurred significantly more in subjects receiving coadministration therapy (11%) compared with those receiving dutasteride (2%) or tamsulosin (4%) as monotherapy.

The Bottom Line:  Issues with sexual dysfunction that are caused by certain BPH treatment medications should be taken into consideration.

These issues can be very upsetting and have a detrimental effect on a man’s private life and relationships. Therefore it’s important to discuss any risk of sexual problems that can come alongside your preferred treatment method for BPH.

There are many options out there for treating an enlarged prostate, so it’s important to be open and honest about your concerns and work with your doctor to find the best treatment option with the lowest risks of sexual side effects, such as Prostate Artery Embolization.

To learn more about this state-of-the-art procedure, please call and set up a consultation today.

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Urinary Symptoms and Sexual Dysfunction

The Mayo Clinic Proceedings published the results of a study that looked at the link between BPH urinary symptoms and sexual dysfunction.

The periodical Mayo Clinic Proceedings published the results of a study that looked at the link between common BPH urinary symptoms and sexual dysfunction.

Researchers studied 2,115 men between the ages of 40 and 79, by having them complete a questionnaire about their sexual function and urinary tract symptoms every two years.

What they found was that sexual function and urinary tract symptoms were indeed related. To put it simply: The greater the urinary symptoms, the lesser the sexual function.

The study also found that the urinary tract symptoms caused by an enlarged prostate that were most associated with sexual dysfunction were:

–  A feeling of urgency

–  Needing to get up multiple times at night to urinate

–  A weak urine stream

–  Straining to start urinating

These urinary symptoms were all associated with:

–  Difficulty getting or maintaining an erection

–  The way men felt about problems with sexual drive, erection, and ejaculation

–  Sexual satisfaction problems

So the solution is to treat the urinary issues caused by BPH, and then as a result, sexual function will improve?

Well, it’s not that simple.

Though there are many ways to treat the urinary symptoms caused by an enlarged prostate, some of these treatment methods can actually make things worse, or even cause sexual dysfunction.

In fact, some drugs that are commonly used to treat benign prostate hyperplasia, can actually cause erectile dysfunction and reduce sperm count.

Though prescription drugs are often very good at improving the symptoms of BPH, they do not tackle the real problem, and they can cause their own set of problems, such as ED.

In order to avoid such issues, some men may resort to surgery. However, it’s important to keep in mind that this too can come with the risk of sexual problems.

Many of these surgical procedures for men with an enlarged prostate, can increase the risk of inadvertently damaging structures around the penis which can lead to erectile dysfunction and other problems.

In our next article, we’re going to dive deeper into the connection between BPH treatment methods and sexual dysfunction.

In the meantime, if you’d like to learn more about Prostate Artery Embolization, an outpatient procedure with proven results without the risk of sexual issues, please call us and schedule a consultation today!