Tag: BPH

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Enlarged Prostate

When Prostate Surgery Fails

Adverse outcomes and risks that come with prostate surgery.

When it comes to surgical procedures of any kind, there is always a risk that things won’t work out. When surgery fails or leads to side effects and complications that are permanent, the reality can be devastating.

Therefore, when it comes to deciding which treatment method is best for treating your benign prostate hyperplasia, it’s important to be aware of the potential side effects and risks that come with each method.

One of the most common procedures to treat a symptomatic enlarged prostate is the transurethral resection of the prostate, also known as TURP.

TURP is a procedure that involves removing prostate tissues through the urethra, in order to allow urine and other bodily fluids to pass more easily.

Though the most common side effects, like experiencing some post-op blood in your urine, will pass with time. Other side effects and undesirable outcomes might not.

Not every prostate procedure is guaranteed to cure the issue it is aiming to treat. And, TURP is no exception to this.

First of all, sometimes the TURP surgery will not relieve all of your symptoms, such as urinary symptoms that might not change or be entirely cured.

You might be wondering- How is that possible, given that during the surgery the blockage was cleared?

The urinary issues may be continuing due to urethral strictures.

Urethral strictures are caused by scarring that can occur after TURP, both in and around the urinary tract. This scarring can actually cause further blockage to urine flow. And as a result, another surgery may be required.

Some patients also experience urinary incontinence following the TURP procedure. This can happen due to continuing bladder problems or even sphincter muscle damage.

Another concern for men undergoing transurethral resection of the prostate in order to treat benign prostate hyperplasia is the risk of having erectile issues following the procedure.

Erectile dysfunction is a potential risk that comes with just about any prostate surgery, and can usually be treated with medication. However, it’s important to keep in mind that these medications also come with their own set of side effects and risks.

Fortunately, there are other treatment methods for an enlarged prostate that have a much lower risk of experiencing these unwanted outcomes, especially in regard to sexual function.

In fact, Prostate Artery Embolization has been shown to actually improve erectile function following the procedure. And it comes without the risk of retrograde ejaculation, which is the most common long-term complication following the TURP procedure, affecting as many as 65 to 75% of men.

In our next article, we will take a look at this unfortunate potential complication from TURP.

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Enlarged Prostate

Weighing the Pros and Cons of Each Procedure

When it comes to seeking treatment for benign prostatic hyperplasia, it's important to consider the pros and cons of each treatment approach, as well as the benefits and risks.

When it comes to seeking treatment for benign prostatic hyperplasia, it’s important to consider the pros and cons of each treatment approach, as well as the benefits and risks.

Being aware of the benefits, as well as the potential risks and complications of each treatment or procedure, can be of great help when working with your doctor to determine which is best for you. Taking into account not only the benefits and risks but also looking at how each procedure fits with your individual lifestyle and prostate condition.

Today we will start by looking at the treatment method that for most of the 20th century, roughly from 1909 until the late 1990s, has been the premier treatment for symptomatic benign prostatic hyperplasia. That treatment method is transurethral resection of the prostate (TURP).

TURP became famous among the treatment methods for BPH when it became the first successful, minimally invasive surgical procedure of the modern era. And, to this day, it remains a standard therapy for obstructive prostatic hypertrophy and is often the surgical treatment of choice when other methods fail.

However, as more medications and non-invasive non-surgical procedures have become available, such as prostate artery embolization, the need for a surgical intervention like TURP has been reduced substantially.

That being said, TURP continues to be performed due to its effectiveness in treating and relieving the symptoms of an enlarged prostate. But as with all surgeries, it does come with its own set of possible risks and unwanted side effects that should be taken into consideration.

So let’s take a look at what those are.

A successful TURP procedure involves removing prostate tissue through the urethra, thus allowing urine and other bodily fluids to pass through more easily.

TURP is a serious surgery that involved anesthesia and the use of a catheter during and post-operation, as well as a recovery that includes a hospital stay.

The most common side effects experienced by men after the TURP procedures are:

Swelling in the urethra, penis, and lower abdominal area.

This swelling can cause these areas to be tender, red, and swollen for several weeks after the surgery, and can cause problems with urination.

Another common side effect is feeling weak and tired easily. This side effect can last for several weeks as the body recovers from the operation.

Other common side effects of TURP surgeries include but are not limited to:

  • bleeding after the operation – this usually reduces over time and should stop after four weeks
  • difficulty completely emptying the bladder
  • urinary incontinence or leakage
  • urinary urgency or the sudden urge to urinate
  • discomfort during urination
  • small dribbles or clots of blood in the urine, for up to 6 weeks

Another potential side effect of the TURP procedure is something called retrograde ejaculation, which is the result of semen flowing backward into the bladder during ejaculation.

Though retrograde ejaculation isn’t necessarily harmful, it can cause potential complications such as male infertility and can make the male orgasm less pleasurable.

In our next article, we will take a look at some of the rare, but possible risks associated with the TURP procedure, and then we will move on to looking at the benefits and risks of other popular procedures to treat a symptomatic enlarged prostate.

In the meantime, if you are interested in learning more about a state-of-the-art non-invasive treatment that could be an option for you, please contact our office today to set up a consultation and learn more about Prostate Artery Embolization.

 

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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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Enlarged Prostate

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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Enlarged Prostate

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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Enlarged Prostate

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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Enlarged Prostate

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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Enlarged Prostate

Prostatitis and BPH

When it comes to experiencing prostate symptoms sometimes it’s hard to tell if the symptoms point to prostatitis or an enlarged prostate, also known as benign prostatic hyperplasia. Though both conditions can share similar symptoms, there are certain differentiating factors including the cause and the treatment.

First of all, BPH is a normal part of aging for men. In fact, between the ages of 20 and 50 years old, it is estimated that the prostate nearly doubles in size. And by age 80, it is not uncommon for the prostate to double in size again.

Sometimes men with an enlarged prostate have very few symptoms and do not require treatment. While others with an enlarged prostate will experience pressure on the urethra causing a slew of urinary issues.

If the enlarged prostate is particularly troublesome, an excellent treatment option is Prostate Artery Embolization, which we perform regularly here at MidAtlantic Vascular and Interventional.

However, if you are experiencing an enlarged prostate under the age of 50, chances are this is actually inflammation caused by prostatitis.

Prostatitis, which we covered more in-depth in a previous article, is usually caused by a bacterial infection. This infection causes the prostate to become tender, swollen, and enlarged. Unlike benign prostate hyperplasia, prostatitis is usually treated with antibiotics. Sometimes medications to relax the muscle in the upper part of the urethra are also administered to help relieve any pain associated with the infection.

Enlarged prostate and prostatitis are different diagnoses, however, when it comes to chronic bacterial prostatitis, there can be a connection between the two.

Chronic Bacterial Prostatitis is defined as an ongoing or recurring prostate infection, and one common culprit- an enlarged prostate.

Why is this?

The most common reason for this is that having benign prostatic hyperplasia can cause urinary problems which inhibit the ability to completely empty the bladder. As a result, the stagnant urine acts as a growth medium for bacteria.

Though the symptoms of an enlarged prostate and prostatitis can be similar, there are differences. First, let’s take a look at the symptoms of each.

Symptoms of Benign Prostate Hyperplasia:

  • An urgent, at times uncontrollable, need to urinate, which may lead to incontinence if the person can’t make it to the bathroom in time
  • Trouble urinating
  • Frequent urination
  • Urinary hesitancy, i.e. slow start till urine streams out
  • Weak flow of urine
  • Frequent need to urinate at night, known as nocturia
  • Intermittent flow, i.e. stopping and starting
  • Leaking or dribbling urine
  • Urinary retention

Symptoms of Prostatitis

  • Hematuria (blood in the urine) or blood in semen
  • Pain in the penis and testicles
  • Burning or painful sensation during urination
  • Painful or difficult ejaculation
  • Urethral discharge
  • Pain and/or pressure in the rectum
  • Painful defecation (painful bowel movements)
  • Discomfort and/or pain in the genitals, groin, lower back and/or lower abdomen
  • Recurring urinary tract infections (UTIs)
  • Sexual problems and loss of sex drive
  • Postcoital pain (pain after having sex)

As you can see, both an enlarged prostate and prostatitis are associated with similar urinary problems, however, prostatitis may also be associated with pain during ejaculation,  general abdominal pain, and the other symptoms listed above.

Another key difference is that since prostatitis is usually caused by a bacterial infection, it can cause symptoms such as fever, chills, and a pus-like discharge. These symptoms are rarely associated with an enlarged prostate.

If you think you may have a case of prostatitis or an enlarged prostate, it is important that you reach out to your doctor right away, as ignoring the symptoms, will only make it worse. And by getting the proper diagnosis, you and your doctor can develop a treatment plan, and work to reduce your symptoms and potentially resolve the issue.

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Enlarged Prostate

Erectile Dysfunction and an Enlarged Prostate- What’s the Connection?

We’ve all seen the commercials, and heard the jokes. Or maybe you are someone or know someone who’s used it. We’re talking about viagra, and more specifically Erectile Dysfunction. Fortunately, erectile dysfunction, commonly referred to as ED,  is no longer something that’s only whispered about within a relationship, or embarrassingly disclosed to a doctor. It’s an accepted issue, with accepted solutions. However, for those with an enlarged prostate, the solution might not be as easy as a prescription and a pill.

We already know that a man’s prostate continues to grow as he ages, making an enlarged prostate, or BPH, quite commonplace. However, sometimes, without proper treatment, an enlarged prostate can be problematic. An enlarged prostate can lead to many urinary symptoms and increased urinary infections, and yes, it can affect a man’s sex life.

A study published in Mayo Clinic Proceedings 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 severy of urinary tract symptoms had a definite inverse relationship. The more urinary problems, the less 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 BPH that is causing the urinary issues that are then leading to ED, right?

Yes, but it’s complicated.

Treating the enlarged prostate can be helpful when it comes to urinary issues and ED, however, not all treatments are created equal. In fact, some drugs that are used to treat BPH can actually cause ED and reduce sperm count. Proscar, for example, which is an anti-testosterone drug used to treat BPH has been linked to ED. In fact, studies have found that 3.7% of men using Proscar struggle with ED, and 3.3% report having diminished libido.

That being said, research has also discovered that there is a  positive correlation between drugs used to treat ED, like Viagra and Cialis, which can actually improve BPH and reduce urinary symptoms. It has also been shown that the drug Flomax, an alpha-blocker that relaxes the muscles in the prostate and bladder neck, making it easier to urinate- can improve the symptoms of BPH with a lower risk of sexual side effects.

Another treatment option that can help solve problems with ED by reducing or even eliminating the symptoms of BPH, is Prostate Artery Embolization ( PAE).

This minimally invasive procedure, which we offer here at MidAtlantic Vascular and Interventional,  has a high rate of success, with over 90% of men experiencing relief in the first year. And unlike some of the other treatment options, PAE does not affect sexual performance.

If you are one of the many men that struggle with prostate conditions that are causing or contributing to ED, there is a solution.

Please call us today to talk about your treatment options.

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Enlarged Prostate

Enlarged Prostate:  What’s Normal and What’s Not

signs of an enlarged prostate

One of the most common symptoms of an enlarged prostate is frequent urination.

Unless you’re drinking excessive amounts of water before bed, if you find yourself needing to urinate throughout the night, this could signal that you may be experiencing the effects of benign prostatic hyperplasia, also known as an enlarged prostate.

But what exactly is a prostate? And what does it have to do with urinating?

The prostate is a small gland that is part of the male reproductive system. It is responsible for aiding in the production of fluid that carries sperm from the testicles and helps to push semen through the urethra during ejaculation. The prostate is located below the bladder and in front of the rectum and surrounds part of the urethra.

Typically the prostate is about the size and shape of a walnut, however, as a man ages, it is normal for the prostate to become larger. Though it is normal for the prostate to grow, sometimes this growth can be excessive to the point where it can cause problems with urination.

This growth and its impact on urination are so common, that on average about 8 out of 10 men will eventually experience it. However, only around 30% will find these symptoms to be bothersome enough to consult their doctor.

The growth of the prostate is commonly referred to as benign prostatic hyperplasia or BPH. Unfortunately, BPH can not be prevented, however, just like with the rest of the human body, diet, and lifestyle can definitely play a part in its health.

So what are the signs of an enlarged prostate, and when should an appointment be made with your doctor?

The most obvious sign of prostate enlargement is its impact on urination, especially at night. Some of the other symptoms you may experience are:

Straining to urinate.
Stopping and starting during urination.
Feeling the need to urinate when you don’t actually need to. Inability to empty the bladder completely.

It is important to see your doctor if you have symptoms of BPH, especially if you are under the age of 40. Although it’s fairly uncommon, it is possible for enlarged prostate to lead to serious problems such as bladder or kidney damage. If your symptoms are bothersome, your doctor will work with you to find a treatment that is best. This could be medicine, lifestyle changes, or in more extreme cases, surgery.

The bottom line, an enlarged prostate is common, and it is normal for the prostate to grow with age. However, if you are experiencing any discomfort or symptoms of an enlarged prostate, it is best to see your doctor.

An enlarged prostate is not the same as an infection or inflammation of the prostate, however, some of the symptoms can be similar. So the earlier these issues are detected and treated, the better.