Benign prostatic hypertrophy, also known as benign prostatic hyperplasia or BPH, is a condition that involves compression of the urethra and bladder base stemming from enlarged prostate tissue. The result is blocked or impaired urine flow, with typical symptoms such as frequent urination, difficulty starting urination, a weak urine stream, and incomplete bladder emptying.
BPH is commonplace, affecting about half of all men 60 and older. In men ages 85 and older nearly 90% suffer from BPH symptoms. BPH treatment options depend on the severity of the condition and symptoms and may involve prescription drugs like Flomax, minimally invasive procedures, and surgery.
Let’s review the standard minimally invasive procedures for BPH.
Rezūm Water Vapor Therapy
Rezūm Water Vapor Therapy uses the energy of steam, or water vapor, to remove excess prostate tissue. Controlled, targeted doses of stored thermal energy are applied directly to the prostate tissue area, helping shrink the enlarged prostate with minimal effect on surrounding tissue. Depending upon the size of the prostate, this in-office procedure consists of two to seven injections of sterile water vapor (steam) into the prostate gland for nine seconds. When the patient arrives, the medical team asks him to eliminate urine before they check his bladder. If urine is still present, they will drain it. Before the procedure, the doctor numbs the penis and prostate, then inserts the Rezūm device and deploys a needle to inject vapor into the prostate. Due to the initial swelling, the doctor inserts a catheter that remains anywhere from two to five days. The catheter is connected to a bag that remains on the leg. A patient who opts for this procedure must have a driver to take him home. He can expect an inflammatory response that takes two to four months to resolve. There will be initial swelling in the prostate, and his symptoms will get worse before they improve. After four weeks, he’ll be back to where he started before the Rezūm procedure, and at six weeks, he can wean off his medication.
Aquablation® therapy is a minimally invasive BPH treatment procedure performed through the patient’s urethra with the help of a robotic surgical system. During the entire process, the patient remains under anesthesia. Although it typically takes less than an hour, Aquablation® involves an overnight stay in the hospital.
The procedure relies on a cystoscope (a camera inserted up the urethra) for multi-dimensional ultrasound imaging that allows the surgeon to deliver a targeted heat-free waterjet with maximum precision. The result is incision-free excess tissue removal. It is possible to use Aquablation on prostates of any size.
Following Aquablation® therapy, the patient wakes up with a catheter, which allows him to urinate while his urethra heals. Once he’s home, he may experience mild burning during urination for a couple of weeks, which can be managed with mild pain medication.
Although the procedure typically lasts under an hour, it requires anesthesia and usually overnight hospitalization. In many cases, follow-up cauterization may be necessary to control bleeding. Side effects may include a burning sensation or slight discomfort while urinating.
UroLift® is an inpatient procedure performed in the office under local anesthesia. It utilizes tiny implants to lift and hold the enlarged prostate tissue out of the way, so it no longer blocks the urethra. The UroLift® involves inserting a delivery device through the obstructed urethra and placing tiny implants that push the enlarged prostate tissue out of the way to enable normal urine flow. There is no cutting, heating, or removal of the prostate tissue. Instead, UroLift compresses tissue that blocks the urethra to improve the urine flow. Post-procedure side effects may include frequent urination, general and sensitivity, and blood in the urine. UroLift® is safe in suitable candidates with prostate glands under 50gm.
Transurethral Resection of the Prostate (TURP)
TURP is the most common type of surgery used in BPH treatment. During the procedure, the surgeon removes the enlarged prostate tissue blocking the patient’s urine flow.
As access is through the urethra, there are no visible incisions. The procedure takes around 90 minutes and requires general or spinal anesthesia. The patient can usually feel positive results within a few days.
However, with TURP, most men will experience retrograde ejaculation, which means semen flows into the bladder instead of exiting through the penis. Retrograde ejaculation can lead to male infertility. Other side effects include temporary difficulty urinating and urinary tract infections, and sometimes permanent erectile dysfunction or even urinary incontinence.
Prostate Artery Embolization: The Superior Choice in Minimally Invasive Procedures
Prostate Artery Embolization, or PAE, is a minimally invasive in-office procedure that can help improve BPH-caused lower urinary tract symptoms. Through a tiny puncture in the patient’s thigh or wrist, the doctor inserts an ultra-thin catheter and guides it to the prostate artery, where the catheter releases microspheres that reduce blood flow to the prostate. The prostate will begin to shrink, leading to improved symptoms within two weeks.
PAE is effective and safe. Unlike other procedures to treat BPH, PAE does NOT affect sexual performance. You can resume regular sexual activity after 24 hours, but be aware that you may see blood in your ejaculate for 7-21 days, which is normal. You may also resume strenuous activity and return to work 24 hours after the procedure.
With PAE, most patients notice an improvement in their symptoms within two-to-three weeks. Prostate artery embolization has a high success rate, with over 90 percent of men experiencing relief after the procedure. The research concludes that PAE offers long-term success in treating an enlarged prostate, with 82 percent of men still enjoying a successful PAE three years after their procedure. Roughly 78 percent of men experienced success three years post-procedure.
Why Choose Dr. Adam S. Gropper and Prostate Specialists of Miami for PAE?
Interventional Radiologist Dr. Adam S. Gropper, M.D., has been practicing vascular and interventional radiology in Florida since 1999. He has training as an engineer and a medical doctor and a decade of experience as chief of radiology. Over the years, Dr. Gropper has performed countless vascular procedures. When you choose to work with Dr. Gropper and Prostate Specialists of Miami for your PAE procedure, you can trust that you’re receiving top medical care that combines state-of-the-art technology with a caring, patient-centric approach.
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