Archive for the ‘BPE’ Category

Don’t Fight the Nite With Prostate Enlargement

February 6, 2017

 

Nearly every man over the age of 50 experiences symptoms of prostate gland enlargement.  The symptoms are going to the bath room frequently, poor force of the urine stream, dribbling after urination and perhaps the most troublesome of all is getting up at night to urinate.  Every night, between 12 and 15 million men in the U.S. are likely to have loss of sleep because of an enlarged prostate gland.  This article will discuss the purpose of the prostate gland and what treatment options are available for this common condition.

The prostate gland is typically the size and shape of a walnut and is located in the lower part of the pelvis, below the bladder. It envelops the urethra, the tube through which urine flows from the bladder out of the body. When the prostate gland grows bigger – which happens to virtually every man as he ages – it can compress the urethra and make it difficult to pass urine.

Benign enlargement of the prostate gland does not cause prostate cancer or affect a man’s ability to have, but if the symptoms bother you, seek treatment. If left untreated, BPH can lead to urinary retention and cause bladder, urinary tract and kidney problems.

Coping Techniques.

Try behavioral changesPerhaps the easiest suggestion is limiting your fluid intake at night and not drinking anything for two hours before bedtime.  I also caution to decrease those foods and beverages that are diuretics (and will therefore prompt you to urinate more), such as coffee, caffeinated tea, herbal tea, lemon juice, chocolate, pineapple, grapes and cherries.

If those behavioral changes don’t help much, consider medication. A change in habits will help some but not all men with BPH, and for those whose symptoms aren’t relieved, medication is an option.  The most commonly used medications are alpha blockers, (Flomax) which can relax the muscle at the base of the bladder and the prostate, and 5 alpha reductase inhibitors, (Proscar) which can, over a period of months, shrink the prostate.  Like nearly all medications, they do have side effects.  For example, alpha blockers can cause the man taking them to faint and by decreasing his blood pressure when moving from laying down to standing upright quickly.  Alpha blockers also can cause sexual side effects like decreasing the volume of the ejaculate or having no ejaculation at all.  The 5 alpha reductase inhibitors can cause sexual dysfunction, such as impotence. Some physicians are also prescribing tadalafil, commonly known by its brand name Cialis, which is often marketed as a drug that treats erectile dysfunction, but can also help to relax the muscles in the prostate gland and thus relieve urinary symptoms.

If behavioral changes and medication don’t work or cease to be effective, surgical procedures are an option.  Until recently the two most common procedures are a transurethral resection or TURP, in which an instrument is inserted up the urethra to cut out the part of the prostate that’s blocking urine flow, and a laser procedure, which vaporizes the tissue obstructing the urethra. Both procedures are typically effective but carry the risk of side effects such as erectile dysfunction. Other, newer procedures, such as the UroLift System, in which a urologist places tiny implants in the prostate to increase the opening of the urethra and allow for greater urine flow.  This procedure can be accomplished in the outpatient or ambulatory treatment center or even in the doctor’s office.  The advantage of the UroLift is that there are no sexual side effects and the results are noted almost immediately after the procedure.

Bottom Line:  The enlarged prostate gland affects millions of American men.  It significantly impacts a man’s quality of life.  Help is available.  Speak to your doctor.

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The Care and Feeding of the Enlarged Prostate Gland

October 21, 2016

If you are a man, then you have a prostate gland.  If you have a prostate gland, then you are likely to be one of the 14 million American men who experience bothersome symptoms beginning around age 50.  This article will discuss the diagnosis of the enlarged prostate gland and what are some of the available treatment options that can reduce the symptoms associated with this common condition.  It is a walnut sized organ at the base of the bladder and surrounds the urethra or tube that is in the penis and transports urine from the bladder to the outside of the body.  It is common and even normal for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until middle age or around 50. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have symptoms of BPH.

The prostate gland encircles the urethra like a donut, so problems with urination can occur if the gland restricts urine flow through the urethra. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

  • The bladder wall becomes thicker and will contract without the owner’s permission causing urgency of urination.
  • The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.
  • Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder.

The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Some problems associated with BPH are

  • Urinating more often during the day
  • Need to urinate frequently during the night
  • Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time and soil your clothing-very embarrassing!
  • The urine stream is slow to start
  • Dribbling after urination
  • A sensation that the bladder isn’t emptied after urination
  • Lack of force to the urine flow, which makes aiming more difficult
  • The sensation of needing to go again a few minutes after urinating

Diagnoses

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor can determine the size of the prostate gland during a physical examination.

The diagnosis is made with several of the following tests:

Symptom Score

This is a brief questionnaire that provides a numerical value to the symptoms associated with urination.  The higher the score (maximum is 25), the more symptoms a man has and the more likely he will want to have treatment for relief of his symptoms.

Urinalysis

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis. 

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).

Urine flow rate

This test consists of a man urinating in private over a funnel which measures the volume of urine and the time that it takes to empty the bladder.  The urine flow rate is expressed in milliliters per second.  Normal is greater than 15 ml\second.

Urodynamics

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Imaging studies

The ultrasound examination evaluates the size of the prostate gland which often determines the treatment option which is best for your situation.  It is a painless examination consisting of the insertion of a small pencil-size probe into the rectum and uses sound waves to determine the appropriate treatment for prostate gland enlargement.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment options

  1. Watchful waiting-If the person has BPH but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.
  1. Drug therapyYour doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.
  1. Minimally invasive treatments-The prostatic urethral lift or UroLift is an implant of several polyester sutures connected by two small metallic tabs that opens the prostate gland located in the urethra and improves the flow of urine thus decreasing the symptoms of the enlarged prostate gland. UroLift has been approved by the FDA to relieve the symptoms of the enlarged prostate gland. There have been nearly xx thousand of men who have had the treatment which reports favorable results up to 4 years. Most insurance companies will now pay for the UroLift procedure 
  1. Surgery-Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (Trans Urethral Resection of the Prostate). This procedure requires an admission to the hospital, a general anesthesia, a urinary catheter for several days, and the risk of sexual problems afterwards.

Bottom Line:  Nearly all men will experience the problems associated with the enlarged prostate gland.  The enlarged prostate gland impacts a man’s quality of life.  Help is available and nearly all men can be helped.  If you have symptoms associated with urination, speak to your doctor.

Benign Enlargement of the Prostate Gland Affects Millions of U.S. Men-New Treatment With Prostate Urethral Lift

November 11, 2015

Benign enlargement of the prostate gland affects nearly millions American men. In the past the procedure of choice was a surgical procedure, transurethral resection of the prostate gland, which is often referrd to as the rotor router procedure. Now a first line treatment is the prostate urethral lift PUL, is a new alternative. This blog will discuss the PUL, how it works, and what are the risks and complications of the procedure.

Lack of awareness about a common health condition may be causing millions of men to suffer unnecessarily. Benign prostate enlargement (BPE), affects more than 37 million men in the United States alone. Unfortunately, many men postpone treatment for this disorder because of concerns about side effects such as problems with ejacualtion and impotence or erectile dysfunctihowever, their concerns may be alleviated with additional information.BPE occurs when the prostate gland that surrounds the male urethra becomes enlarged with advancing age and begins to obstruct the urinary system. Symptoms include sleepless nights and urinary problems, and can cause loss of productivity, depression and decreased quality of life.

About one in four men experience BPH-related symptoms by age 55 and, by age 70, over 80 percent of men suffer from BPH. Most men blame their symptoms on aging. They may not be aware of the high prevalence of BPH or the available medical or surgical treatment options. There is a high risk to delaying treatment and so men should proactively talk with their doctors.

The prostatic urethral lift is a minimally invasive procedures the risks are low compared to medications or other surgeries. BPE can have a significant impact on quality of life for men as well as their partners, and can place limitations on their activities. For example, the need for frequent urination may make travel, sleep and sports activities difficult. We hope that with greater awareness of symptoms and treatment options, men will take a more active role in treating BPE, and live life with greater vitality.

A recent U.S. survey of more than 1,000 men over the age of 50 demonstrated that concerns about the risk of side effects, such as loss of sexual function or urinary incontinence, would cause a majority to postpone or avoid treatment of BPH.

This is unfortunate because, not only is early treatment important to alleviate symptoms and stop the
disorder from worsening, but a new minimally invasive treatment option is available that does not require cutting, heating or removal of prostate tissue, and as such does not result in loss of sexual function or urinary incontinence.

The survey results mirror other research and anecdotal evidence from patients that show that men
rarely mention their BPE-like symptoms.

The more recent survey, which was completed in October 2015, demonstrated that:
• A majority of men (61 percent) would postpone treatment for BPH because of the risk of sexual
• side effects or urinary incontinence from traditional treatments
• Eighty-four percent of respondents indicated they would be more open to seeking treatment for
• BPE if the treatment options available held less of a risk of impotence or incontinence
• Nearly half of the men surveyed (44 percent) were not aware that BPH is more common than
• prostate cancer. In fact, BPE impacts more than 12 times as many men in the U.S. as prostate cancer
• Concerns over surgical treatments was high among respondents, with 83 percent stating they
• were interested in a treatment option that could improve BPE symptoms without cutting, heating or
• removing prostate tissue1

In the past,mMedication is often the first-line therapy for enlarged prostate, but relief can be inadequate and temporary. Side effects of medication treatment can include sexual dysfunction, dizziness and headaches, prompting many patients to quit using the drugs. For these patients, the classic alternative is surgery that cuts or ablates prostate tissue to open the blocked urethra. While current surgical options can be very effective in relieving symptoms, they can also leave patients with permanent side effects such as urinary incontinence, erectile dysfunction and retrograde ejaculation (dry orgasm).

About NeoTract
The PUL is a minimally invasive and clinically effective device that address unmet needs for men with BPE. The PUL is a minimally invasive permanent implant system that treats symptoms while preserving normal sexual function.

The UroLift System consists of a delivery device and tiny permanent implants. FDA cleared in 2013, this
unique technology works by directly opening the urethra with tiny implants that hold the enlarged tissue out of the way, like tiebacks on a window curtain. No cutting, heating, or ablating tissue is involved, making the UroLift System the first and only BPE treatment that does not remove prostate tissue and does not negatively impact a man’s sexual function.

4 pins in the prostate open the gland and allow improvement in urinary symptoms

4 pins in the prostate open the gland and allow improvement in urinary symptoms

I have done over 40 cases using the PUL and none of the men have experienced any sexual side effects from
the procedure. Most men can have the procedure in the office setting. They can leave the office without
a catheter and have marked improvement immediately or in a few days. The side effects are frequency of
urination and small amount of bleeding which only last for a short period of time. Research has demonstrated
that the procedure lasts for at least three years.

Most insurance companies, including Medicare, pay for the PUL procedure.

If you would like to more about the PUL, go to my website, http://www.neilbaum.com, or go to YouTube and use the following URL: https://www.youtube.com/watch?v=cEJsJ3E0pJI

Bottom Line: BPE is a common condition affects millions of American men. A first line treatment that is effect is the prostate urethral lift. Give my office a call if you have
any questions.