Don’t Fight the Nite With Prostate Enlargement

 

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 changes. Perhaps 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.

Options for Treating The Enlarged Prostate Gland

For reasons not entirely known, the prostate gland starts to increase in size around age 50 and causes symptoms of difficulty with urination. The prostate gland is a walnut sized organ at the base of the bladder and surrounds the tube, the urethra, which transports urine from the bladder to the outside of the body. When the prostate gland grows, it compresses the urethra making urination difficult.

By the time men are in their 40s or 50s, many are already experiencing symptoms, such as having to get up at night to urinate. Into their 60s and 70s, they may have to get up two or three times.

In addition, an enlarged prostate can also result in other urinary symptoms such as having to go frequently during the day, having a weak stream or having to go urgently.

The “gold standard” is called a transurethral resection of the prostate (TURP), where an instrument is inserted up the urethra to remove prostate tissue that is blocking urine flow. It is sometimes colloquially referred to as a “roto-rooter” procedure. The purpose of the TURP to carve out the inner portion of the prostate and leave just the shell. The procedure allows a much stronger stream and men who have it will have to urinate much less frequently.

However, the procedure requires general anesthesia and a hospital stay. While it does not usually interfere with the ability to have an erection, more than half of those who have it will experience “retrograde ejaculation,” meaning that no fluid comes out of the penis during orgasm. Instead, the fluid goes into the bladder where it is eliminated during urination. Men will also have to wear a catheter for a few days after the procedure and will require several months before they can resume all activities including sexual intimacy and heavy lifting.

Similar procedures known as GreenLight Laser Treatment, which uses a high-energy laser to vaporize prostate tissue, and holmium laser enucleation of the prostate (HoLEP), which also uses a laser to destroy prostate tissue, are also available. They are pretty much the same in terms of outcomes. They just use different energy sources.

Now there is a new treatment, the UroLift, that doesn’t remove any tissue but relieves the compression on the prostate gland making urnation easier and reducing the symptoms. The procedure can be done in the office setting, does not require any catheter, and does not cause any sexual side effects or retrograde ejaculation.

Bottom Line: Many middle aged men have sympotms related to the enlarged prostate gland. There are multiple treatment options and men can plan to resume their activities after treatment for benign prostate disease.

If you are 50 or older and you have any of these symptoms and they are bothersome, talk to your doctor.

 

 

 

 

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

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

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.

Bee Venom Takes the Sting Out of An Enlarged Prostate Gland

Around age 50 most men will develop a benign enlargement of the prostate gland that causes urinary symptoms such as getting up at night to urinate, dribbling after urination, frequency of urination, urgency of urination, and rarely urinary retention. About three of four men in their 60s have the condition, and it affects more than 90 percent of those over the age of 80. The cause is not known but may be a result of hormonal changes in middle aged men. The treatment consists of watchful waiting if the symptoms aren’t impacting a man’s quality of life, medication or minimally invasive surgery, such as microwave, lasers, and the new treatment, UroLift, which uses pins to open the obstructing prostate tissue. Now bee venom is being evaluated as a treatment option.

Bee venom has long been used in folk medicine to treat immune-related diseases, such as arthritis. In recent decades, researchers have been exploring its use in fighting many conditions, including cancer. Researchers in South Korea have found still another use for the venom: A study found that the venom from honey bees may be as effective in treating enlarged prostates as conventional drugs.

An animal study was conducted with rats. One group was treated with bee venom, and the second was treated with the drug finasteride (Proscar), which is commonly used to treat enlarged prostate. The third group got no additional treatment. A fourth group of uncastrated rats received placebo shots and served as a control.

Researchers found that the prostates of rats castrated and then given testosterone were significantly larger — 1.8 times — than the control rats. But the prostates of rats given either bee venom or finasteride were much smaller: When compared to control rats, the rats given bee venom were only 1.1 times larger, and those treated with finasteride were 1.3 times larger.

The research was published in the journal Experimental Biology and Medicine.

New Help For the Enlarged Prostate Gland-The Uro-Lift

The enlarged prostate is a medical condition in which the prostate gland that surrounds the male urethra (tube in the penis that transports urine and semen located in the penis) becomes enlarged with advancing age and begins to obstruct the urinary system. The condition is common, affecting approximately 37 million men in the United States alone. BPH symptoms include sleepless nights as men are awakened to empty their bladder and urinary problems such as dribbling after urination, frequency of urination, and urgency of urination. This condition can cause loss of productivity, depression and decreased quality of life. About one in four men experience these urinary symptoms by age 55 and by age 70, over 80 percent of men suffer from BPH.

Treatment options
Medication is often the first-line therapy for enlarged prostate, but relief can be inadequate and temporary. Side effects of 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, such as transurethral resection of the prostate (TURP or “roto rooter”), can be very effective in relieving symptoms, it can also leave patients with permanent side effects such as urinary incontinence, erectile dysfunction and retrograde ejaculation (dry orgasm).

A new study in published in Urology Practice, an official journal of the American Urological Association, concluded that the UroLift System preserves sexual function and provides rapid improvement in symptoms, flow and quality of life that are sustained to two years.

UroLift, which provides rapid relief of enlarged prostate symptoms with minimal side effects, are durable for at least two years after treatment, with less than one in ten patients requiring an additional procedure for symptom relief. At two years only 7.5% of patients required an additional procedure for lower urinary tract symptoms. Adverse events were typically early, mild and transient. There was no occurrence of de novo sustained ejaculatory or erectile dysfunction\impotence.

Bottom Line: Millions of American men suffer from the enlarged prostate gland. Help is available often starting with medication. Another option is Uro-Lift which can be done in the ambulatory treatment center and has immediate results.

Benign Prostate Enlargement (BPH) – Help Is Available

Millions of middle age men suffer from non-cancerous prostate gland enlargement. The cause is not known but is probably related to hormonal changes that occur normally in men after age 50.

The symptoms are going to the bathroom frequently, urgency of urination, poor stream, dribbling after urination. However, the most bothersome symptom that impacts a man’s quality of life is getting up multiple times during the night to go to the restroom.

Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties, and as many as 90% in their seventies and eighties, have some symptoms of BPH. Moreover, because drug treatment is not effective in all cases, researchers in recent years have developed a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery.

Thus, BPH is an age-related condition like many others, such as memory deficiency, reduced bones density and muscles flexibility.

As for natural treatment options, it has been noted Saw palmetto, a popular herbal therapy among men with prostate symptoms, is not effective and more and more scientific studies are showing that saw palmetto has no benefits in the treatment of BPH.

There are oral medications such as alpha-blockers such as Flomax and Rapaflo that relax the muscles in the prostate and make it easier for the bladder to empty the contents from the bladder. There are also medications that reduce the size of the prostate gland. These drugs, Proscar and Advodart, actually help decrease the size of the prostate thus decreasing the resistance to the flow of urine from the bladder to the outside of the body. Unfortunately, these drugs have mild side effects and since so many Americans are polymedicated, and alternative solutions are often more attractive to active middle aged men.

Minimally invasive treatments

Men with enlarged prostate glands have symptoms of going to the bathroom frequently, dribbling after urination, and getting up at night to go to the bathroom. The problem is usually caused by a benign enlargement of the prostate gland, which blocks the flow of urine from the bladder to the outside of the body. The cause of the benign enlargement is not known but is probably related to alternations in the hormones, testosterone, of middle aged and older men. Treatment usually consists of medications, alpha-blockers and medications to actually relax the muscles in the prostate gland but these are often ineffective especially if used for long period of time. The other options include minimally invasive procedures such as microwaves that can actually shrink the prostate gland. Now there’s a new treatment option that can be done in the doctor’s office under a local anesthetic.

What are some of the minimally invasive treatments available for BPH?

Laser vaporization: Anesthesia is usually required for this procedure, but patients can usually go home the same day. The technology involves placing a “cystoscope” (metal tube through which the visual lens and laser can be passed). A laser is used to burn and vaporize the obstructing or blocking prostatic tissue. Studies to date have shown limited long-term benefits.

Microwave thermotherapy of the prostate (TUMT): This is an office-based procedure performed with topical and oral pain medication and does not require a general anesthesia. Computer-regulated microwaves are sent through a catheter to heat portions of the prostate. A cooling system is required in some types for better tolerance. Traditionally, the best use of this procedure has been for patients who have too many medical problems for more invasive surgery or for patients who truly wish to avoid any type of anesthesia. Benefits are that there is no need for anesthesia and there is no blood loss or fluid absorption (these would be significant benefits in a person with a weak heart). Patients usually go home the same day. Men may need a catheter for one or two days after the procedure.

The UroLift system, made by NeoTract Inc. of Pleasanton, Calif., is the first permanent implant to relieve low or blocked urine flow in men age 50 and older with an enlarged prostate.

By pulling back prostate tissue that presses on the urethra, the system allows more natural urine flow.   This procedure is compared to pulling back the curtains with a sash. The procedure can be done in the doctor’s office under a local anesthetic and will actually open up the urethra to allow the flow of urine and reduce the urinary symptoms of frequency of urination, improve the force and caliber of the urine stream, and decrease the number of times a man needs to get up at night to empty his bladder.

Of course with any procedure there may be side effects and complications. Some b patients reported pain or burning during urination, increased urgency, decreased urine flow, incomplete bladder emptying, and blood in the urine. Most of these symptoms and side effects were temporary and resolved a few days or weeks after the UroLift was performed.

Bottom Line: Millions of American men suffer from symptoms as a result of an enlarged prostate gland. Certainly medications are a first line treatment option. However, the UroLift may be a permanent solution to this common problem and help men get a good night’s sleep!

Prostate Gland Enlargement-A New Minimally Invasive FDA Approved Treatment

Most men experience benign enlargement of the prostate gland that causes symptoms of difficulty with urination, dribbling after urination and getting up multiple times at night to urinate. All of these symptoms can impact a man’s quality of life.
Enlargement of the prostate gland occurs naturally as men age. Unfortunately, this process can press on the urethra and result in some frustrating side effects including urination and bladder problems. The good news is that an enlarged prostate is benign (not cancerous) nor will it increase your risk of prostate cancer; for these reasons it is often referred to as benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy.

The exact cause of BPH is unknown; however, a common hypothesis points to changes in the balance of the sex hormones during the aging process. The testicles may also play an important role in prostate growth: for example, men who have had their testicles removed (i.e. as a result of testicular cancer) do not develop BPH. Furthermore, men who have their testicles removed after having developed BPH will experience a decrease in prostate size.
Medications

Prescription drugs are typically the first line of treatment for BPH. Alpha blockers are typically associated with high blood pressure, but in the case of BPH, act by relaxing the muscles in both the bladder neck and prostate, resulting in effortless urination. The effects of alpha blockers are typically seen very quickly (in about a day or two). Some well-known examples are drugs like Rapaflo or Flomax.

Another set of medications, 5 alpha reductase inhibitors, reduce the size of the prostate, thus reducing the pressure on the urethra. Examples of these are Avodart or Proscar. Often, improvements are not seen for a couple of weeks or even months. Common side effects include decreased sex drive and erectile dysfuction. Combination therapy of alpha blockers and 5 alpha reductase inhibitors can be more effective than either drug alone. Antibiotics may also be prescribed to treat prostatitis (prostate inflammation) which can accompany BPH.

Minimally Invasive Procedures
GreenLight Laser uses a high-powered laser combined with fiber optics to vaporize the overgrowth of prostate cells quickly and accurately. The heat of the laser also cauterizes blood vessels, resulting in minimal bleeding. It is an out-patient procedure that involves catheterization for about two days. Stents can be placed in the urethra to help keep it open and allow urine to flow easier. These stents must be replaced every four to six weeks, and as such, are not considered a long term treatment option.

Now a new treatment, the Urolift, has been approved by the FDA and is a minimally invasive treatment that can be done in the doctor’s office under a local anesthetic with immediate results after a 20-30 minute procedure. The procedure consists of inserting two to four implants that opens the urethra directly by retracting the obstructing prostatic lobes without cutting, heating, or removing prostate tissue. The implants pushes aside the obstructive prostate lobes like opening window curtains. Small permanent UroLift implants are deployed, holding the lobes in the retracted position, and thus opening the urethra while leaving the prostate intact. Patients report marked improvement in symptoms immediately after the procedure. There is no problems with erections after the procedure.

Prostate, shown in yellow, with blockage of the urethra

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

Surgical Procedures
If medications are not effective, or if your prostate is too large, surgical intervention may be necessary. Transurethral resection of the prostate (TURP), or the modified Button TURP, involves the removal of portions of prostate which block urine flow. Hospital stay is typically one day with a two-day catheterization. Reserved for those with unbearable BPH symptoms and extremely large prostates, prostatectomy is the complete removal of the prostate gland. It is more invasive than either TURP or GreenLight Laser, and usually has a higher risk of complications and side effects and requires a longer catheterization. For these reasons, prostatectomies are typically not recommended for those with BPH, but rather the go to surgical intervention for men diagnosed with prostate cancer.
Bottom Line: Prostate enlargement affects nearly 14 million American men mostly after age 50. There are many treatment options available for BPH: medications, minimally-invasive procedures and surgery. Which treatment option is best for you depends on your overall treatment goals, the size of your prostate, your symptoms, your age, and your overall health. Make sure you speak with your doctor about the different treatment options; your doctor will recommend treatments based on your symptoms and treatment goals.