New way to stop a chap’s endless trips to the loo: a quick blast of steam

He first sign something was wrong was about six years ago when my bathroom habits began to change. I started getting sudden urges to go and would have to rush to the loo — this would happen three or four times a day without warning.

AROUND 45,000 men a year have surgery for an enlarged prostate. Dave Livie, 63, a grandfather of four and warehouse supervisor from Alton, Hants, was one of the first to try new procedure, as he tells ADRIAN MONTI. THE PATIENT T

It was quite embarrassing at times and I have had a few accidents.

At other times I’d struggle to go and couldn’t manage a proper flow; I’d spend ages in the loo and my colleagues made jokes about it.

I do lots of driving in my job, so I’d have to stop at service stations and if there wasn’t one close enough, I’d find a field by the roadside.

At weekends when my wife Gillian and I would take our four dogs for long country walks, I’d have to disappear behind a bush when the urge came. It was a constant worry and got worse over time, until I was having to go once an hour during the day and two or three times at night.

I went to see my GP in early 2012, a few months after I noticed the symptoms, and he gave me a rectal examination to check my prostate. He said my symptoms were probably due to it being enlarged.

Apparently this is normal for men my age, but it meant the gland was starting to restrict the urethra, the tube the urine passes through.

At first I didn’t need treatment, but I went back a few months later as my symptoms were getting worse and I was urinating more than once an hour.

I was prescribed a tablet to reduce my prostate, which I took for a few years. It didn’t make a big difference but I was worried it would get worse without it.

At the end of 2016, I went back to my GP for a check-up and told him I was still having to rush to the loo. He

referred me to our community hospital where they gave me an ultrasound and urine flow test three weeks later. results showed my bladder wasn’t emptying properly and my flow was slower than normal — so they referred me to a urologist.

I saw him six weeks later — I’d read about new treatments for the condition, so was quite informed. I knew surgery could help, but I didn’t want to undergo an operation.

The urologist told me about a new treatment he was going to trial where steam is fired into the prostate to kill off some of the enlarged tissue. I would be one of the first in the UK to have it and, as it avoided invasive surgery, I was happy to give it a go.

I had the 20-minute procedure a week later at the Basingstoke and North Hampshire Hospital under local anaesthetic and sedation.

I remember waking up in recovery and feeling a bit uncomfortable, but nothing significant. I had a catheter fitted to help me urinate while the swelling in my prostate reduced.

Three hours after the surgery, I was able to go home, feeling a bit tender, but able to walk. That night I had trouble sleeping as I had a dull ache around my prostate, so I took painkillers.

Two days after surgery I felt well enough to go for a ten-mile walk with Gillian and our dogs.

The catheter was removed four days after and I went back to work as normal. My urine was red-tinged for about a week, but as soon as the catheter was removed, I noticed that the flow was better and the urges pretty much disappeared.

I now only need to get up once a night to go to the loo compared with three times before; and go once every few hours during the day — like most people.

I no longer take medication and can enjoy long walks with my wife and play with my grandchildren without worrying.

THE SURGEON

RichaRd hindley is a consultant urologist at hampshire hospitals nhS Foundation Trust in Basingstoke and BMi hampshire clinic. ABoUT half of men aged 50 — and 90 per cent of those over 80 — have an enlarged prostate. The condition, called benign prostatic hyperplasia ( BPH), occurs because the walnut- sized gland under the bladder gradually grows naturally as we age.

As it does so, it squashes the urethra which transports urine, restricting the normal flow.

Medication such as finasteride and dutasteride to reduce the prostate’s size can help, as can alpha blockers, which relax the muscles around the bladder to ease urination.

for more serious cases, we offer surgery called transurethral resection of the prostate (TUrP), where a section of the prostate tissue is cut away using a heated loop of wire.

About 65,000 of these operations are carried out each year, but it’s not for everyone and has downsides: it can cause temporary incontinence and some men suffer short-term impotence or retrograde ejaculation, where there’s less semen in the ejaculation.

At Basingstoke hospital, we were the first to start using a new treatment called rezum, where steam is used to kill the enlarged prostate tissue. The advantage is that it’s much less invasive compared with TUrP — carried out under local anaesthetic rather than general — and the patient can go home a few hours later.

TUrP patients are in hospital for up to four days in case of bleeding afterwards. recovery from rezum is faster too; patients are back to normal life within a few days, compared with up to three months with TUrP.

for the steam procedure, the patient is given a local anaesthetic and sedated. Their legs are raised on the operating table to give the doctor better access to the prostate and we insert a tube with a tiny camera on the end through the urethra. This relays pictures on a screen, which we use as a guide.

The steam is applied through a handheld device that looks like a gun, with a thin barrel which houses a needle. There’s a 0.42ml droplet of sterile water in the needle and this is heated to 103c using an attachment on the device.

Next, we make a puncture in the skin directly above the part of the prostate closest to the urethra. We push the needle in and press a trigger on the device to activate a nine- second burst of steam through the needle directly into the enlarged prostate tissue. This kills it.

The dead tissue is then naturally removed by the body as the prostate heals. This opens up the previously squashed urethra, making urinating easier. DePeNdING

on the size of the prostate, patients need between four to ten blasts of the steam. After the tube and needle are removed, the puncture heals naturally. So far I’ve carried out 20 rezum procedures and the results have been very encouraging with no side-effects.

The majority, if not all, have noticed an improvement in symptoms within three months.

rezum will appeal to patients who don’t want to stay on medication or undergo major surgery. It could eventually help those with prostate cancer, too.

I hope one day we might do away with medication for BPH and instead turn exclusively towards surgery as a way to treat it.