Why a device that looks like the wire cage for champagne corks could help with prostate trouble
AN ENLARGED prostate is a common problem for older men that causes a frequent and urgent need to go to the toilet. A new device that’s left inside the patient for a week to ease this is now being trialled by the NHS. Lloyd Wadey, 56, a data analyst and father of two from Brighton, was one of the first to benefit, as he tells ADRIAN MONTI. THE PATIENT
I was in my mid-40s when I started needing to rush to the loo, day and night. But then I’d stand there for ages as it never felt like I had properly emptied my bladder.
My GP said that I had benign prostatic hyperplasia ( BPH) — an enlarged prostate gland — which was pressing on the urethra [the tube from the bladder that urine passes through]. I was prescribed daily alpha blocker pills that would relax the muscles around my bladder and make it easier to urinate.
That was in 2013, and at first it was a revelation. However, I developed sideeffects, including light- headedness, blocked sinuses and headaches, so I was told to take the tablet every other day.
Things improved, but by 2016 my flow was slowing down again. I was referred to hospital, where I was offered a procedure called transurethral resection of the prostate (TURP), in which a heated wire is used to cut away a section of the prostate so urine can flow better.
But when the doctor ran through the possible side-effects, including erectile dysfunction and incontinence, I decided to stick with the tablets.
However, my symptoms got worse, and needing the loo so often was making everything stressful. I dreaded car journeys or trips to a restaurant or cinema. at night I was getting up at least three times while trying not to disturb my wife angela, 58, a student nurse.
In 2020 I went back to my GP and reluctantly joined the waiting list for TURP. But I continued to look for other options, and came across good reviews from patients about consultant urologist Neil Barber, so I asked my GP to refer me to him.
At my appointment in august last year he outlined the treatments available, and mentioned iTind — a tiny device that is put into your urethra where it expands, creating a larger channel for urine to flow through.
What really appealed to me was that, with iTind, there were minimal potential side- effects compared with TURP.
Mr Barber was running a trial of the device and I was lucky enough to be chosen to join it.
Two weeks before the procedure in November I had to stop taking my alpha blockers — at that point I usually needed the loo about 17 times a day.
On the day I was given sedation, and ended up sleeping through the 15- minute procedure. afterwards, when I went to the loo, there was blood in my urine and a stinging sensation, but I was told everything had gone well.
Almost instantly I noticed how much my flow had improved.
I was back home five hours later. I took painkillers for two days until the stinging eased. The device felt slightly uncomfortable, but it quickly became bearable.
A plastic string coming out of my urethra was used to help remove the device a week later.
I had a local anaesthetic gel applied to my penis, and then the device was pulled out in a few seconds. It looked like the wire case from the cork of a champagne bottle.
A week later I was riding my bike, lifting weights and jogging.
I’m no longer on medication and I need the loo seven times a day or so — which is about normal.
I don’t struggle to empty my bladder, either, and have had no side- effects. The treatment has transformed my life.
THE SURGEON Neil BARBER is a consultant urological surgeon at Frimley Park Hospital in Surrey.
AN ENLARGED prostate is a normal part of getting older. The gland grows from around the age of 30 and, as it gets bigger, it narrows the urethra, preventing urine from flowing freely. about 50 per cent of men aged 51 to 60, and up to 90 per cent of men over 80, will have symptoms of BPH, such as difficulty urinating and having to go more often and more urgently.
If the symptoms are mild you should drink less alcohol, caffeine or fizzy drinks, as these can make you need the loo even more. Medication such as alpha blockers can help make urinating easier.
For moderate and severe cases, surgery could be needed.
TURP is regarded as the gold standard treatment, which on average improves symptoms by 85 per cent. It involves passing a thin tube containing a loop of wire via the urethra.
The loop is then heated and used to remove small pieces of the prostate, to make a wider channel for the urine flow. a patient stays in hospital for about 48 hours and it can take a month or two for the full benefits to be felt, though they are usually long-lasting.
However, 60 to 70 per cent of men are left with side-effects such as dry ejaculation, and 5 to 10 per cent will experience deterioration in their erectile function.
Less invasive approaches have become available in recent years, including Urolift, where small clips are fired into the enlarged prostate tissue to pull it away from the urethra, and iTind. It’s the speed with which patients return to normality that makes iTind stand out — they can carry on with their life within 24 hours.
Unfolded, the iTind device measures 2in by 1in and consists of three struts made of the metal alloy nitinol.
During the procedure, the folded iTind is passed along the urethra using a thin, flexible tube with a camera inside, and is positioned at the neck of the urethra where it is surrounded by the prostate.
The device is then released, and as its three struts unfold they widen the opening to create a channel through the enlarged prostate that makes it easier for urine to pass through. It is secured with thread taped to the outside of the penis.
We think the majority of the remodelling of the urethra tissue takes place over three or four days, but to be on the safe side the device is left in for a week. It is then removed under local anaesthetic.
This option is suitable only for patients whose prostate is less than 70ml in size (an 18-year-old’s prostate is about 15 to 20ml).
The patient’s bladder muscles must also be effective at pumping to push out urine, so it’s usually better for younger men rather than older patients.
The current global trial plans to recruit 250 patients before it ends next year. The aim is to compare the efficacy and safety of iTind with Urolift.
An earlier trial involving 175 men with BPH found that those given the iTind experienced ‘rapid and sustained improvement of symptoms while preserving sexual function’, as reported in the journal Urology in 2021.
Side-effects such as discomfort and minor bleeding were resolved once the device was removed.
The treatment has been given conditional approval by NHs watchdog NICe because we don’t yet have long-term studies about its effectiveness. But urologists can now offer it to patients as another option.
■ THE cost of iTind to the NHS is about £1,208, compared with £1,320 for Urolift and less than £500 for TUrP.