Groundbreaking treatment available for prostate issues
Do you find yourself getting up a lot in the night to pee? It could be a sign of something more serious. Here Neil Fenn, consultant urologist at HMT Sancta Maria Hospital in Swansea, talks about enlarged prostates and how a groundbreaking new “stream trea
Aa many men get older, they find themselves needing to pass water with greater frequency in both the day and night.
This often leads a poor night’s sleep or the need to plan regular comfort breaks when out of the house or on long car journeys.
While it might be tempting to dismiss these symptoms as a normal part of the ageing process, it is important to listen to these symptoms and to talk to a medical professional about them.
In most cases these symptoms point to a benign prostatic hyperplasia (BPH), in some cases they may signal prostate cancer, so it is not a condition to be ignored and swift assessment is important to aid prompt diagnosis and treatment.
It is true that from the age of 40, men’s prostates get larger. The enlarged prostate puts pressure on the urethra (the tube through which urine passes from the bladder) causing lower urinary tract symptoms.
These symptoms can be grouped into two types:
1. Voiding symptoms:
■ Hesitancy (difficulty beginning to pee)
■ A variable slow flow of urine when peeing
■ Some dribbling after peeing
2. Storage symptoms:
■ Increased frequency of urination ■ Urgency
■ Urge incontinence (not being able to get to the loo fast enough)
■ Nocturia (having to get up at night to empty the bladder)
It is these storage symptoms, especially the need to get up in the night to pee, which drive reluctant patients to their doctor because it disturbs their sleep patterns – or because it disturbs their partner’s sleep.
These storage symptoms occur because the bladder has to push harder to get urine past the obstructing enlarged prostate, so it becomes irritable which we medically call “bladder overactivity”.
Unfortunately, we see one or two men every day admitted as hospital emergencies, who have ignored their symptoms for so long they are now unable to empty their bladders, and they require temporary catheterisation.
Clearly this can and should be avoided.
These urinary symptoms can be assessed and treated effectively here at HMT Sancta Maria.
We have a portfolio of treatments at our disposal that can work very well for benign prostatic hyperplasia.
We look at each case carefully to assess which treatment is appropriate and likely to be the most effective for the patient in question. MR Fenn, MB BCh (Wales), FRCS (Ed), FRCS (Urol), qualified from the University of Wales College of Medicine and remained in south Wales for his basic surgical and urology training.
He was appointed as a consultant urological surgeon in Swansea and has practised since 2001.
He has continued to develop his expertise and trained further with fellowships at Flinders University Adelaide and then the Cleveland
HMT is also about to offer a new treatment, which sits alongside an already effective arsenal of treatments for benign prostatic hyperplasia, giving an alternative that is speedier and that carries with it a shorter recovery time.
Rezum can be carried out under a local anaesthetic, and it uses hot water vapour to effectively shrink the prostate tissue, creating a new channel through which the patient can pee effectively.
The treatment has been available for four years in America and has been shown to be effective with good durable control of symptoms and improvement of flow.
Treatment options available include: 1. Alpha-blockers
These tablets relax the muscle in the prostate gland and at the base of the
bladder, so it is easier to pass urine.
2. 5-Alpha reductase inhibitors These tablets will shrink an enlarged prostate to ease the pressure on the urethra.
3. Anticholinergics
These tablets will relax an over-active bladder
4. Desmopressin
These tablets will reduce urine production, so the sufferer may find it easier to go through the night without needing to get up to pee. 1. Rezum
As with all of the procedures and treatments detailed here, Rezum is a NICE- (National Institute for Health and Care Excellence) approved treatment used to ease lower urinary tract symptoms brought on by BPH.
The technology uses heated water vapor to destroy excess prostate tissue and to shrink the enlarged prostate.
The procedure takes up to 30 minutes, so it can be done as a day case surgery. As is the case with the TURP procedure, there will be some pain and swelling immediately after the procedure, with the patient expected to be fully recovered, pain and catheter free after four weeks.
2. Transurethral resection of the prostate (TURP)
This is a common and an effective treatment to remove part of the prostate gland, effectively cutting a new channel through the prostate so the urine can pass more freely.
Full recovery after this procedure can take up to six weeks.
3. Prostate artery embolisation (PAE) This procedure sees tiny particles injected into the blood vessels that supply the prostate gland, in order to reduce its blood supply and to shrink the prostate.
4. Prostatic urethral lift implants (PUL)
These implants hold the enlarged prostate away from the urethra, so it is no longer blocked by the prostate.
5. Catheterisation
Installing a catheter will help the bladder to drain efficiently. But this is generally used as a short-term solution.
■ For further details about the effective treatment of lower urinary tract symptoms, caused by benign prostatic hyperplasia, go to: hmtsanctamaria.org/treatments/ urology-treatments/ or call 01792 479040.