About half of men over 50 develop an enlarged prostate, which can make urination difficult.
Treatment usually involves major surgery, but a new 30-minute laser procedure can be effective, with minimal side effects.
Martin Klein, 70, a semi-retired NHS worker and father of two from London, is one of the UK’s first men to benefit, he tells Roger Dobson.
About half of men over 50 develop an enlarged prostate, which can make urination difficult. Treatment usually involves major surgery, but a new 30-minute laser procedure can be effective, with minimal side effects (file photo)
Five years ago I noticed that I had frequent urges to urinate; and that when I went, I had trouble peeing.
My bladder would never empty properly, and as a result I was up and down every hour during the night. It was exhausting as it really affected my sleep.
I went to my GP and after trying a number of things – including medication – that didn’t work, I was referred to a urologist, Dr Chris Ogden, last year.
I was diagnosed with benign prostatic hyperplasia (BPH) or an enlarged prostate.
(As the gland enlarges, it presses against the bladder, causing frequent trips to the bathroom. And if the urethra is crushed, it can make urination more difficult.)
He said I would need surgery, but explained that a new technique was available, which uses a thin laser to burn away excess prostate tissue.
It was quick, non-invasive and had a lower risk of side effects than other types of surgery (eg, transurethral resection of the prostate, which removes part of the prostate, which can cause incontinence and erectile dysfunction).
What are the risks?
There is a risk of infection, which in very rare cases causes a prostate abscess.
Sometimes the bladder neck must also be treated in addition to the prostate, which is not so easy with this laser.
Professor Raj Persad, a urologist consultant at Bristol Urology, says: ‘This new technique is probably the most minimally invasive treatment for benign prostatic hyperplasia that I have come across.
The instrument is not passed through the urethra, so there is no damage to the urethra or bladder neck, which can have important consequences for sexual function afterwards.
“There is no bleeding and the procedure can be repeated if necessary.”
There was no cutting, which means there would be no bleeding either, so I would recover quickly.
The laser was in a needle and would be inserted through the skin of the perineum, the area behind the penis, and into the prostate.
I decided to continue. During the procedure, I felt no pain, just a little discomfort from the urinary catheter (thin tube) that was put in immediately after – it was removed in a few days.
I soon noticed the results, which were excellent: I was able to urinate and empty my bladder well.
Where I used to get up every hour at night to go to the toilet, that is now only a few times, despite my habit of drinking a lot of tea! I have had no side effects and am happy to be able to get a good night’s sleep again.
Dr. Chris Ogden is a urologist consultant at Princess Grace Hospital and University College Hospital, both in London.
Benign prostatic hyperplasia (BPH) is common in older men. It occurs when the prostate gland begins to grow — this gland, which is about the size of a walnut and located below the bladder, wraps around the urethra, the tube that carries urine from the bladder out of the body.
Benign prostatic hyperplasia (BPH) is common in older men. It occurs when the prostate gland begins to grow – this gland, which is about the size of a walnut and located below the bladder, wraps around the urethra, the tube that carries urine from the bladder out of the body
As the prostate enlarges, it can squeeze the bladder and constrict the urethra, with symptoms such as difficulty initiating urination, a frequent urge to urinate, and difficulty emptying the bladder completely.
Up to three million men in the UK have urinary symptoms associated with the condition.
We don’t know the cause of BPH, but it’s likely linked to hormonal changes that occur with age.
Treatments begin with lifestyle changes, such as cutting back on caffeine, which can irritate the bladder and make urinary symptoms worse. If such changes do not help, medications may be offered.
This includes alpha blockers, which work by relaxing the muscle in the prostate and at the base of the bladder, making it easier to urinate; or 5-alpha reductase inhibitors that shrink the prostate.
But 30 percent of men with BPH will need some form of surgery.
Transurethral resection of the prostate (TURP) is the gold standard treatment for BPH.
A thin metal tube with a light, camera, and loop of wire is passed down the urethra to the prostate and heated to cut away the excess tissue causing the symptoms.
WHAT IS URINARY INCONTINENCE?
Urinary incontinence is the loss of bladder control.
It affects up to six million people in the UK and 17 million in the US to some degree.
Some patients occasionally leak urine when they sneeze or cough, while others get such sudden urges that they don’t get to the toilet in time.
It is more common with age and can occur due to conditions such as arthritis if patients cannot undo their pants buttons fast enough.
Other causes may include urinary tract infection, pregnancy, childbirth, menopause, hysterectomy, and prostate cancer.
Alcohol, caffeine, carbonated drinks, and spicy foods can stimulate the bladder, making symptoms worse.
Sufferers should seek help from their GP, as urinary incontinence may indicate a more serious underlying condition.
It can also limit people’s daily activities and increase their risk of falling when they rush to the bathroom.
People can reduce their risk by maintaining a healthy weight, eating plenty of fiber, doing pelvic floor exercises, and not smoking.
Source: Mayo clinic
While effective, TURP can have side effects such as nerve damage because the bladder neck muscles can be accidentally severed, which can cause erectile dysfunction and incontinence.
Martin was one of the first in the UK to receive Echolaser last year after being referred to Princess Grace for NHS treatment.
Echolaser differs from existing techniques for trimming an enlarged prostate in several ways.
First, we access the prostate through a tiny needle that is inserted through the perineum, the space between the anus and scrotum, rather than invasively through the urethra.
As a result, this procedure does not damage bladder neck tissue and thus has fewer side effects.
In addition, the target tissue is melted away by light emitted by the laser – so there is no cutting or bleeding, which means shorter treatment and recovery times.
Usually, the patient is first anesthetized and given a spinal nerve block to provide local anesthesia. Then I insert the needle, about a third of a millimeter in diameter, into the perineum.
I can see where to go through a thin ultrasound probe in the rectum. I pass the flexible cable, about the size of a human hair, containing the laser probe – which is about a third of a millimeter wide – into the enlarged prostate.
Once in position I activate the laser and the energy generates heat which creates a circular glow 1-2 cm wide at the tip of the needle.
I move the fiber to the tissue to be destroyed. Within seconds, this tissue has evaporated.
The use of the laser allows for a very comprehensive treatment of BPH without the risk of damaging the bladder neck.
In addition, unlike other laser treatments, the trimmed tissue does not need to be collected, as it is melted away and naturally removed from the body.
Because there is no bleeding, you usually do not need to stay overnight and patients go home the same day.
Because Martin was one of the first to have it, he was kept indoors for surveillance as a precaution.
Patients see an improvement in symptoms in the first few weeks and the full benefit after three months as the swollen tissue shrinks.
I just presented the results of the first eight cases at the annual conference of the British Association of Urological Surgeons.
The results show that three months after treatment, 80 percent of patients have doubled their flow rate and their quality of life has improved significantly.
The Echolaser treatment costs £4,000 to £8,000 privately.