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An enlarged prostate is a common problem in older men. A new device that is left inside the patient for a week is being tested by the National Health Service. Lloyd Wadey, 56, data analyst and father of two, from BrightonHe was one of the first to benefit, according to ADRIAN MONTI.
The patient
I was around 40 years old when I started urgently needing to go to the bathroom, day and night. But then I stayed there for a long time because I never felt like I had properly emptied my bladder.
My GP said I had benign prostatic hyperplasia (BPH), an enlargement of the prostate gland, which “grows” as you age, putting pressure on the urethra (water pipe). I was prescribed ‘alpha blocker’ pills to relax the muscles around the bladder and make it easier to urinate.
Lloyd Wadey, 56, was one of the first to benefit from iTind, a small device inserted into the urethra; It then expands, creating a larger channel for urine to flow through.
That was in 2013 and at first it was a revelation, but I developed side effects: dizziness, blocked sinuses and headaches, so I was told to take the tablet every other day.
Things improved, but in 2016 my flow decreased again. I was referred to the hospital, where I was offered a procedure called transurethral resection of the prostate (TURP), in which they use a heated wire to cut a section of the prostate so urine can flow better.
But when the doctor discussed the possible side effects, including erectile dysfunction and incontinence, I decided to stick with the alpha blockers.
However, my symptoms got worse and needing to go to the bathroom so frequently made everything stressful. I dreaded car trips or visits to the restaurant or the movies. At night, I got up at least three times while trying not to disturb my wife Angela, 58, a nursing student.
In 2020, I saw my primary care doctor again and reluctantly joined the waiting list for TURP.
But I kept looking for other options and found good patient reviews about urologist Neil Barber, so I asked my GP to refer me to him.
At my appointment in August last year, he described the treatments available and mentioned iTind, a small device that is placed in the urethra; It then expands, creating a larger channel through which urine flows.
What really attracted me was that there were minimal side effects compared to TURP.
Lloyd says that a week after the device was removed he was able to bike, lift weights and jog again.
The device, Lloyd says, looked like the wire box on the cork of a champagne bottle.
Mr. Barber was testing the device and I was lucky enough to be randomly chosen by a computer to be in the iTind wing.
Two weeks before the procedure last November, I had to stop taking my alpha blockers; at that point I needed to go to the bathroom about 17 times a day again.
They gave me a sedative during the 15-minute procedure, which makes you sleepy, and I ended up sleeping through the entire process. When I went to the bathroom after the procedure there was blood in the urine and a stinging sensation, but they told me everything went well.
I returned home five hours later. Almost instantly, I noticed how much my flow had improved.
I took painkillers for two days because the device was a little uncomfortable, but it quickly became bearable. A plastic string coming from my urethra was used to help remove the device a week later; First they applied a gel with a local anesthetic to my penis and then they took out the device in a few seconds. It looked like the metal case of a champagne bottle cork.
A week later I was cycling, lifting weights and jogging.
I no longer take medications and need to go to the bathroom about seven times a day, which is normal. It is also not difficult for me to urinate or empty my bladder and I 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.
Prostate enlargement is a normal part of aging. The gland grows after the age of 30 and as it grows it narrows the urethra, preventing urine from flowing freely. About 50 percent of men between ages 51 and 60, and up to 90 percent of men over age 80, will have symptoms of benign prostatic hyperplasia (BPH), such as difficulty urinating and having to urinate more frequently. and urgency.
If symptoms are mild, you may be advised to drink less alcohol, caffeine, or carbonated drinks, as they can make people need to go to the bathroom even more. Medications such as alpha blockers can help make it easier to pass urine.
For moderate and severe cases, surgery may be necessary.
TURP is considered the “gold standard” treatment. Improves symptoms by 85 percent on average. It involves passing a thin tube containing a loop of wire through the urethra. The loop is then heated and used to remove small pieces of prostate and create a wider channel for urine flow.
A patient usually stays in the hospital for 48 hours and it may take a month or two for the full benefits to be felt, although the benefits are usually long-lasting.
However, 60 to 70 percent of men suffer from side effects such as dry ejaculation; Between 5 and 10 percent will experience a deterioration in their erectile function.
Less invasive approaches have become available in recent years, including UroLift, where small clips are fired into overgrown prostate tissue to separate it from the urethra, and now, iTind. It is the speed with which patients return to normal that makes this device stand out. Patients can continue with their normal lives within 24 hours.
Unfolded, the iTind device measures 2 by 1 inch and consists of three struts made of a nitinol metal alloy.
It is placed using a thin, flexible tube with a camera inside. The iTind is passed along the folded urethra and placed at the neck of the urethra, where it is surrounded by the prostate.
The device is then released and, as its three struts are deployed, three longitudinal incisions are made, creating a channel through the enlarged prostate to make it easier to pass urine.
We believe that most of this tissue remodeling takes place in the first three or four days, but to be safe, the device is left in place for a week.
It is secured with a thread taped to the outside of the penis and removed under local anesthesia a week later.
This option is only suitable for patients whose prostate measures less than 70 ml (an 18-year-old’s prostate weighs between 15 and 20 ml).
Additionally, the patient’s bladder muscles must be effective at “pumping” to expel urine, so it is usually better for younger men than older patients.
The current global trial plans to enroll 250 patients before the end of next year. The objective is to compare the effectiveness and safety of iTind with Urolift.
An earlier trial involving 175 men with BPH found that those who received iTind experienced “rapid and sustained improvement in symptoms while preserving sexual function,” Urology magazine reported in 2021.
Side effects, such as discomfort and minor bleeding, resolved once the device was removed.
The treatment has received conditional approval from NICE because we do not yet have long-term studies into its effectiveness. But urologists can now offer it to patients as another option.
- The cost of iTind to the NHS is approximately £1,208, compared to £1,320 for Urolift and approximately £500 for TURP.