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Prostate Health
Norman J. Nemoy, MD, FACS Most men after the age of 50 have some prostatic enlargement, but it's only real significance is reflected by the severity of symptoms caused by that enlargement. The most common symptoms are frequency of urinating, having to awaken two or three times at night to void, small urinary stream, and a sensation of incomplete bladder emptying. The indications for treatment depend on whether these symptoms are particularly bothersome to the patient or are causing a change in his lifestyle (i.e., unable to sit through a movie, a play, a ball game, etc.). In very severe cases, the urine can back up into the kidneys causing kidney failure. For those patients in whom treatment is indicated, the number of treatment options is steadily increasing. It seems as if one or two new technological approaches and/or drugs are being introduced each year. Still, the most effective surgical therapies are those which are physically able to remove obstructing prostatic tissue. The "gold standard" still remains the transurethral resection of the prostate, although good results are now being achieved with electro-vaporization of the prostatic gland. The advantage of this latter procedure is that there is minimal blood loss and a very short hospital stay. In those patients with obstructive symptoms and a small prostate gland, a simple transurethral incision of the prostate can produce dramatic results, and the procedure can be done as an outpatient. Before considering any type of surgical procedure, however, it should be noted that in most patients, medical therapy can be quite effective. The two types of therapy are: 1) Alpha blockers which relax the opening of the bladder neck, and, 2) Androgen blockers which can reduce the size of the prostate gland. In some patients, both types of medication are indicated for maximum relief of symptoms. Newer modalities of treatment which are on the horizon include transurethral microwave thermal therapy (TUMT) and transurethral radio frequency ablation of the prostate. Although these procedures have had much coverage in the press, the number of patients which have been treated are small in number and it has been shown that in these patients symptoms can recur one or two years after their treatment. Lasers have also been utilized to remove prostatic tissue, but experience has shown that this is not the most effective choice in treating prostatic obstruction. In summary, there is no existing therapy which is universally applicable to all men with prostatic obstruction. It is critical, then, that these varying options be properly evaluated so as to choose which would be most efficacious for the individual patient. |
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What is Urology?