Men With BPH: Don’t Suffer In Silence

5 min read  |  July 02, 2020  | 

If you’re finding that those trips to the bathroom are becoming more frequent, the ability to empty your bladder becomes a real chore, and you need to know the location of bathrooms before you leave home, well, you’re not alone.

BPH is a disorder that impacts over 30% of men over the age of 50. It accounts for more than 8 million doctor visits a year in the U.S.  It can create a constellation of symptoms, termed lower urinary tract symptoms, or LUTS for short.

These consist of:

  • Storage symptoms (urgency, frequency, nocturia, and even incontinence)
  • Voiding symptoms (a reduced force of stream, hesitancy, straining to sustain the flow, and intermittency)
  • Post- micturition (dribbling and sensation of incomplete emptying)

Medical therapy has proven highly successful in managing LUTS attributable to BPH.  We have many highly successful first-line agents, called alpha adrenoreceptor antagonists, which are safe, effective, and well-tolerated by most men. Combination therapies, which add a 5-alpha reductase inhibitor, such as finasteride or dutasteride, have proven effective for those men with larger prostates. Finally, we have several treatments that help manage bladder overactivity as well as daily tadalafil, a medication that has been found to improve both LUTS and erectile function.

Despite the expanding number of pharmaceutical options, up to 30% of men taking these medications will stop taking them, either due to a lack of perceived benefit or adverse effects.

At one point, these men only had only two surgical options: transurethral resection of the prostate (TURP) or, for those men with larger prostates, simple prostatectomy.  While these options were effective, they required the use of a general anesthetic. They carried potential risks of bleeding, particularly in men with larger prostate glands and those taking blood thinners. Other shortcomings were the need for an overnight hospital stay, the need for an indwelling catheter, several weeks of recovery from surgery, and always some degree of uncertainty regarding its impact on sexual function.

Over the last few years, several minimally invasive treatments (MISTs) have been developed to address many of these issues.

“We are now entering an era of personalized BPH treatment, and UM is at the forefront of this revolutionary shift,” says Bruce Kava, M.D., director of men’s health at the University of Miami Health System.

Contemporary BPH patients have multiple treatment options that strike a balance between managing their specific voiding problems, mitigating the risks of sexual dysfunction, and expediting their recovery. The University of Miami is one of the few centers worldwide with an All-Star lineup of faculty, with the expertise to offer the entire gamut of surgical options for BPH.

– Dr. Kava

With highly specialized equipment that the University of Miami urologists have, including high definition cameras to magnify the operative field, bipolar saline-based irrigants, and warming devices to keep patients comfortable during the procedure, TURP has become safer and more effective than ever.  Another procedure, the Greenlight laser prostatectomy, offers a similarly effective therapy with a significant reduction in bleeding risk, even for patients on anticoagulants and antiplatelet agents.

With the recent addition of Hermendra Shah, M.D., urologist, UHealth now offers another type of laser procedure called Holmium Laser Enucleation of the Prostate (HoLEP).  HoLEP is a procedure that is so technically demanding, that fewer than 5% of urologists worldwide can perform it. Dr. Shah is a world-recognized expert in the procedure, which allows for complete removal of obstructing prostatic tissue, with a significant reduction in the risks of bleeding, the need for a catheter, and without a prolonged recovery.

In fact, “HoLEP allows us to treat even enormous prostates which we previously would have needed to remove surgically,” says Dr. Shah. “These patients can expect to go home the next day, usually without an indwelling catheter.”

For patients who require surgery, UHealth also offers a robotic surgical approach. Ramgopal Satyranarayana, M.D., is a bonafide expert in the use of robotic surgery to manage BPH.

“Robotics offers us the opportunity to provide all of the benefits of a simple prostatectomy, with the precision that only the DaVinci system offers, and without the pain associated with open surgery.”

UHealth is also offering office-based therapy for BPH. Dr. Kava is particularly excited about the addition of Water Vapor Thermotherapy to the armamentarium of options for BPH therapy.

“This new technology has demonstrated 4-5 year efficacy in well-designed clinical trials.  It may be used in men with prostate glands up to 80g, and takes only a few minutes to perform in the office with nothing more than a local anesthetic.”  With Water Vapor Thermotherapy, sexual function is fully preserved in close to 98% of patients, another major advantage to this approach.

Finally, the team performs Prostatic Artery Embolizations (PAE), a technique that has been championed in the United States by Shivank Bhatia, M.D., chair of Interventional Radiology at UHealth. Working closely with his colleagues, Dr. Bhatia has become a world expert in this technique, in which microscopic “embospheres” are injected directly through the prostatic arterial system, depriving it of its blood supply, and essentially cause the gland shrink by up to 40% of its size.  The procedure is used primarily in larger prostate glands. PAE has demonstrated an excellent safety profile in patients who are not good surgical candidates because of advanced age or comorbid medical conditions.  “Most patients can have the procedure in approximately one hour, don’t require a bladder catheter, and can have complete preservation of sexual function,” says Dr. Bhatia.

With the expanding landscape of options available to patients with LUTS, we truly have become a global destination for BPH therapy, which can have profound benefits on a man’s quality of life.

If you or someone that you know has LUTS and could benefit, don’t suffer in silence.  Make an appointment with one of our caring, compassionate, and expert urology providers at 305-689-2636 today.

Tags: BPH, Dr. Bruce Kava, robotic surgery, Urology

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