26.SEP.2019 3 MIN READ | 3 MIN READ

In conventional treatments for an enlarged prostate, sexual dysfunction can occur as a side effect. Consultant urologist Dr Ronny Tan discusses how a new minimally invasive treatment can help without hurting your sex life.

As a man ages, his prostate, the gland that makes the fluid in semen, also grows in size as a response to male hormones such as testosterone. This is usually not a cause for concern unless the prostate, typically the size of a walnut, enlarges to almost the size of a lemon and causes problems like urinary obstruction. A non-cancerous enlargement of the prostate gland is medically referred to as benign prostatic enlargement (BPE) or benign prostatic hyperplasia (BPH).

How an enlarged prostate can cause urinary problems

Located between the bladder and the penis, the prostate gland also surrounds the urethra – the tube that transports the urine from the bladder out of the body. When the prostate gland enlarges beyond a healthy size, it can cause urinary obstruction by increasing the muscle tone at the neck of the bladder and/or by compressing the urethra. Common symptoms of BPE are urinary tract issues such as a sense of incomplete bladder emptying, difficulty in starting urination, frequent urination (including at night, after bedtime), urgency to pass urine, urine leakage, and frequent interruption of the urine stream.

Treating an enlarged prostate

BPE is a lot more common than you think – in fact, it’s estimated that 1 in 2 men aged between 51 – 60 have it. The condition is treatable, but some men avoid seeking help because they’ve heard about the unpleasant side effects of current treatment options. Oral medications prescribed for BPE, such as alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase-5 inhibitors (specifically tadalafil) can adversely affect a man’s sex life by causing erectile and ejaculatory problems.

Similarly, surgical procedures that reduce the size of an obstructing prostate can cause such side effects. Studies show that many men who have undergone prostate surgery experience an inability to ejaculate during sex. Some experience discomfort during orgasm, while others experience erectile dysfunction.

Left untreated, however, BPE can cause bigger problems. The bladder outlet obstruction due to an enlarged prostate gland can actually lead to irreversible bladder damage. What’s more, when there is bladder failure, surgery for BPE becomes ineffective.

A new option that doesn’t hurt your sex life

Fortunately, there is now a new treatment option for BPE that provides relief from the troublesome symptoms without the side effects of sexual dysfunction. UroLift is a minimally invasive day surgical procedure that involves the use of small permanent implants to draw apart the enlarged prostate tissue which is compressing on and narrowing the urethra within the prostate gland.

UroLift®
Unlike conventional surgical treatments for BPE, UroLift often does not require the insertion of a catheter (urine tube) into the urethra after the procedure is performed. The UroLift implant comprises a suture (stitch) with a nitinol capsular tab on one end, and a stainless steel urethral end piece at the other. This capsular tab is placed on the outer layer of the prostate (known as the capsule), while the end piece is attached to the urethra within the prostate. This helps to increase the opening of the urethra by drawing apart the obstructing tissue of the prostate.

UroLift may be recommended for men who want to stop long-term medications for BPE, as well as those who find the side effects of other treatment options unacceptable. If you wish to consider an alternative to conventional treatments, speak to your doctor to find out whether UroLift can benefit you. Note that the prostate can continue to grow after any surgical treatment, so those who have had the UroLift or any other surgical procedures should consult their doctors if their symptoms become distressing as they may need further treatment.

 

Article contributed by Dr Ronny Tan, urologist at Mount Elizabeth Hospitals

References

At what age do men usually get benign prostatic hyperplasia (BPH)? (May 3, 2019). Retrieved August 27, 2019, from https://www.webmd.com/men/qa/at-what-age-do-men-usually-get-benign-prostatic-hyperplasia-bph

Benign Prostatic Hyperplasia (n.d.). Retrieved August 27, 2019, from http://sua.sg/clinical-guide/patient-info/benign-prostatic-hyperplasia/

26.SEP.2019
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Tan Ban Wei Ronny
Urologist
Mount Elizabeth Hospital

Dr Ronny Tan is a urologist practising at Mount Elizabeth Hospitals and Parkway East Hospital, Singapore.