.......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ..........It started about 15 years ago.
Bob Cannady, now 74, recalls that going to the bathroom to urinate was no longer second nature. His urine stream was stop and go, his bladder never felt completely empty, and sudden urges to urinate interrupted his sleep repeatedly throughout the night.
“I went to the doctor and was diagnosed with an enlarged prostate,” said Cannady, of Rio Rancho. “I was put on generic Flomax, and it helped for quite a while, but then about a year ago it began getting worse, so they doubled the pills and added a third medication.”
The medications improved his urine stream but the trade-off in side effects, which included some sexual dysfunction, weren’t worth it, Cannady said.
That’s when he found his way to Dr. Andrew Grollman, a urologist at Lovelace Medical Group, who had begun using a quick, easy and fairly painless procedure to open the channel through the prostate to restore urine flow.
The relatively new UroLift system is just one more procedure in the toolbox available to doctors who treat enlarged prostate, and Grollman is one of the very few doctors in New Mexico who perform it.
“More often than not, by the time I see people, they’ve already tried the medicine,” Grollman said. “It used to work but doesn’t anymore, or it never worked for them and they’re looking for another treatment.”
Enlarged prostate, technically called benign prostatic hyperplasia, or BPH, is extremely common, Grollman said. “About 30% of men age 45 and older start to have symptoms, and about 70% of men age 70 and older have symptoms.”
According to the Medscape medical and health care website, more than 14 million men in the United States have symptoms of BPH, and it affects an estimated 30 million men worldwide.
To better understand the condition, a basic anatomy lesson may be helpful:
The prostate, about the size and shape of a walnut, is part of the male reproductive system. Its main function is to manufacture a fluid that goes into semen and aids in the viability of sperm and male fertility. The prostate sits at the base of the bladder, which holds urine. A channel, the urethra, that runs through the center of the prostate, allows urine to pass from the bladder through the penis, so it can exit the body.
“Think of the bladder as the pump, and the channel through the prostate like the tubing,” Grollman said. “After a man’s reproductive years, the prostate doesn’t have much function, other than to cause a whole lot of problems. As men grow older, their prostates also tend to grow.”
That growth can squeeze the channel, making it progressively smaller, impeding the flow of urine and resulting in the symptoms associated with an enlarged prostate, or BPH.
To be clear, he said, “an enlarged prostate is not indicative of prostate cancer,” which can be present regardless of the size of the prostate or in the absence of any enlargement at all. And because prostate cancer is asymptomatic, separate screening is required.
The UroLift system is an outpatient procedure that can be performed under local anesthesia in a doctor’s office, though Grollman does his in operating room at one of the Lovelace hospitals while the patient is under sedation, minimizing movement.
A rigid metal catheter is first inserted into the penis through the urethra to the blocked area within the prostate. Through that, Grollman inserts the UroLift delivery device. A camera attached to the device allows the image to be seen on a monitor. Grollman then uses the device to compresses the prostate tissue on one side of the channel and with the push of a button delivers a staple-like clip that holds the tissue in place. He then compresses the tissue on the opposite side of the channel and attaches another clip. Anywhere from four to six clips may be used to completely open the channel, he said.
Unlike other procedures, the UroLift procedure, which takes a matter of minutes, does not require cutting, heating, vaporizing or removal of tissue. Patients can typically return home the same day without a catheter, and experience rapid symptom relief and recovery with low complication rates and preservation or restoration of sexual function.
However, not everyone is a candidate for the UroLift procedure. If a prostate is larger than say the size of a tangerine, Grollman uses a more traditional procedure called Trans Urethral Resection of Prostate, or TURP.
With TURP, a catheter is inserted through the penis to the blockage in the prostate. A device is then passed through the catheter to heat and vaporize the prostate tissue that is impeding urination. Some doctors use a laser as the source of the heat, others use something that looks like a metal button.
In extreme cases, the doctor may have to physically cut into the prostate and hollow out the channel.
These procedures are more invasive, require the patient to wear a catheter for anywhere from a couple of days to a couple of weeks, and have a higher risk of bleeding, infection and sexual dysfunction, Grollman said.
He is careful to not call the UroLift procedure a “permanent fix,” because “no matter what you do, the prostate can still grow over time and everybody is different – for some it may grow fast, for some it may grow slow, for some it may not grow at all.”
Rather, Grollman prefers to call the UroLift system “durable,” and although the procedure is relatively new, he notes that 90% of patients who have had it report they are satisfied.
Though only six months removed from his UroLift procedure, Bob Cannady counts himself among those who are satisfied.
He daily goes to the gym and when he other men with a few years under their belts get together and talk about their aches and pains – as they are inclined to do – Cannady relates his story and encourages them to contact Grollman.
“I’m very happy I did the procedure,” he said. “There was really no pain afterwards and now I can sleep through the entire night. I can’t pee like I did when I was 16 years old, but I go like when I was 40, and that’s pretty darn good.”