MINIMALLY INVASIVE SURGERY FOR BENIGN PROSTATIC ENLARGEMENT

The prostate sits at the neck of the bladder like a ring doughnut, and produces the majority of the semen fluid. As men age, it often enlarges and causes blockage of the bladder's outflow, causing typical symptoms of poor flow, the need to pass urine frequently and urgently, and getting up several times at night to pass urine. 

Options for the management of prostate related urinary symptoms have traditionally focussed on medications first, and surgery only if you really need it. This is because surgery often came with long operations, several days in hospital, a prolonged recovery period and potentially long term side effects. Many men therefore have chosen to avoid interventions, but its increasingly realised that the bladder can be injured by long term over distension or outflow obstruction, leading to poor results if surgery is deferred too long. Likewise, the long term effects of prostate medication, such as feeling tired, sexual side effects and the effects on blood testosterone levels can potentially lead to long term harm. 

Whilst traditional more invasive options do give excellent results, and are still favoured in some men in certain circumstances, there are now several less invasive options. These are more minor procedures which can produce great improvements in symptoms, enable men to stop prostate tablets and prevent long term bladder damage. They produce far less side effects, in particular less effect on erections and ejaculation, and can usually be performed in just a few minutes, often under local anaesthetic only, unlike more major operations.

Two options Mr Streeter has introduced to East Kent are Urolift, and Rezum (steam) treatments.

 
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UROLIFT

Small implants are inserted into the prostate, showing as the yellow structure blocking the neck of the bladder in the diagram. The implants are tightened to pull the internal lumen of the prostate open, improving flow and emptying. This is usually performed under local anaesthetic, and takes about 10 minutes in total. Side effects are normally short lived, and can include minor bleeding, and some mild discomfort for a few days. There are no reported sexual side effects, and men normally pass urine and go home within an hour or two of the procedure.
Mr Streeter was the first surgeon to perform these operations in East Kent. Press the link below for the British Association of Urological Surgeons information sheet on the technique.

REZUM

Steam is injected into the prostate, via a narrow telescope inserted under local or general anaesthesia (awake with sedation or asleep). The steam causes the prostate to shrink over time, allowing faster and more complete bladder emptying. The procedure takes about 10 minutes and men usually go home an hour or so later. A catheter is left in the bladder for a few days then simply removed. Steam treatment is more flexible and can be used effectively where Urolift may not be as useful. It also has less side effects than more major surgery and preserves sexual function. The full symptomatic benefit may take two to three months as the prostate shrinks back gradually. Long term studies have shown very few men need to go on to further treatment. Press the link below to a patient information booklet on Rezum steam treatment.

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Image by Lucas Sandor

ONE STOP PROSTATE ASSESSMENT

If you have urinary symptoms and you want to be fully evaluated in one visit, then Mr Streeter has set up one stop prostate assessment clinic. You will be given information in advance on lifestyle measures to take, to bring a record of your bladder habit, a urine test and a PSA blood test if applicable. At the appointment a full discussion and examination can be followed if required by a local anaesthetic bladder inspection, which can rule out any problems in the bladder but also importantly help to guide what treatment options would be effective. Please contact Mr Streeter's secretary via the button below if you wish to discuss further.