Last month, the Daily Mail Good Health section revealed news of a pioneering procedure to tackle enlarged prostates, a common problem in men as they age and one of the main causes of incontinence issues in men.
Ken Jordan, 58, from Hitchin, was one of the first patients in Britain to undergo it a pioneering procedure to tackle enlarged prostates.
‘I scoured the internet for something that could help, and found a new procedure called Urolift,’ said Mr. Jordan.
In his late 40’s, Mr. Jordan realised that he had started to need the loo more frequently and was going up to ten times a day.
Knowing that this could be a sign of prostate cancer, after six months he decided to visit his GP who said it was likely to be a benign prostate growth and that needing the toilet more frequently was very common in men as they get older.
This is because the prostate is like a doughnut that wraps around the urethra, the tube which carries urine from the bladder. As men get older, the prostate grows and as a result it starts to press on the urethra, making it harder to empty the bladder properly — thus you feel you need to go more often.
Mr. Jordan was referred to a urologist, who told confirmed that there was some prostate growth. He also carried out a blood test for prostate-specific antigen, a protein that can be a sign of prostate cancer, but the levels were very low, which was obviously good news. The urologist prescribed alpha blocker tablets to relax the prostate — this helped initially, but then the symptoms got worse again. And although I often felt I needed the loo urgently, when I got there I’d produce less.
“Next, my urologist tried finasteride, which stops testosterone changing into a form that causes the prostate to grow. But it didn’t really help, and both the drugs had side-effects — I suffered light-headedness, nausea and sleeplessness.” Mr. Jordan said
The urologist mentioned the problem could be treated with surgery, where they would cut or laser away parts of the prostate. But he knew that it carried a risk of impotence and incontinence.
Although he tried cutting down on the seven mugs of tea he drank each day, and avoided drinks in the evening, nothing seemed to work.
“It was starting to annoy me — on holidays I’d find long coach trips really difficult. If my partner, Jacky, and I went to the theatre or cinema, I’d always want to sit on the end of the row, so I wouldn’t disturb anyone.”
However, whilst scouring the internet for something that could help, last summer he found a new procedure called Urolift.
Here, surgeons simply move the prostate so it’s not pressing against the urethra, and then use two tiny anchors to hold it in place out of the way.
As there was no cutting or lasering involved, just moving part of the gland aside, the risk of impotence was much less.
In July last year, Mr. Jordan saw a specialist, Professor Tom McNicholas. He confirmed that Mr. Jordan was suitable for the procedure and would be the third patient in the UK to have it as part of a pilot study at the Lister Hospital in Stevenage.
The operation was carried out under sedation and afterwards there were no bandages, though he needed painkillers for the first few hours. Mr. Jordan took one day off work and within days, felt as that he had much more control over his bladder, and didn’t need to go to the loo as frequently.
Now, seven months after the op, Mr. Jordan feels that his body is as good as it was 15 years ago, “I might occasionally get up just once in the night, but I don’t have to worry about long journeys and days out. I really do feel liberated.”
Professor Tom McNicholas is consultant urological surgeon at the Lister Hospital in Stevenage, Hertfordshire commented on the problem and the treatment. He says:
“Pretty much all men will have some degree of prostate enlargement once they are over 50 — and around 43 per cent will experience the need to go to the loo more frequently and more urgently as a result.
By the age of 80, 40 per cent of men will have been treated for it.
The prostate is a small, ring-shaped gland that lies directly under the bladder and surrounds the urethra. It grows as men age, and can start to compress and narrow the urethra.
The urethra can be around 7mm in diameter, but if the prostate becomes enlarged, it can narrow to just a few millimetres.
The bladder then has to work harder to empty, and as a result men have difficulty passing urine.
Doctors can advise men to avoid substances that irritate the bladder, including caffeine and fizzy drinks — smoking also makes the problem worse.
We can also offer drugs to relax the tissues of the prostate, which work very well, though some men have side-effects, including feeling dizzy, under par and having a stuffy nose. Or we can prescribe hormone-based drugs to shrink the prostate, which can affect erection and libido.
At the moment, the gold standard operation is transurethral resection of the prostate, which means operating through the urethra and trimming or lasering away parts of the prostate, taking the pressure off the urethra.
This involves a general anaesthetic, up to three days recovery in hospital, and carries a small risk of bleeding as well as a five per cent risk of nerve damage, which can cause impotence and urinary incontinence.
More often (in around 80 per cent of patients), it can cause a loss of ejaculation.
I have been working with a U.S. company that developed Urolift about five years ago. This is a brilliantly simple device to move the prostate aside and keep it there, which we have just started doing on the NHS in a pilot study.
The operation takes around 25 minutes.
First, I slide a protective sheath, about 5 to 7mm in diameter, into the urethra, and put a fine telescope in to find the narrowest spot.
Then I insert a handpiece, which is basically like a plastic tube with a firing trigger, through the same sheath. I use the handpiece to push one side of the prostate away from the urethra.
To fix the prostate into its new position, I use the handpiece to fire a surgical stitch from inside the urethra and out through the prostate.
On each end of the stitch is a tiny anchor. One anchor sits on the outside of the ring-shaped prostate, the other inside it, with the stitch connecting them.
After being pulled tight, the anchors squeeze the prostate and pull it away from the urethra.
I put a second stitch with two anchors further down in the prostate to ensure the urethra remains clear.
Then I use the handpiece to push the prostate away on the other side, and do the same thing, fixing four more anchors there.
If the prostate goes on growing, we can repeat the operation — ten per cent of patients need further treatment.
Our patients’ experiences have been encouraging.
Urolift is still at the pilot stage and is being done only at the Lister Hospital, but the plan is to extend it to six more NHS centres. Once past the trial stage, we expect it to be available both privately and on the NHS.”
The operation costs around £3,500 privately and the same amount to the NHS.