While many older men suffer from symptoms due to enlarged prostate, or benign prostatic hyperplasia (BPH), as it is known in medical terms, they often simply keep quiet and continue living with the uncomfortable symptoms associated with this condition.
“During Men’s Health Month in June we are likely to hear a great deal about male medical conditions such as prostate cancer, but few South Africans are aware of BPH although it is common among men,” points out urologist Dr Steven Cornish, who is part of a team offering a new treatment for BPH called prostate artery embolisation treatment at Netcare Sunninghill Hospital in Johannesburg.
“In addition, many of the men who suffer debilitating symptoms from BPH are not aware that highly effective new treatment options for this condition have become available in South Africa.”
Warrants greater attention
“The focus on medical conditions such as prostate cancer is perhaps understandable given the fact that, unlike prostate cancer, BPH is rarely life threatening,” notes Dr Cornish. “Nevertheless, it is the most common non-cancerous prostate medical condition to develop in men by the time they reach their 60s, and it has been estimated that half of all men older than 60 years of age are likely to have at least some BPH symptoms.
“Thousands upon thousands of older men’s quality of life is negatively impacted, sometimes quite severely, by this condition and as such, it warrants much greater attention than it currently receives,” observes Dr Cornish.
Dr Cornish says that symptoms of BPH may include trouble urinating, and/or a frequent and urgent need to urinate, particularly at night (nocturia); interrupted and weak urinary stream; urine leakage and sometimes sexual dysfunction.
Robert Pieters*, a 66-year-old man from Johannesburg, describes what it’s like living with BPH: ”I first noticed symptoms early in 2012 and these steadily worsened over time. I was initially prescribed alpha-blocker medicine by my doctor, which helped for a while. Eventually, however, I was again getting up to go to the toilet seven or eight times a night, and at times I couldn’t empty my bladder properly.
“I eventually reached the point of despair; as you may imagine my sleep patterns were severely disrupted and I was becoming a really grumpy and irritable old man,” he recalls.
The prostate gland surrounds the urethra, the tube that conveys urine from the bladder so that it can be expelled from the body. As part of the natural ageing process, the prostate however often enlarges, sometimes to the extent that it presses on and partly blocks the urethra, causing problems with urinating.
Dr Cornish says that while BPH is not commonly a life-threatening condition, if left untreated it can be an important risk factor for urinary tract infections as well as kidney and bladder stones. In some cases, a severely enlarged prostate can even completely block off urine flow, causing acute urinary retention. This would be considered a medical emergency and, if not treated, could potentially result in kidney damage. Such a case would usually require a urinary catheter to be inserted in order to allow the urine to be passed.
More treatment options available
“Men who are suffering severe symptoms as a result of BPH should be aware that more and more treatment options, including medication, surgery and prostate artery embolisation — a newly introduced minimally invasive procedure undertaken through a small puncture wound in the skin — are available to treat the condition. “Men in this country do not need to suffer this condition in silence any longer,” he emphasises.
According to interventional radiologist, Dr Andrew Lawson, prostate artery embolisation (PAE) has shown excellent results since early 2016, when the dedicated PAE centre at Netcare Sunninghill Hospital was established.
“While we have yet to observe long-term clinical outcomes of this relatively new procedure, excellent five-year outcomes are being achieved around the world,” he adds.
“Certainly, all of the PAE procedures that we have completed at Netcare Sunninghill Hospital centre have been successful and have resulted in a meaningful reduction in patient symptoms and improved quality of life. PAE is an important new treatment option for men who suffer severely enlarged prostate not only internationally but now also in South Africa.”
Pieters, who underwent the procedure at the PAE centre in January this year says: “I had the operation as an outpatient; it was pretty painless and I was able to go home the same day. The doctors explained to me that PAE involves administering a substance that works to shrink the enlarged prostate.
“I must say that I am most impressed with the end result; I am no longer having problems with urination and having to get up all the time during the night. It has been life changing and I am most grateful to have been able to have the procedure.”
Dr Lawson says the PAE procedure is indicated when patients have a significantly enlarged prostate that is causing severe symptoms and discomfort but points out that not all men with this condition will necessarily need this procedure. Doctors are likely to prescribe medicine such as alpha-blockers as a first line of treatment but in some cases these tend to become less effective if the prostate enlarges further.
Dr Lawson recommends that men discuss possible options with their urologist to find a treatment approach that will best meet their needs.
Self-management of symptoms
According to Dr Cornish, the following can assist men to manage milder symptoms themselves:
- Undertake pelvic strengthening exercises as these can help strengthen bladder muscles and improve urinary control.
- Stay hydrated by drinking liquids in smaller amounts more often rather than drinking large amounts at a time.
- Urinate when you feel the urge; try to avoid holding it back.
- Exercise and follow a healthy diet while reducing alcohol and caffeine intake.
- Discuss any medication you are taking with your doctor to get advice, and try to avoid antihistamines and decongestants in particular.
Dr Lawson and Dr Farrell Spiro are the principal interventional radiologists involved in offering the PAE service at Netcare Sunninghill Hospital. They established the treatment centre in partnership with Dr Cornish and the hospital.
The centre, which is internationally accredited, organised a medical symposium in March 2017 to facilitate the introduction of PAE to South Africa. Urologists and interventional radiologists from around the country were familiarised with the procedure, which is relatively new to South Africa and not yet widely employed as a treatment option for BPH.
*The patient requested that his real name not be used.
Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare Sunninghill Hospital
Contact: Martina Nicholson, Graeme Swinney, or Meggan Saville
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