British doctor says he would have TURP.

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Question from a reader in today's Daily Mail Health section.

  For a long time I’ve suffered from an enlarged prostate, but I cope quite well so I’ve managed to avoid surgery. Nevertheless, when I heard about UroLift I thought I’d finally found the answer. Now I’ve read about yet another procedure, PAE (prostate artery embolisation). If you were in my shoes, which procedure would you choose?

Answer: After four decades in medical practice I have learned to be cautious of any new drug or treatment, medical or surgical, especially before making recommendations, because experience tells me that new quite often isn’t better and can sometimes end up being worse.  An enlarged prostate, known medically as benign prostatic hyperplasia, is increasingly common in men with age.  Over the years, male hormones cause the gland — which sits around the urethra and underneath the bladder — to become slowly enlarged. This can obstruct the urethra, leading to a poor stream, hesitancy (an intermittent stream), urgency (needing to go in a hurry) and nocturia (going more than once at night).  Medications can be very effective — alpha-blockers work by relaxing the muscle of the prostate tissue, while alpha-reductase inhibitors block the effects of male hormones — but a significant number of men do still require surgery. 

Since the Eighties, the most popular option has been transurethral resection of the prostate (TURP), a keyhole procedure where a wire, guided by a camera, is inserted into the urethra then heated to burn away some of the enlarged gland. TURP remains the gold standard because it’s the only procedure that long-term studies have shown is safe and effective.  However, some men fear TURP as it involves a general anaesthetic and two or three days in hospital. Some are also anxious about the potential risks, as TURP can damage a sphincter (or valve) at the entrance of the bladder, causing retrograde ejaculation — where semen is sent backwards into the bladder. Erectile function is not harmed, but patients are no longer fertile.  The UroLift System is a new option that can be done under local anaesthetic. Two to four pairs of what are effectively treasury tags are used to pull back the enlarged tissue, improving flow.  The procedure seems to be effective, but no more so than TURP, and there are questions about how long the effects might last as we don’t yet have enough long-term studies to know. 

Also the treasury tags are, in part, metallic, which may distort the signal in MRI imaging should that be needed in the future, for example to diagnose prostate cancer. 

PAE is another new procedure (first used in the UK in 2012) that must be regarded as experimental until we see the results of large studies — and the National Institute for Health and Care Excellence approves it. Here, the prostate is shrunk by using microscopic particles to block the blood vessels supplying it. It’s done by feeding a catheter up through the main artery in the groin under local anaesthetic.  

I think you will guess the option I’d prefer if I were in your shoes.

 

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  • Posted

    Interview him again after he has had it done. cheesygrin
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    • Posted

      I agree ask him how it went afterwards.

      I have had a PAE which cannot have worked as I have had 2 or 3 episodes of Acure rentention since.

      However I now carry catheters around with me and the last 3 times I have had AUR I have self catheterised and this has been a god send. I only get AUR when Im out on the p**s so it is all self-inflicted.

      However I would never, ever submit myself for a TURP despite the local hospital saying I need it!

      Just not prepared to take any risk of the potential downside.

      I am now trying out Finasteride to see if i can tolerate it, so far so good.

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    • Posted

      I hope that you are aware of this:

      Avoid sex without a condom if your partner is pregnant or of child-bearing age. Crushed tablets should not be handled by women who are pregnant or planning to become pregnant. Consult your doctor or pharmacist for more details.

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    • Posted

      The good doctor would have told you not to have PAE. He is a good doctor with an extensive private practice although he may from some comments have recently retired. He is also the medical script advisor to a medical TV series..
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    • Posted

      Derek

      I appreciate your warning re Finasteride however having a TURP will guarantee us never being able to have any more children in the conventional way at least!

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    • Posted

      According to most figures about 80%. At the age people have prostate surgery they usually have completed their families. 
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    • Posted

      RE does more than impact your ability to procreate. It also has a significant effect on the sex esperience
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    • Posted

      Don't shoot the messenger, I'm showing what a doctor would choose for himself.

      Perhaps the choice is between getting up six times a night as opposed to getting it up twice a night:-)

       

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  • Posted

    What is this?

    ​Some sort of advert for Turp.

    ​Who is this doctor supposedly advising?

    ​Does this doctor value his sexual function.

    ​Please explain

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    • Posted

      No its not an advert for TURP. If you read it, he is answering a readers question and covers all sorts of medical questions each week.  
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  • Posted

    Again, why would anyone do TURP as anything but a last resort? There are very few surgeries that have "been around since the 80s" that they still do. Dangerous, long recovery, guaranteed RE and a risk of devastating side effects for results that are typically functionally comparable to the other procedures he disparages. A quack IMO.

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    • Posted

      I'm not arguing I'm just quoting the article. I ran a mile from TURP in 1995 and waited for a good laser procedure to come along but from the figures TURP is still the most used procedure. 

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    • Posted

      Your preaching to the converted but you cannot deny that it is still the most widely used procedure like it or not.You may have had a choice but many do not.
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