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A tiny metal ring could be a radical new treatment for enlarged prostates. Inserted surgically under a local anaesthetic, the ClearRing forces enlarged prostate tissue away from the walls of the urethra — the tube that carries urine from the bladder out of the body. This reduces pressure on the walls of the urethra so that it opens up, allowing men to go to the loo — difficulty to pass urine is one of the first symptoms of an enlarged prostate. It would be a major breakthrough in the treatment of benign prostatic hyperplasia (BPH), which affects 2.5 million men in the UK.
The prostate is a walnut-shaped gland surrounding the urethra that produces components of semen. At different stages in a man’s life, it grows
— first during puberty and then from the age of 25, until, in many cases, the
prostate presses on the urethra. The first sign of the condition is usually
trouble passing urine, or difficulty starting, even when the bladder is full. Untreated,
BPH can cause kidney damage or bladder stones and can seriously affect quality
of life. Treatment often involves drugs, but they can have side-effects.
Around 50,000 men a year end up having surgery to correct the problem, however this carries a risk of impotence and urinary incontinence, as surgery targets areas packed with nerves that control these functions.
The ClearRing is thought to tackle the problem with little or no side-effects. First, under local anaesthetic, doctors insert a catheter — a thin plastic tube — through the urethra, before inserting a thin wire through this. On the end of the wire are a camera and a tiny, deflated balloon. On the outside of the balloon is the ClearRing, a partially opened C-shaped ring made from Nitinol, a soft metal that can be easily expanded. Doctors inflate the balloon once it reaches the narrowed part of the urethra. As it inflates, it increases the diameter of the urethra from a couple of millimetres to well over a centimetre. The metal ring expands by the same amount.
Then the doctor inserts a tiny, T-shaped prong along the wire which fits through the gap in the C-shaped ring. The prong is used to pierce one side of the urethra wall and penetrates a millimetre or so into the prostate tissue. One end of the
ring is then fed through the hole, until the whole ring is buried inside the
prostate, around the urethra. This holds the prostate — well away from the
urethra — and allows urine to flow easily out of the bladder.
Depending on the extent of the blockage, up to three rings can be implanted in one go and the procedure takes ten minutes. A study in the journal European Urology
Focus by scientists from Pauls Stradins Clinical University Hospital in Latvia
and Rambam Health Care Campus in Haifa, Israel, involved 29 men with BPH who
had failed to respond to drug treatments.
A year after their procedures, the severity of symptoms such as trips to
the loo was reduced by half and quality of life scores improved by more than 50
per cent, with no lasting side-effects. Syed Rahman, a consultant urologist at Spire Leeds Hospital and St James’s University Hospital, said: ‘The initial results are quite promising. It merits consideration in patients with BPH.’
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