MEN'S HEALTH MATTERS:Prostate operations and inflatable penile pumps, writes THOMAS LYNCH
Q I am now 61 and have had troublesome bladder symptoms for the past 12 months. I have tried medication but it has not really helped. My doctor tells me that the prostate is obstructing the flow of urine and I should now consider a prostate operation. I have heard this operation can be done with a laser. Can you tell me more about the standard operation and the laser?
A The prostate gland (found only in men) is situated at the junction between the neck of the bladder and the water passage. The gland tends to enlarge with age and may obstruct the water passage which passes through the middle of it giving rise to a diminished flow. This obstruction may also cause some bladder irritation which may manifest itself with an increased unavoidable frequency of urination.
This situation is generally not harmful but is more of a nuisance. Prostate surgery, which is frequently very effective, is often recommended for men with troublesome bladder symptoms. Surgical intervention is generally recommended for quality of life rather than an absolute necessity for the sake of one’s health. Rarely, this obstruction may not allow the bladder to empty properly and put pressure on the kidneys and intervention is important when this situation arises.
Open operations are rarely performed and are generally reserved for very large prostates. The standard operation on the prostate is a Trans Urethral Resection of the Prostate (TURP). A telescope is passed through the water passage and the centre of the prostate gland is “cored out” to create a larger channel, thus allowing the bladder to drain more easily.
This operation has been (and continues to be) the standard operation for many years and is known to have good long-term outcomes.
Lasers have been used for more than 20 years to perform a similar operation to help relieve the obstruction. Initially the results using this technique were poor but the laser equipment has improved over the years and the outcomes have improved also.
There are two main types of laser currently being used. The green light laser is used to vaporise prostate tissue rather than to trim it away. There are no long-term studies to indicate whether this has better long-term effectiveness than the standard procedure (TURP). It is associated with a much shorter hospital stay (daycase in some cases) than the standard operation but its general complication rate (low for all these procedures) seems similar to a TURP. A second type of laser procedure (holmium laser enucleation of prostate) reproduces the type of removal of the gland which can be done either at open surgery or with a telescope. Its long-term outcome seems to be the same as a TURP. It seems to have similar complication rates and although the operation generally takes longer it is associated with a shorter hospital stay. Laser procedures might be more suitable for patients who need anticoagulant drugs such as Aspirin or Clopridogel but, otherwise, there is little to choose between them. The majority of urologists would favour a TURP as it is considered the gold standard and, like all these procedures, more than 80 per cent of patients are happy with the outcome of surgery. You should consult further with your doctor and get advice as to which procedure is the most suitable for you.
Q I have a quick question for you. You wrote recently about medications used for erectile dysfunction. Unfortunately, none of them have worked for me and my doctor has recommended an inflatable penile pump. Can you tell me what this is?
A A penile pump is a cylinder that is fitted over the penis, with a manual or motorised pump to create suction. As the apparatus creates a vacuum around the penis, blood is drawn into the penis, helping it to become engorged. Flexible compression rings are then pushed by hand onto the base of the erect penis before releasing the vacuum. This restricts blood flow, enabling the erection to be held. In the best circumstances, erections can be maintained for a considerable time, but for safety and to prevent damage rings should be removed after no more than 30 minutes.
Pumping must be done very carefully to avoid injury. It is very important to read the information leaflet provided with the device. A significant number of people using this device are very satisfied with the results.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Mr Dermot Lanigan, consultant urological surgeon, the Cork Clinic, Cork