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Men’s Health: The Prostate Conversation

by L.M. Jarvis

June is Men’s Health Month, no better time to talk about the P word. Go ahead, grab a cup of coffee. You might want to wake up first.

We’re talking about the prostate. It’s a must-have conversation, especially for men of, ahem, a certain age who are experiencing predictable symptoms when they urinate.

But we’re getting ahead of ourselves here. First, an anatomy lesson: The prostate is part of the male reproductive system and is about the size of a walnut. It surrounds the urethra, which empties urine from the bladder.

For about half of men, the prostate becomes a problem between the ages of 51 and 60, according to a study in the Journal of Urology. They are urinating at night more frequently; the urine stream becomes weaker or starts and stops. They may feel sudden urges to go to the bathroom, are unable to completely empty the bladder or be unable to hold in the urine.

That is happening because the muscle of the prostate begins to turn into scar tissue. As the amount of scar tissue increases, it’s more scar than functional muscle. Over time, if left unchecked, patients will be forced to use a catheter permanently.

All signs of trouble with a capital P. But good news, South Jersey—technology has developed to make an uncomfortable procedure a bit less stressful.

Twelve million men a year see a urologist seeking treatment for an enlarged prostate, according to urologist Dr. Thomas Mueller of Inspira Medical Center Vineland.

There are several surgical options available for those dealing with a troubled prostate. Urologists most often choose what is considered the “gold standard” treatment, known as TURP. According to Dr. Mueller, TURP (which stands for transurethral resection of the prostate) “works well,” but “efficacy isn’t the only thing to consider when it comes to [medical] interventions.”

In fact, TURP is starting to fall out of favor with some urologists. Most guys worry about post-surgical side effects, which can get ugly. Yes, the procedure will make it so patients can urinate again. But—brace yourself, gentlemen—some guys may also notice such side effects as erectile dysfunction, urinary incontinence, and ejaculatory malfunction.

Think of TURP, Dr. Mueller said, as a sort of “roto-rooter” of the prostate. Once ‘roto-rooter’ has done its work, about five percent of men will be left with erectile dysfunction. That’s not a high number to most people, but it is for urologists. And it’s certainly enough to make most guys wince at the possibility.

TURP’s worst side effect is urinary incontinence, Mueller said. “It’s by far the most detrimental. From a [psychological] standpoint, it’s the worst,” he said. TURP patients have a three percent chance of being permanently incontinent, he said. “That’s a very, very high number in my business.” The rate of ejaculatory dysfunction is recorded at between 60 to 80 percent after a TURP procedure, he said.

Another reason that TURP is starting to fall out of favor—in addition to the three dreaded side effects—is it takes much longer to improve post-surgically. Patients may have to go to the bathroom more frequently, with more urgency, experience blood in their urine, or even feel a burning sensation. It may take two to four months for those side effects to fade, while aquablation shortens that time to two to four weeks.

Inspira Vineland has added the new option, aquablation, which Dr. Mueller thinks will one day be considered the new gold standard. It’s growing in popularity. As of now, Vineland is the only location in the state where it can be performed, Mueller said.

Aquablation is a robotic procedure that uses a heat-free waterjet to remove prostate tissue. It also allows the surgeon the ability to see the entire prostate in real time because it uses ultrasound and a type of camera, a cystoscope.

It also greatly minimizes the chance of side effects from the surgery. In the five years that aquablation has been performed, the chance a man will have urinary incontinence shrinks to less than 0.5 percent. While ejaculatory malfunction may happen to 60 to 80 percent of men following the TURP procedure, that percentage shrinks to 15 percent with aquablation. “It’s not zero, said Dr. Mueller, but it’s significantly improved.”

As for the chance of erectile dysfunction after aquablation, that side effect is near zero. Aquablation still requires hospitalization as well as a general anesthetic for the patient. Mueller, who has been performing the procedure for four years, said more and more of the aquablation machines are selling around the country.

“New technologies take forever to develop,” he said. “Even though it’s been out for five years, it doesn’t translate to the public as to why. Doctors and patients are extremely skeptical.”

Dr. Mueller said men, as they are beginning to feel the effects of an enlarged prostate, will find themselves making more frequent trips to the bathroom and noticing a weaker stream. Most of them will want to put off that trip to the doctor and will delay treatment. Do that, he warned, and you may make things much worse for yourself. It can lead you down a path to permanent bladder damage.

“That’s the big problem,” said Dr. Mueller, who added that most urologists didn’t help the situation.

In the 1990s, most doctors relied on medication. Today, Mueller said, “that paradigm is shifting.” Rely on medication for too long and “you are going to miss the opportunity to make yourself better.”

Most doctors may have just prescribed medication or told the patient to return when the problem worsened. Those days are largely gone.