New Treatments Offer Relief for Prostate Enlargement. That’s Good News for Roughly Half the Population.

Virtually all men, if they live long enough, will develop an enlarged prostate. On its own, the condition isn’t a portent of larger health problems; it doesn’t raise your risk for prostate cancer, for example. But it can cause some uncomfortable symptoms, including sudden and frequent urges to urinate, especially at night, when it can disrupt your sleep. And as urinary issues become chronic, they can cause lasting damage to the bladder and kidneys.

Prostate enlargement, or benign prostatic hyperplasia, can happen as early as age 40, but it becomes more common with age. About half of all men between ages 51 and 60, and up to 90 percent of men older than 80, are affected, according to the National Institutes of Health. About 14 million Americans have urinary tract symptoms related to an enlarged prostate.

Emergency medicine physician William Edwards is one. Now 71, his symptoms had been getting progressively worse for years, interfering with his life and his work. He was getting up as many as five times a night to urinate, and had to run to the bathroom frequently during the day.  

“When I needed to go, I needed to go right then,” he says. “I told my colleagues, ‘Don’t stand between an old man and the bathroom.’ They didn’t really understand, because they’re younger, but it was serious.”

Medication wasn’t helping much, and Dr. Edwards didn’t like the side effects, including orthostatic hypotension, which made him dizzy every time he stood up. “I’m a pretty active guy, so that wasn’t really working for me,” he says.

Then he heard about a Memorial Hermann urologist, Dr. Olubayo Tojuola, who was performing a relatively new procedure called a prostatic urethral lift, which doesn’t cause the unwanted side effects that drugs and older surgical procedures do.

“With the urethral lift, we put a camera into the middle of the prostate and we essentially staple your prostate open. Implants are placed to create an open channel,” Dr. Tojuola says. “It’s a minimally invasive procedure that takes about five to 10 minutes. Over 95% of patients go home without a catheter, and they see symptom relief almost right away.”

The prostatic urethral lift has been an option since it was approved by the U.S. Food and Drug Administration nearly a decade ago, but it became more widespread after it was recommended by the American Urological Association in 2018. Another minimally invasive procedure, approved in 2015, uses targeted steam to shrink the prostate. And a few more procedures are in testing stages now. Advances like these represent a new frontier in treating a condition that will ultimately affect roughly half the population — but hasn’t always been top of mind for men or their doctors, Dr. Tojuola says.

“Since your prostate continues to grow throughout your life, at some point all men will develop urinary symptoms, and those symptoms will get worse the longer you live,” he says. “But this has been an undertreated population, partly because, one, men don’t go to the doctor; two, if they do go, they don’t always talk about these symptoms because they’re embarrassed; or three, they might talk to their primary care doctor, who’s not a urologist and doesn’t know about all the treatment options, so they end up on meds.”

Even when medications do alleviate the symptoms, they are a Band-Aid at best, Dr. Tojuola explains. “You’re still voiding through an obstructed urethra, and the longer you do that, the more damage is done to the bladder. You can end up with bladder failure, and we can’t fix that. So urologists are a little more aggressive with treatment now than we used to be.”

Dr. Edwards was aware of the risks. A friend of his waited too long to treat an enlarged prostate, and the damage to his bladder can’t be undone. “His bladder function has deteriorated to the point where he has to self-catheterize four times a day,” he says.

His own urinary issues had become a near-constant irritation. An active outdoorsman who regularly goes hiking, biking, surfing, sailing and skiing, he found ways to adapt his activities to include more and more bathroom breaks over time. “I’ve made accommodations, little by little,” he says. “I didn’t like it very much. And I think if I’d waited longer, I’d have not just limitations, but I’d have accidents.”

The ER doctor did careful research about the ins and outs of the urethral lift, and when Dr. Tojuola performed the procedure in June, Dr. Edwards was confident he’d made the right choice. He was home the same day; his symptoms were gone the next. He worked a nine-hour ER shift the following day.

“I was overjoyed, to say the very least. It was life-changing,” he says. “I almost couldn’t keep myself from texting Dr. Tojuola and telling him how successful it was. Instead, I sang his praises to other people. I know a lot of other old men like me who need this procedure, and I’ve already referred several of them to him.”

The effects of the urethral lift have been demonstrated to last at least five years. It could be longer, since the procedure has only been studied for about that long, Dr. Tojuola explains.

“What I tell patients is: If I can buy you five years where your bladder isn’t taking on more damage and you’re not having symptoms, that’s great,” he says.

Dr. Edwards agrees. He’s grateful to finally have relief, and to be able to keep his bladder and kidneys in good condition.

“I especially didn’t want to take the chance on having to wear a catheter for a long time — or forever,” he says. “That’s why I would tell anyone with symptoms not to wait too long. This is an easy procedure with the least amount of side effects of any prostate treatment out there. Your threshold for getting it done should probably be lower than it is. I was at the point where I knew I had to do something, and this was the perfect solution.”

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Ali Vise