One option for treating an enlarged prostate in men involves an invasive form of surgery known to have serious side effects. A urologist in North Texas has been certified for a newer, minimally invasive form of treatment called UroLift.
Dr. Jeff Toubin with Methodist Dallas Medical Center says medication can help with symptoms of an enlarged prostate. So, too, can an invasive form of surgery that cuts away prostate tissue.
“But that procedure has side effects such as retrograde ejaculation, incontinence, a need to wear a catheter for a week or so, and possible hospitalization,” he said.
Toubin has become the first physician in Dallas-Fort Worth — and the third in Texas — to be classified as a Center of Excellence in using UroLift. Small implants are placed inside the prostate on both sides to keep it open. The procedure lasts about 10 minutes, and patients usually go home the same day.
“Think of the prostate as two curtains on a stage together,” Toubin said. “When the curtains are pulled apart, this opens up the stage. UroLift does the same thing."
What is enlarged prostate? Benign prostatic hypertrophy has different symptoms: urgency and frequency of urination, nocturia, which is getting up at nighttime to urinate, and a slow stream or burning sensation during urination. There are also sometimes problems with erectile dysfunction. A lot of men aren’t treated, though, because they do watchful waiting, or they go to their doctor and they're treated with medication.
Most commonly a patient comes into the office. They have been on medication already under their primary care doctor, and they’d like to get off the medication because the medication has side effects. It can decrease blood pressure, causing dizziness. It can cause ankle swelling, nasal stuffiness, plus the hassle of taking a pill every day. There’s also a big factor in retrograde ejaculation, where when a man has an orgasm, it causes no ejaculate to occur.
What is UroLift? It's a treatment option that’s been available for about six years. It was developed by a biomedical engineer who wanted to treat his father. The procedure is done under anesthesia and involves using a cystoscope, a tube that goes into the urethra and allows the doctor to see the prostate. Very small implants — about the size of the top part of an ink pen — are placed into the prostate. Two in each side basically pushes the prostate permanently and keeps it open. It takes about 10 minutes, and the patient goes home the same day. Effects are pretty rapid as opposed to other treatment options. Generally, they can get off the medication in two to three weeks.
Is more invasive surgery still an option? That’s why we like to do a preoperative evaluation in the office. Some patients have a very large prostate that may not make them a candidate for UroLift. Those candidates may be more apt to have a procedure where prostate tissue is cut away. But that procedure has side effects such as retrograde ejaculation, incontinence, a need to wear a catheter for a week or so and possible hospitalization.
More study is needed on UroLift: However, the data’s looking pretty good. I’ve done approximately 200 cases and the patients have done really well. Maybe one or two patients have had to do retreatment or have additional implants placed. But no major side effects noted and the patients are quite happy with the experience.
- Prostate Enlargement (NIH)
- 4 tips for coping with an enlarged prostate
- UroLift: a minimally-invasive treatment for benign prostatic hyperplasia
Interview responses have been lightly edited for clarity.