New Options for Prostate Problems

Benign prostatic hyperplasia (BPH), the overgrowth of the prostate gland, is one of the most common medical problems for men as they age. By age 80, BPH affects 80% of the male population.

Located just below the bladder, the walnut-size prostate gland serves as a kind of traffic cop, helping to direct the flow of urine and semen in the right direction at the right time. So when the prostate grows beyond its healthy dimensions, it causes troubling symptoms such as frequent urination, particularly at night, as well as difficulty starting to urinate and being able to fully empty the bladder.

Faisal Ahmed, M.D., is a urologist who performs both conventional and minimally invasive procedures to treat BPH. Here he talks about one of the newest treatments, Aquablation, performed with AquaBeam. In 2021, Dr. Ahmed became the first physician in the South Bay to use the robotic 3D ultrasound-guided system from Procept BioRobotics.

Why is the prostate such a troublesome little gland?
The problem is that it continues to grow as we get older. It never stops. There’s no proven diet or medical prevention for it. It’s a problem gland for everyone with the Y chromosome.

What’s the typical progression of treatment for BPH?
We start with recommending that patients avoid caffeine, spicy food and too much fluid before bedtime. If those don’t work, we usually try medication, something in the alpha-blocker family, like Flomax. Then you start moving to options like traditional TURP and, more recently, Aquablation.

What is TURP?
It’s transurethral resection of the prostate. It’s a standard procedure that every urologist feels comfortable doing. But for larger glands, the long-term outcomes aren’t nearly as good as what we can accomplish with newer procedures like Aquablation.

What are some options in the newer procedures?
We break the procedures down into two categories. One category is resective, like TURP, meaning we’re removing tissue, and the other is minimally invasive surgical technologies, or MIST. Those don’t usually involve removing a lot of tissue, but just creating more space in the prostate.

There are plenty of new MIST procedures, such as the Optilume balloon. The idea behind the MIST procedures is quick surgery with quick recovery and quick return to normal life. And that’s an attractive option for men who are still working or younger and just need to feel better but they don’t want to be down for 5, 10, 15 days, whatever it may be.

So how does Aquablation work? 
It’s a high-pressure water beam that has laser focus with ultrasound guidance; you get very focused destruction of tissue down to the millimeter. It’s done under general anesthesia, because we’re using very complex, real time ultrasound guidance. It takes approximately 60 to 90 minutes, and most patients will stay overnight in the hospital, although that’s not always required. I’m doing it routinely with great success.

Aquablation is often used as the next step if another procedure fails. For example, if a patient comes back a year or two after UroLift, which is a minimally invasive procedure that uses small implants to push back prostate tissue, and says, “I’m just not feeling the results I need here,” then often we’ll move the patient to Aquablation. There’s plenty of data supporting the use of Aquablation in very, very large glands.

The risk of complications from Aquablation, including sexual problems, is much lower than with conventional surgeries, right?
The most recent published data is a 9% risk of ejaculatory dysfunction, which is lower than even with medications now. It’s probably the lowest risk profile for any procedure that involves tissue removal. Bleeding would arguably still be the highest risk of the procedure, but it’s only a 1% chance of significant bleeding. That’s the reason we keep patients overnight, just to observe and make sure that the urine color is clear before they go home.

Are any of these treatments a cure for BPH?
I don’t think anyone should be advertising anything as a cure, because it’s just not true. You hope your work will last the patient five to seven years, but the number of re-treatments and the percentage of patients back on medicines starts to rise after six, seven years. They’re very effective for that time frame. And re-treatment is very easy with all of these options.

For more information on Providence Little Company of Mary hospitals, call 844-925-0942.