Articles

Category: Prostate Treatment

Comparison between TRUS and TP: The patient perspective

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Authors: S.Mustafa, W.Elabroni, A.McAdam,S. Elamin A.Thwaini

Urology Department, Belfast Health and Social Care Trust. United Kingdom

Accepted at the ANNUAL MEETING OF THE IRISH SOCIETY of UROLOGY (ISU)
Friday 23 and Saturday 24 September 2022

Introduction

Prostate cancer is the most common cancer in men with around 47,500 men in the UK diagnosed every year. Diagnostic approaches have evolved throughout the years, with a shift from transrectal (TRUS) biopsies to transperineal (TP) for various reasons. This study focuses on the patient experience of these procedures.

Method

We evaluated men who underwent prostatic biopsies between January 2019 and April 2020. 110 underwent local TP biopsy with a previous history of local TRUS biopsy. We used a modified validated patient-related outcome measure for our questionnaire for our cohort.

Results

The response rate was 78% (N=86). Overall, the majority of respondents (77%) prefer TP over TRUS biopsy. A large proportion, 86%, found TP to be a “minor- moderate procedure” with only 14% viewing it as a “major but tolerable under local anesthetic”. In terms of pain with TP biopsy, 22% of the respondents found the procedure to be completely painless, 43% experienced a little amount of pain, 29% found it to be somewhat painful, and 6% experienced a lot of pain during the procedure. 50% would not have a problem with undergoing a further TP biopsy in the future. Only 9% felt that it would be a major problem for them to undergo further procedures.

Conclusion

Our study demonstrates, that Transperineal Prostate biopsy appears to be preferable with patients having undergone both procedures; with the majority experiencing little or no pain with TP biopsies and a large proportion describing it as a “minor- moderate procedure” that they would not mind undergoing again if needed.

Day Case Prostate Operation- “the Weight is Lifted!”

Posted on by Dr. Ali Thwaini

Enlarged Prostate Treatment

Prostatic enlargement is one of the most common problems encountered in men. Around 50% of men in their 50s will have a prostate Enlargement. Half of those require medical treatment. If medicine fails then surgery is the solution.

However, men would be keen to avoid the most common side effects of prostate surgery. These are Mainly dry orgasm and urinary incontinence. Of course, men would be very keen to go back to their normal activities as soon as possible.

What are the side effects of prostate surgery?

There are several types of surgery for prostate enlargement. All have side effects including hospital stay and urinary catheterization, and the above-mentioned side effects.

What Is UroLift?

A few years back a new method has emerged. The concept of which included simply pinning the prostate lobes to the side, hence, opening the occlusion created by the prostate Enlargement. This is called prostatic urethral lift, or UroLift.

Source

What are the Benefits of UroLift?

The whole process would take up to 15 minutes. The patient is hardly in need of a urinary catheter afterward. Most would go home on the same day. They would return to their daily activities almost immediately.

However, When first introduced, the UroLift Procedure was largely rejected, because of a lack of knowledge for the long-term effects.

Since then, several trials were carried out and the results were outstanding. The procedure proved its efficacy, safety, and tolerability.

Patient satisfaction was phenomenal. The objective results of the operation including the IPSS score and the flow rate were significant.

UroLift procedure has proven to be even safer for men who are high-risk surgical candidates.

This procedure is simply revolutionary. Intermediate-term results are very encouraging. Long-term effects are still awaited

For Enlarged Prostate Treatment and more information, book an Appointment with Dr. Ali Thwaini on +971 50 435 4853. 

Chronic Prostatitis

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Background

Chronic prostatitis is a condition with a persistent inflammation of the prostate gland. This is rather a very common condition affecting man that’s all ages. It is presumed that at least one of two men will have at least one attack prostatitis during their lifetime.

Types of prostatitis

There are several types of chronic prostatitis ranging between those caused by a bacterial invasion and the more coming others being caused by chronic inflammatory process of unknown origin. This is traditionally called chronic abacterial prostatitis. Other forms of put the tightest could give the same symptoms without an inflammatory reaction and they are typically called prostatodynia or type III prostatitis. The last form is being only histologically diagnosed without any symptoms.

Chronic prostatitis Symptoms

There’s a reason behind naming chronic prostatitis as chronic pelvic pain syndrome. This is usually due to the vague presentation and different manifestations in different men. This could be ranging in the form of penile tip pain or scrotal discomfort. Others could present with chronic low back pain and pain during ejaculation. This could be well associated with storage lower urinary tract symptoms.

Chronic prostatitis Management

Thankfully this condition is not sinister however due to its vague symptoms and chronicity, curing it remains a challenge

The management starts from lifestyle modifications and adopting a healthy lifestyle, including sexual health, and avoiding irritating food and extreme temperature changes.

The medical management and has a wide spectrum of treatment options including empirical antibiotic courses, according to the European Association of Urology guidelines. These were historically from the family of quinolones. However, that has now changed into Fosfomycin. In addition, there are other medical treatments, which are mainly for symptom symptom control those are in the form of alpha-blockers and nonsteroidal anti-inflammatory agents in addition to amitriptyline small doses.

For resistant cases, peri-prosthetic injection of local anesthetic and / or steroids can be tried with promising intermediate term outcomes.

Other interventional procedures the experimental have some limited success mail in the form of shockwave therapy and microwave therapy.

Prostate symptoms (bladder outlet obstruction)

Posted on by Dr. Ali Thwaini

The prostate gland lies just beneath the bladder and is normally about the size of a chestnut. The urethra (water pipe) runs through the middle of the prostate. The main function of the prostate is during your reproductive life. It produces fluid containing chemicals which nourish sperms to help with fertilisation.

If you have difficulty starting or stopping your urine flow, a weak stream, a feeling that you do not empty your bladder completely, increased frequency and urgency of urine passage by day or night and a tendency to dribble after you have finished, you should contact your GP for further advice.

Facts about prostate symptoms

  • By the age of 65 years, 50% of men will experience benign enlargement of the prostate. At the age of 90, 90% of men have prostatic enlargement;
  • An enlarged prostate alone does not always cause symptoms;
  • The severity of the symptoms is not related to the size of the prostate;
  • 1 in 3 men will suffer prostatic symptoms during their life;
  • 1 in 10 men will require surgical treatment for their symptoms;
  • Not all urinary symptoms in men are due to an enlarged prostate – incontinence, pain or blood in the urine may be due to other conditions;
  • The risk of prostate cancer is not increased by having benign enlargement of the prostate. You are no more likely to develop prostate cancer than a man without benign prostatic enlargement;
  • 30-40% of men with prostatic symptoms do not experience worsening of their condition with time and may not require any treatment;
  • If treatment is indicated, this usually involves with drugs which relax the muscle in and around the prostate and/or drugs which shrink the glandular component of the prostate;
  • If symptoms are severe, if there is no response to medical treatment or if there are complications of prostatic enlargement, surgical treatment may be indicated; and
  • The risk of acute, painful retention of urine is small (approximately 1 in 100) and it is not always preceded by prostatic symptoms. Acute retention usually requires surgical treatment.

What could have caused my prostate to enlarge?

In general terms, we know very little about why the prostate gland enlarges with increasing age but hormone imbalance within the gland itself probably plays a part as well as certain genetic factors

There is some evidence that hormones and certain growth factors may work together to cause the prostate gland to enlarge. There also seems to be an inherited tendency in approximately 10% of men (1 in 10).

Medical treatment:

General measures (“watchful waiting”)

If you and your GP decide treatment is not necessary initially, some simple, self-help measures can improve your quality of life:

  • limit your fluid intake when you know you will be out of the house;
  • try emptying your bladder twice each time by returning to the toilet after a few minutes for another attempt at emptying;
  • reduce your caffeine, alcohol & nicotine intake which all cause you to make more urine;
  • if you suffer from urgency, try distraction techniques (e.g. by using breathing exercises or counting) to take your mind off the urge to pass urine;
  • if your stream is slow to start, try relaxation measures when standing to pass urine; and
  • try “holding on” as long as possible to improve your bladder capacity.
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Drugs

Alpha-blockers (e.g. tamsulosin, terazosin, alfuzosin, doxazosin) will normally be the first type of drug your GP prescribes. They relax the muscles in and around the prostate/bladder neck area to make the passage of urine easier. They may cause low blood pressure, a stuffy nose, skin rashes and impaired ejaculation.  They should not be taken if you are due to undergo cataract surgery because they cause floppiness of the iris; this can result in complications after cataract surgery.

5-alpha-reductase inhibitors (e.g. finasteride, dutasteride) shrink large prostate glands (>40 grams) and may be used together with alpha-blockers if your PSA is more than 1.5 (an indication that your prostate is significantly enlarged). They can cause ejaculatory problems. They take at least 6 months to have maximum effect and do not work well if your prostate is small. They also reduce your PSA level by up to 50%.

With larger prostates, a combination of both types of drug has been shown to be better than either type used alone, to reduce the risk of complications (especially retention) and the need for surgery.

Herbal Remedies

Some herbal & plant extracts (e.g. saw palmetto, pictured right) are effective in relieving symptoms without the risk of side-effects. They probably work because the extracts contain plant hormones which alter the abnormal hormone balance within the prostate. These extracts are not usually available on prescription from your GP.

Surgery

Surgical treatment is usually recommended if symptoms are severe, medical treatment has failed or if there are complications (e.g. a large residual urine,. retention of urine, infection, bladder stones).

Conventional telescopic surgery (TURP) involves resecting the central part of the prostate using a telescope passed into the bladder through the penis (transurethral resection or TURP). There are risks to this procedure so other techniques, such as electrical vaporisation and laser surgery, have been developed which also give good results with less risk.

Less invasive alternatives to surgery

More recently, the UroLift® procedure has proved promising; this is performed by inserting two to four “tags” through the prostate to pull the obstructing prostate lobes away from the urethra. The advantage of this procedure is that it has little or no adverse effects on your sexual function (ejaculation & erection) but it is not suitable for everyone.

details:

The Urolift procedure involves passing implants into your prostate, using a telescope passed into your bladder. The implants (pictured) are placed between the inner and outer surfaces of the prostate, so that they pull the obstructing prostate lobes away from your urethra. They become incorporated into the prostate tissue within three months, so they cannot be seen in your bladder after that.

The main benefits of this procedure, compared with other surgical treatments for prostate enlargement, are:

  • a short stay in hospital;
  • a minimally-invasive (minor) procedure; and
  • no sexual side-effects such as retrograde (dry) ejaculation or erectile dysfunction (impotence).

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