Death, taxes, enlarged prostates: Men can be certain about these

Death and taxes are not the only things certain in life.  Men — at least more than 90 percent of men — can also count on dealing with an enlarged prostate.

Benign prostatic hyperplasia, or BPH, affects most men, although some will not experience symptoms. New treatment methods that don’t involve a pill a day for life or invasive surgery are providing hope for those afflicted. One of those less-invasive treatments is called Prostatic Urethral Life, or Urolift, which is now available in Northern Colorado and the Boulder Valley.

A little anatomy helps to explain what happens with this disorder.

The prostate is a walnut-sized male reproductive organ that sits below the bladder. Its normal size is about 3 by 3 by 5 centimeters and about 25 grams. Its main function is to secrete a fluid that is part of semen; its muscle helps propel the semen during intercourse.

Urine from the bladder flows through the prostate. As the prostate expands as men age, it can and often does restrict the flow of urine, starting in the 40s for some men and increasing into their 60s, 70s and 80s. The Mayo Clinic lists common symptoms as:

• Frequent or urgent need to urinate.
• Increased frequency of urination at night (nocturia).
• Difficulty starting urination.
• Weak urine stream or a stream that stops and starts.
• Dribbling at the end of urination.
• Inability to completely empty the bladder.
• Cancer of the prostate or bladder.

The disorder can also cause bladder infections, damage to the bladder when it tries and fails to force urine into the urethra, and kidney damage.

Common remedies include treatment with drugs such as Flomax, which would need to be continued throughout life; transurethral resection of the prostate, or TURP, in which a doctor scoops out tissue that is blocking urine flow; or the relatively new Urolift system in which tiny clips are carried into the prostate through the urethra and implanted in a way that spreads the urine pathway wider.

The Urolift procedure is growing in popularity, according to Dr. Timothy Soper, a urologist with UCHealth in Fort Collins.

“It is something that has gradually been disseminated into clinical practice, and it has caught on like wildfire,” Soper said. The urologist has used the procedure for about 18 months and in that time has performed more than 90.

“Recovery is much quicker, it’s much less invasive, and in 99 percent of patients it preserves ejaculation,” he said. The other procedures can result in retrograde ejaculation, which means the semen goes into the bladder instead of out through the urethra.

He said the results of Urolift are reported to be about 85 percent success without deterioration over a seven-year period. That is borne out in his patients, too, with about 85 percent reporting improved symptoms.

“It’s a kinder, gentler approach and it seems to be a more-durable therapy,” Soper said. At age 55, he recognizes that he might also be a candidate for it in the future. “I want to teach one of my partners so they can do me at some point,” he said.

Dr. John Kefer, who practices with Colorado Urology in Lafayette, said his experience with the Urolift has been similar; he’s performed about 200.

“It benefits men who want to stop taking medication every day and don’t want to go into the operating room. Recovery time is within a couple of weeks, and the real benefits continue to present themselves for weeks after,” Kefer said.

He said “the bladder is unhappy” in men who have suffered with an enlarged prostate for long periods. The bladder wall gets thicker as it works to expel urine.

“I tell patients that the bladder becomes like a weight lifter when what you want is a bladder like a yoga instructor — thin and lithe.”

Success of the procedure can be measured in different ways, both Kefer and Soper said, but commonly the International Prostate Symptom Score, an eight-question screening tool, is used to determine whether Urolift had results. A 10-point decline in the score at two weeks is considered a success, and then continued decline over time.

“I had a patient yesterday who went from a 33 to a six,” Kefer said.

Another doctor who performs the procedure, Dr. Charles Anderson with Colorado Urology at Louisville, said, “A boatload of patients on Flomax will experience years of pills that they don’t have to take. A five minute procedure can alleviate symptoms,” he said.

Anderson has performed it for about four years. He said in his experience patients see continual improvement over months. The bladder, for example, continues to improve for a year or longer even after the patient has recovered.

Urolift, a trademarked system offered by NeoTract Inc. of Pleasanton, California, requires physicians to be certified in the system. There are six doctors in Northern Colorado and the Boulder Valley currently certified, and they practice in Fort Collins, Lafayette, Louisville, Boulder, Westminster and Longmont.

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