Amy Krambeck, MD, Professor of Urology, talks about a ‘one and done’ treatment for benign prostatic hyperplasia.
What is BPH?
DR KRAMBECK: BPH stands for benign prostatic hyperplasia and is a natural enlargement of the prostate that occurs with age. So as men age, their prostate slowly grows. In some men this causes no issues whatsoever. But in other men it can make it difficult to urinate, resulting in a situation where people are unable to urinate. This can damage your kidney or require that a catheter be placed.
What’s the likelihood of a man getting this?
DR KRAMBECK: BPH is exceptionally common. Fifty percent of men in their 50’s will have symptoms of BPH as well as 80 percent of men in their 80’s. Every year more and more men are affected. What’s more interesting is that men tend to not talk about it. So, they’re unaware that the people around them are also having symptoms and experiencing difficulties urinating.
Are there any other things, besides kidney damage, that could happen if left untreated?
DR KRAMBECK: Yes. Most BPH symptoms are nuisances. You need to go the bathroom often and you have to get up multiple times at night. You start to change your daily routine around the need to go to the bathroom. But then there’s other symptoms of BPH that are more problematic and can be damaging to your health such as blood in the urine, formation of bladder stones that can become infected and make you very sick, and obstruction so you’re unable to urinate. In those situations, the urine can back up to the kidneys and cause kidney damage. So, every year I do see maybe one or two men who are near dialysis because of their enlarged prostate.
What are some current treatments out there?
DR KRAMBECK: Because BPH is so common, there are many current treatments available. It all has quite a bit to do with the size of the prostate. Treatments applicable to smaller prostates can be performed in the office. As the prostate gets larger it becomes more difficult to treat. So, there’s only certain treatments such as HOLEP, which is what I offer, that can be used in extremely large prostates or small prostates.
How’s that different than other treatments?
DR KRAMBECK: Gary had a procedure called holmium laser enucleation of the prostate where we use a holmium laser to cut and core out the inside of the prostate. The MOSES technology is an upgrade of the holmium laser. By changing the morphology of the bubble, because the laser creates a water bubble, and how that bubble interacts with the tissue, we’ve significantly improved the surgery so that there’s much less bleeding and very little pain associated with it. Oftentimes, patients can go home the same day without a catheter in place. So, huge improvements in the short-term side effects as well as long-term benefits by just changing the bubble.
What are the side effects, and are there disadvantages of using this procedure?
DR KRAMBECK: Some of the benefits of surgery are patients will immediately urinate better. This surgery should last the patient’s lifetime. Even though the prostate grows every year of your life, about 2 percent per year, it should not grow enough to cause blockage again after the HOLEP surgery. The one possible disadvantage to the procedure is that you will notice blood in the urine for about a week. It all depends on their activity and the medications they’re taking. You may have some burning with urination that usually lasts a week, some people a little bit longer, but it will go away. About 30 percent of men may experience intermittent leakage of urine where they may have to wear pads or protective garments until their pelvic floor heals and their body becomes accustomed to the new situation. The likelihood of it being permanent is one percent. So, all of those are short-term disadvantages. There is one long-term disadvantage which is retrograde ejaculation. Men will still have their erections. Whatever they had before surgery will be unchanged by the procedure. They’ll still climax and orgasm, but they’re not going to see their semen. This is a byproduct of most procedures that open up the prostate channel. It’s because there’s not enough pressure in the urethra to push the semen out of the penis. So, they’re still going through all the motions, they just don’t see it.
Is this a permanent fix? Are there any patients that need new treatments or different treatments?
DR KRAMBECK: One difficulty in treating BPH is that the prostate continues to grow. So many treatments currently available on the market have a high retreatment rate. So, they get the initial treatment, but then in a few years the patient is going to require another surgery as the prostate grows. One of the huge advantages of HOLEP and HOLEP with the MOSES technology is that you should not need another surgery ever again and that’s because we are coring out so much prostate tissue that we’re getting down to the capsule of the prostate, or the rind, or the outer shell, and there’s very little tissue left to grow again. Men have been studied out to 18 years after their procedure and the retreatment rate was 1.4 percent. I tell most of my patients that this should be the last surgery you will need on your prostate.
After surgery, how long does it take for patients to get back to how they were before?
DR KRAMBECK: Immediately after surgery people will notice that their stream is great and they’re able to urinate. They have a good flow, but it takes time to get back to the new normal. It’s usually a week of no strenuous activity. In the second week, you can do about half your normal activity and start easing back into exercising. If you notice bleeding, you must back off. I usually say most patients are fully at baseline and where they’re going to be by three months after surgery. Some people it’s just a couple of weeks, but the vast majority are there at that point at three months.
Going back to BPH, how does that impact men’s daily activities? How does it impact how they live their lives?
DR KRAMBECK: BPH is a slowly occurring condition, so a lot of men do not realize how much they’ve changed their life to accommodate it because it starts in their late 40’s to early 50’s and slowly progresses over time. They change their habits to accommodate this. Many men will stop doing long trips or they are even hesitant to leave the house. They’ll put a urinal in their vehicle or will think it is normal to get up four to five times a night to try and urinate. Some men will have accidents and start to wear pads or protective garments to control accidents. It oftentimes takes something very serious, like what happened with Gary, to get men to seek treatment. And I think the take home is if you’re starting to have these symptoms, seek treatment earlier because this is correctable and with minimal downtime.
How do you believe the MOSES laser has impacted quality of life?
DR KRAMBECK: I’m a big believer in the MOSES technology because of how it has changed my practice. Before having this technology, the procedure was a big deal. You spent at least one night in the hospital. There was a risk of blood transfusion, so you might have to spend two nights in the hospital. You would have a catheter in your bladder, so it was a bigger investment in their time and a bigger risk. Now that we have the newer technology, it has made the procedure safer, and the downtime is less. Patients can often go home the same day which has been great during the COVID pandemic when hospital beds are in shortage. We don’t want people to stay in the hospital because we need those beds to treat COVID patients. I’m able to treat men with their symptomatic BPH and send them home the same day.
I think you’re probably the only woman I’ve interviewed in this field. Have you found other women in this field as well?
DR KRAMBECK: There’s more and more urologists every year that are women. When I started, it was a very small percentage of women. We think about urology as men’s health, but there’s a lot of other aspects to urology. I trained as a stone surgeon. And stone disease affects women as well as men. There’s female incontinence which also is a urological issue that affects only women. So, there’s quite a few female urologists as well as pediatric urologists. I think women are becoming more and more predominant in urology.
For the HOLEP procedure with the MOSES laser, are there any patients that this would be ideal for?
DR KRAMBECK: The great thing about HOLEP is that it’s size independent. So, no prostate is too small, and no prostate is too big for this treatment. Any man who has symptoms secondary to an enlarged prostate is a good candidate for HOLEP. I think that is a unique property of this surgery. So, you want to find a surgeon that does quite a few HOLEP’s when you’re looking for a HOLEP surgeon.
Is there anything else you feel people should know?
DR KRAMBECK: If you’re suffering from BPH symptoms, don’t wait until it becomes a crisis. You would be surprised at the number of people already who are also dealing with symptoms of BPH. It is correctable with minimal changes to your overall health and has huge benefits. You can get your life back and get to a point where you aren’t thinking about urination all the time. It becomes something that you just do and don’t think about. The most important thing is to seek treatment, whether it be a HOLEP or any other treatment, but see your doctor about it.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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