For men over age 50, the prostate gland often becomes a source of trouble. Crucial to male fertility, this walnut-sized gland usually begins to undergo non-cancerous cell growth during middle age. An enlarged prostate, also called benign prostatic hyperplasia or BPH, is so common that most men can expect to experience it if they live to a full life expectancy. Not all men have symptoms with the condition, but many do. An enlarged prostate (not to be confused with an inflamed prostate or with prostate cancer) is not painful or problematic in and of itself. The problem is that the prostate surrounds a portion of the urethra, the tube through which urine flows from the bladder to the penis. When the gland becomes overgrown, it pushes against the urethra, cutting off the flow of urine. And when that happens, it can bring about changes to the muscles of the bladder. Men with BPH often experience difficulty starting to urinate, a stop-and-start flow, and even incontinence or its opposite, urinary retention. In order to resolve these issues many men seek out the best or latest treatments for an enlarged prostate.
Fortunately, pioneering physicians have developed several effective procedures for treating this condition. Some of them work by shrinking the prostate, some by removing part of its tissue, others by moving the troublesome portions of the gland out of the way, and some by otherwise clearing the pathway taken by urine as it traverses the part of the urethra surrounded by prostate tissue. Doctors continually seek to improve upon these methods, and in recent years, the Food and Drug Administration (FDA) has approved several new procedures. Here are a few noteworthy examples.
Rezūm. Back in 2015, the FDA gave the green light to this non-surgical procedure for shrinking the prostate using steam. A man’s penis and urethra are numbed with local anesthesia and the doctor inserts a device into the urethra through the tip of the penis. The device is equipped with a tiny needle capable of releasing radiofrequency-generated water vapor (steam) directly onto portions of the prostate. Each affected area of the prostate is subjected to a nine-second steam injection. Depending on the shape and size of the prostate, a doctor may perform up to 15 of these nine-second injections during one Rezūm procedure. The steam kills off prostate cells so that the gland shrinks and no longer encroaches on the urethra to block the flow of urine.
After Rezūm, most men see relief of their urinary symptoms for at least five years. Over that follow-up period, fewer than 5% of men end up needing an additional surgery or procedure, and only 10% need to take medications for BPH. In fact, up to 90% of men who undergo the procedure report significant symptom relief. However, lack of immediate recovery from the procedure is one of the most common Rezūm complaints. Steaming the prostate to destroy cells causes an inflammatory reaction which can cause discomfort and difficulty with urination.
Men typically must use a catheter for several days as the inflammation from the procedure recedes. Even then, they are warned that their urinary symptoms will get worse before they get better. That’s because the inflammatory response causes the prostate to swell before it shrinks, so the flow of urine can be even more severely blocked than before the procedure. This state of affairs lasts for about two weeks. Between weeks two and four, the man typically finds himself back to where he was before undergoing Rezūm. It is only at around week six that he sees true improvement. At that point, most men get off their BPH medications because they no longer have urinary symptoms.
One significant benefit: The Rezūm procedure doesn’t cause any erection problems. A very small group of men (about 1% or 2%), experience a condition called retrograde ejaculation or dry orgasm, in which, rather than the ejaculate exiting the penis, it travels backward up the urethra and into the bladder. Retrograde ejaculation is not painful or dangerous. The ejaculate simply exits the body the next time you urinate.
iTind. In April of 2020, FDA granted approval for an outpatient procedure called iTind, which reshapes the prostate to keep it from compressing the urethra. In an office setting, the physician inserts a catheter into the penis that’s fitted with a device called a cystoscope, which has a light and lens that allow the doctor to view inside the urethra. The doctor uses the cystoscope to insert a temporary implant, and the man goes home a couple of hours later with the implant in place, able to perform most everyday functions. Over the course of five to seven days, the implant gradually expands, widening out the opening through which urine flows. After expansion is complete, he returns to the doctor’s office where the device is removed. Afterward, most men see a strong improvement in urinary symptoms.
In clinical trials, iTind has shown a favorable safety profile, without sexual side effects. Patients experienced up to 60% improvement in urination flow and quality of life, and the positive effects of the procedure appear to last for at least three years.
Optilume. On June 20, 2023, the Urotronic medical device company (since purchased by Laborie) received FDA approval for a device called the Optilume BPH Catheter System. It consists of an inflatable catheter which the physician inserts into the tip of the penis and feeds into the urethra until it reaches the prostate area. Once there, the catheter’s balloon is deployed to spread the prostate’s lobes out, creating a channel around the urethra. The balloon is also coated with a chemotherapy drug called paclitaxel, which is distributed both to the prostate and to the urethra. This helps prevent inflammation and slows the regrowth of the prostate after the procedure. The balloon is then deflated and removed, and the patient goes home, typically with an immediate improvement in urinary symptoms.
In the clinical trial submitted for the device’s approval, Optilume achieved better urinary flow rates and a better ability to completely empty the bladder than any other minimally invasive prostate procedure to date. Side effects were minimal, and the procedure appeared to have no negative impact on sexual function. However, some men experienced pain and discomfort during the procedure, and some had temporarily painful or difficult urination afterward.
