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Monday, June 15, 2020

Trouble With Urination?

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Determining the option that bests suits you

BPH (Benign Prostatic Hyperplasia) is an extremely common condition that affects almost all men as we age. The prostate is a gland that is located between the located between the bladder and urethra in men. As men age, the prostate will usually increase in size. Many times, as the prostate increases in size, it will restrict the flow of urine. This often will result in a weak stream, straining to urinate and incomplete bladder emptying. Because the bladder does not empty completely, men will notice that they go the restroom more often, and it is usually accompanied by urinary urgency.

It is very important to see a urologist if you are experiencing these symptoms to make sure that these symptoms are not caused by prostate cancer. If your urologist determines that prostate cancer is not a concern, then there are many options available to treat BPH.

Most men will elect to start with medications to see if their urination improves. Most commonly, men are prescribed alpha-blockers, such as tamsulosin, which help the prostate to relax so the bladder empties better. This is a great medication for many men, but this medication can cause retrograde ejaculation. Retrograde ejaculation is when the semen goes back into the bladder instead of coming out of the end of the penis. It is not dangerous, and the semen is urinated out, but it can be bothersome to many men. Other medications like finasteride help to shrink the prostate, but these medications can take three to six months to work and also cause sexual dysfunction.

Thankfully for men who want to avoid taking a daily medication or are failing BPH medications, there are safe outpatient surgical procedures to help men urinate better and stay off medications. Urolift is one of the newer procedures available to treat men with BPH and is the most minimally invasive.

This procedure is typically done in an OR setting with light anesthesia, and several clips are used to suspend the prostate tissue so that the urethra is open and the bladder is able to empty completely.

This procedure typically takes five to 10 minutes to perform and does not require a catheter afterward. Men will usually notice a marked improvement in urination within one to two weeks. Notably, Urolift has the lowest incidence of any sexual side effects.

Another great option is the Greenlight laser. This is also a newer BPH procedure compared to the traditional TURP, where prostate tissue is resected to open the prostate channel. The older TURP (transurethral resection of prostate) procedures typically required one- to two-day hospitalization with a catheter. The Greenlight is unique in that it vaporizes the prostate tissue and results in almost no blood loss. The procedure takes about 30 minutes, and patients are able to go home with catheter the same day. The catheter is typically removed in the office 24-48 hours later. Men will usually notice an immediate improvement in their urinary stream, and their urinary symptoms quickly improve over the next several weeks.

Prior to pursuing any type of surgical procedure, it is very important to make sure that men are properly evaluated. There are approximately seven surgical procedures for the treatment of BPH. In order to determine the appropriate procedure for a patient, the urologist will typically perform a prostate ultrasound and a cystoscopy (look in the bladder). The prostate ultrasound is used to measure the size of the prostate, and then cystoscopy is used to evaluate the internal anatomy. These are both very quick procedures with minimal discomfort and do not require anesthesia. After you have been evaluated, your urologist will review the results and determine if you are good surgical candidate.

For instance, the Urolift is typically best suited for men with smaller prostates that do not have a median lobe. Alternatively, a Greenlight laser might be a better option for men with larger prostates or have a median lobe.

Ultimately, you and your urologist will be able to discuss your test results to determine what procedure is best for you.

Dr. Jared L. Moss is trained to treat all aspects of general urology, with a focus in men’s health. He specializes in male fertility, hypogonadism (low testosterone), erectile dysfunction, sexual dysfunction and inflatable penile prosthesis (IPP). Moss has specialized microsurgical training to help restore men’s fertility. He performs microsurgical vasectomy reversals, microsurgical varicocelectomy and microsurgical testicular sperm extraction on men who do not have sperm in their ejaculate. Moss sees patients at the Shreveport and West Monroe locations. Contact Regional Urology, 255 W. Bert Kouns Industrial Loop, Shreveport, 318-683-0411.

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