I categorize prostate problems into two groups: prostate cancer problems and urinary prostate problems. These thoughts will focus on the latter category.
The prostate is a male reproductive organ and the uterus is its female corollary. Unless women are intentionally carrying a baby, most might consider the uterus a nuisance. The uterus causes a periodic nuisance that can get bad enough that it can lead to a hysterectomy. In a similar fashion, unless a man is trying to father children, the prostate isn’t very biologically helpful.
The prostate is located at the base of the bladder and is shaped like a doughnut. The urine has to flow through the prostate and urethra (in the penis) to get out. As men age the prostate continually gets bigger and the doughnut hole that we urinate through gets tighter and tighter. This makes urination difficult and can cause symptoms such as weak stream, straining to urinate, urinary urgency, urinary frequency, nighttime urination, intermittent urinary stream, urinary hesitancy, and even urinary retention, which requires a trip to the emergency room and placement of a catheter in order to drain the bladder.
For decades the only effective therapy was to pass a small camera through the urethra into the doughnut hole of the prostate and scrape it out to make a wider passageway for the urine. This is called transurethral resection of the prostate, TURP, or in layman’s terms, a “roto-rooter” job. It has an excellent success rate and is still considered the gold standard procedure for improving urination problems caused by an obstructive prostate. However, it requires a trip to the operating room, anesthesia and often an overnight stay in the hospital.
It can be complicated by bleeding, and sexual side effects such as erectile dysfunction and retrograde (backward) ejaculation. Rarely, the rectum can be injured. One of the complications, which happens in about 5 percent of cases, is development of scar tissue called a contracture or stricture that can occlude the urine channel again, requiring more operations.
In the past 20 years, therapies have expanded to include medications that shrink the prostate or relax it and make it easier to urinate. Millions of men take these medications daily. Other technologies such as prostate sutures and energy sources such as laser, microwave, radio frequency and high-intensity ultrasound have been used to treat an obstructive prostate.
The NxThera company has developed a new technology called Rezum, which uses water vapor energy to treat urinary symptoms from an obstructive prostate. It’s performed in the doctor’s office under local anesthesia. It involves passage of a small camera through the urethra into the doughnut hole of the prostate. A small tube then comes out of the tip of the camera and is inserted into the prostate tissue, and a puff of steam is injected. (This reminds me of a mosquito proboscis that the insect pokes into our skin to suck our blood.)
The injected steam condenses into water and that releases heat energy that damages the cell membranes of the tissue in the area. These cells die and are reabsorbed by the body over the course of the next several months, and this process opens up the doughnut hole so it is much wider.
This allows the urine to flow more freely and alleviates a lot of urinary symptoms.
Unique features of this therapy are that it is office-based and does not require a trip to the operating room or a general anesthetic. Patients go home immediately after the procedure.
The process initially causes some prostate swelling, which could make symptoms worse, so patients wear a catheter in the urethra for a few days to give the prostate a chance for the swelling to go down. Patients usually notice improvement in their symptoms starting about two weeks after the procedure, and symptoms progressively improve over the course of a few months as the dead prostate cells are reabsorbed by the body. The procedure does not destroy the overall anatomy of the prostate, so there is no reported backward ejaculation or sexual dysfunction. The steam is at a precisely controlled temperature so there is no tissue charring that often occurs with TURP or laser TURP. There is no risk of scar tissue development.
Five-years after the treatment, 85 percent of patients are still urinating well. Fifteen percent of patients have experienced enough tissue regrowth that their symptoms start to come back.
Millions of American men are bothered enough by their urinary symptoms that they take prostate-relaxing medications, but they are not bothered to the degree that they are willing to have a surgery under anesthesia, spend the night in the hospital and have potential sexual side effects. This procedure offers them the opportunity to get off the medications, have improved urination and avoid a trip to the operating room.
The procedure is FDA-approved and reimbursed by most insurance companies and Medicare. More than 20,000 men have had the procedure – which, until now, had been unavailable in this part of Idaho. This new treatment offers a minimally invasive way to get off the prostate medications and improve quality of life.
Dr. Jared G. Heiner is a board-certified urologist who has practiced adult urology in the Treasure Valley since 2006. He is now with Idaho Urologic Institute in Meridian. Heiner has a special interest in treating prostate disease and prostate cancer. He earned his bachelor’s in music from BYU and attended medical school at the University of California, San Diego. Heiner completed his internship and urology residency training at the Medical College of Georgia in Augusta.