Benign prostatic hyperplasia (BPH) or enlarged prostate affects 70% of men at ages 60 to 69 and 80% of men over 70. The USC Institute of Urology at Keck Medicine of USC has responded with expertise and a full range of innovative treatment options, including the UroLift® System, a minimally-invasive permanent implant device designed to reduce lower urinary tract symptoms (LUTS) due to BPH. It was approved by the U.S. Food and Drug Administration in 2013. The USC Institute of Urology has extensive experience with Urolift in Southern California, which is helping men like the patient seen by Andrew Berger, MD, assistant professor of clinical urology at the Keck School of Medicine of USC. His specialties include advanced robotic and laparoscopic surgery for prostate, kidney and bladder cancer.
By Andre Berger, MD
Case Presentation
The 64-year-old man I saw before me in my office at the USC Norris Comprehensive Cancer Center was in many ways representative of men in the BPH-vulnerable age group. This patient was experiencing severe urinary obstructive symptoms, but medication was not helping to ameliorate those symptoms: very weak stream, inability to empty his bladder and frequent urination — to the point his sleep was interrupted.
Our evaluation showed his enlarged prostate (about 50 grams) was obstructing his urethra. I outlined several treatment options, including a transurethral resection of the prostate (TURP) and prostate laser surgery. Both can carry significant side effects, including loss of sexual function. I also discussed the UroLift System, which requires no general anesthesia and can be completed as an outpatient procedure. Importantly, it typically has not resulted in erectile dysfunction.
Management
My patient chose the UroLift option. After preparing him with local anesthesia (lidocaine jelly), I inserted the UroLift Delivery Device (which includes a scope and camera) through the obstructed urethra to access the prostate. Using a small needle that emerges from the device, I placed four small, permanent implants to hold the prostate lobes apart — much like tying back a curtain — and widened the urethra opening. The entire procedure took 10 to 15 minutes, without any incision, heat or removal of prostate tissue.
Outcome
The patient was able to fully void and empty his bladder within a few minutes. He went home that afternoon, without any need for a urinary catheter. He enjoyed a dramatic improvement in his symptoms and an increase in energy, with the renewed ability to rest at night, and he was able to stop all BPH medication. In general, side effects, if any, include a temporary burning sensation and minor blood in the urine; these disappear in about a week and are less severe than those with a TURP or laser surgery.
Clinical data have shown that patients have significant improvement in urinary flow. In addition, patients report improvement in overall urinary symptoms on validated post-procedure questionnaires.
The USC Institute of Urology is planning a clinical trial to further evaluate UroLift applications, as we continually seek to innovate and move the field forward.