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SIU offers new, advanced therapies to treat benign urinary problems
Written by Rebecca Budde • Photography by Jason Johnson
Though men tend to be reluctant patients, when something unusual is going on “down there,” they often seek treatment. SIU’s Division of Urology is working with men to offer them better quality of life in dealing with lower urinary tract symptoms (LUTS).
Dramatic changes in the division over the last year have allowed SIU’s urology team to better serve central and southern Illinois’ urological needs. Kevin T. McVary, MD, professor and chief of the Division of Urology, has helped to double the size of the faculty, and two nurse practitioners have also joined the team. “All of our faculty are fellowship-trained, and we’ve also added two urological oncologists,” Dr. McVary says. SIU has a new, one-year accredited andrology fellowship with the first fellow completing this year. In addition, the division’s research portfolio has expanded, and urological clinical research is booming, thanks to the addition of two new basic science researchers and a research program manager. More than 50 research studies and projects are in progress at varying stages due to the commitment of faculty and residents.
The three letters BPH likely mean nothing to the average male aged 40 or younger, but those three letters become significantly more important as a man ages. Benign Prostate Hyperplasia (BPH), or an enlarged prostate, is present in the majority of men over age 40, and more than 90 percent of men over age 80 have an enlarged prostate, according to the National Institutes of Health. BPH is typified by men in their twenties who can enter a public restroom and leave in a flash. Forty years later, those same men may take twice as long to void or may even have some leakage before making it to the urinal.
BPH is a symptom-driven disease; patients usually aren’t tested unless their symptoms are severe enough to cause complaint in quality of life. The most common symptom of BPH is frequent urination, more often occurring at night. As the prostate enlarges, it puts pressure on the urethra. Like a garden hose with a kink, the urine can’t flow properly through the urethra, making the bladder muscles work harder to push the urine through. “The muscles in the bladder build up to overcome the resistance, but eventually the decompensation phase begins, resulting in urine retention,” says Ahmed El-Zawahry, MD, assistant professor of urology. BPH can share symptoms and coexist with other diseases, such as prostate cancer. However, having BPH does not mean a man is at a higher risk for cancer.
Over time, the man’s bladder may begin to contract even when only a small amount of urine is present, making him leave his seat at the ball game to visit the men’s room more frequently. The pressure on the urethra may also cause him to linger in front of the urinal waiting to initiate a stream of urine, and when it finally starts, he’s still going while the urinal next to him has seen two other men in the same amount of time.
The majority of men with BPH will have symptoms, and the majority of those who have bothersome symptoms will seek some sort of therapy, according to Dr. McVary. “Based on the symptoms and their severity, some medications, such as prostate-relaxing or prostate-shrinking pills can be used,” Dr. McVary says. “However, many men don’t improve or they have temporary improvement and then the symptoms recur. These men will proceed to surgical intervention.”
Vapor therapy and urodynamics give new and improved options to help men get back in the game
One of the more common surgeries involves shrinking the prostate tissue by blasting it with a laser or electricity while the patient is under general anesthesia. Vapor therapy, on the other hand, is a new, minimally invasive type of therapy for treating BPH now offered at SIU in a phase 2 clinical trial. Unlike the traditional surgeries for BPH, vapor therapy is an in-office procedure done with the patient under local anesthesia.
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Here’s how it works: a camera scope is passed up the urethra and a tiny needle goes into the prostate. It delivers a drop of vapor (steam), rather than using laser or electricity to burn the tissue. “Steam has nice attributes: it travels between the cells, rather than pushing them aside,” Dr. McVary says. “Its heat destroys a large volume of prostate cells quickly, without creating a big mass effect. It’s so fast that the patients can’t feel it. It may prove to be a big improvement over other therapies.”
Other causes for LUTS could be neurological diseases, spinal cord injury, a urinary tract infection, muscle weakness, urinary stone or even kidney failure. Various forms of imaging can determine the cause of the symptoms, and sometimes relief can be as simple as reducing fluid intake or changing diet.>/p>
Urodynamics is an advanced form of imaging that allows the physician to take a peek into the bladder of a male or female patient. A catheter is placed in the rectum and in the bladder, and then, simulating nature, the bladder is filled with fluid. As images are captured, the patient describes the sensations – pressure, pain, etc. — and is then asked to void as the physician or nurse watches the changes taking place in the bladder. The imaging allows the physician to see if the bladder is completely emptied and if the muscles are contracting properly.
“Urodynamics is a very good tool for diagnosing a voiding dysfunction,” says Dr. El-Zawahry. “Some bladders act in a way that can lead to damage to the kidneys; my main goal is to protect the kidneys in these patients and treat them early before permanent damage occurs.”
Lower urinary tract symptoms in men can vary in type and severity, but they can be lessened with lifestyle management. The same factors that drive heart disease – obesity, high blood pressure, etc. – also contribute to LUTS. "Lifestyle has a big impact on the prostate,” says Dr. McVary. “Prostate health is a chance to improve your overall health. Anything that’s good for your prostate is good for your heart and anything good for your heart is good for your prostate."