Enlarged prostate or Benign Prostate Hyperplasia (BPH) is an exceedingly common condition in older men. As the population ages, it is inevitable that the incidence of BPH will rise dramatically and pose a major challenge for the health care system.
This condition can lead to many lower urinary tract symptoms, including the inability to completely empty the bladder, frequent or painful urination, weak or interrupted urine stream, difficulty in starting or stopping urination. If left untreated, it can significantly impact a man’s total health and quality of life. Typically, patients prefer watchful waiting, followed by medical therapy or surgical relief in the form of Transurethral Resection of the Prostate (TURP) commonly known as “Roto-Rooter.”
Positioned between medical treatment and in-hospital surgery is Minimally Invasive Therapy (MIT). The advent of new technologies has revolutionized the management of enlarged prostate. Office-based treatment protocols require no hospitalization and the procedures are performed under local Xylocaine, combined with sedation.
Several minimally invasive treatments are now being used in an effort to satisfy patient demands for alternatives to costly medical therapy – and to eliminate hospitalization and potential complications arising from surgical treatments. With elegant technical solutions, there are demonstrable benefits to the patient’s safety.
Over the past 15 years, Medical Technology has been a powerful and effective driving force in the development of MIT, bringing a steady stream of innovations to our patients. MIT is categorized as microwaves, lasers and radio frequencies, which have evolved considerably due to the rapid expansion of technology in medical science. Urologists have been quick to adopt appropriate innovations where practical and consistent with sound medical practice.
Advances in medical technology have given us many choices from which to make our health care decisions. The use of microwave technology for BPH treatment was first examined in the 1980s. Early systems provided partial symptomatic relief but were abandoned due to poor long term results. High-energy microwave devices became an effective modality in the mid to late 1990s. The addition of cooling systems made this treatment more tolerable for patients and reduced potential complications. By the year 2000, microwave procedures could be performed in a urologist’s office using only oral and topical urethral medication.
The drive to make treatment of BPH less invasive than conventional TURP led to the evolution of other technologies including Transurethral Needle Ablation (TUNA), Water Induced Thermotherapy (WIT) and various laser-based modalities. The central principle driving the success of these procedures was the use of heat to induce necrosis (death) of tissue at a sustained temperature of over 45 degrees C (113 degrees F). The advantages of most minimally invasive technologies include the following:
Office based treatment performed with oral medications and topical anesthetics;
Less than one hour treatment time;
Faster recovery time and less complications than TURP; and,
Ability to treat patients whose co-morbidity made them high surgical risks
I have used almost every MIT product available. With the technological advances in urethral cooling, high-energy modalities outperform low energy modalities for treatment of BPH. My personal preference and recommendation, is for CTC by Targis, which delivers more energy, maintains high temperature (75o C) necessary for increased tissue necrosis, while providing advanced cooling (15o C) peri-urethrally.
This article was submitted by Nick Shroff, M.D. For more information on this procedure, call Midland Urology Center at 432-683-5897. Their website is at www.shroffurology.com and their physical address is 2115 West Michigan Ave.
Disclaimer: The facts presented in this article and the views expressed are solely those of author(s) and do not necessarily reflect the views of the Board of Directors or other members of West Texas Physicians Alliance.