Suffolk Urology

BPH

Benign Prostatic Hyperplasia

There are many possible factors which may contribute to symptoms of difficulty passing urine in men, such as infection, neurological problems, scarring in the water pipe, diabetes and other endocrinological conditions. Often the principal cause is blockage of bladder emptying (bladder outlet obstruction) due to benign enlargement of the prostate (benign prostatic hyperplasia – BPH).

There are a variety of treatments for BPH depending on the degree of bother that the symptoms cause. Mild symptoms can be treated satisfactorily with lifestyle advice alone. Drug treatments are available including alpha-blockers (such as doxazosin, tamsulosin, alfuzosin and silodosin) which relieve blockage by relaxing smooth muscle in the prostate, and 5-alpha-reductase inhibitors (finasteride and dutasteride) which shrink the prostate. Many men find that these medications control their symptoms very well but some notice side effects including altered ejaculation (alpha-blockers) and erectile dysfunction and decreased libido (5-alpha-reductase inhibitors).

Men whose urinary symptoms are not satisfactorily treated with medication may choose to have surgery.

Which prostate operation is right for me?

As we will see, there are several different prostate treatments available which vary significantly in their degree of invasiveness, recovery time and potential side effects. There is certainly no “one size fits all” here. The correct operation for you depends on many factors including the severity of your symptoms, size and shape of your prostate and your personal views and preferences regarding side effects and recovery time.

Treatment Options

TURP

Transurethral resection of the prostate (TURP) is an established operation to treat blockage of bladder emptying due to BPH. It can be performed under a general or spinal anaesthetic. An instrument on the end of a telescope passed down the water pipe removes up to half of the prostate from the inside, relieving obstruction caused by prostatic enlargement. The patient stays in hospital for two or three days.

Risks that many patients may be concerned about include sexual problems and incontinence. In considering risks and potential problems after the procedure, it is important not to confuse this operation with radical prostatectomy (RP) which can be an open, laparoscopic or robotic procedure. This is a very different operation which involves removing the whole prostate and some of the surrounding tissue to treat prostate cancer. In TURP, for men with previously good sexual function, problems with erections can occur in 10 to 20%, and retrograde ejaculation (dry ejaculation) occurs in 80%, but incontinence is very rare. In RP, all men have dry ejaculation, most have some degree of erectile dysfunction and around 10% have persistent troublesome urinary leakage.

TURP remains the standard operation against which other procedures for BPH must be compared and judged. Over the years, many alternatives to TURP have come and gone, including microwave treatment, cryosurgery, and a variety of different laser operations. Problems have included persistent discomfort on passing urine, higher rates of incontinence, inadequate relief of symptoms or short duration of effect.

TURis (bipolar TURP)

The TURis system (transurethral resection in saline) has been developed by Olympus. In many respects, it is not a new operation, but rather an optimisation of all aspects of TURP. The major difference is that the electrical current used to cut prostate tissue is delivered through a bipolar system (rather than monopolar used in conventional TURP) so saline irrigation fluid can be used to flush into and out of the bladder during the operation (rather than glycine in TURP) so that very little extra fluid is absorbed into the body, reducing the risk of serious complications such as TUR syndrome almost to zero. The system has been in use for over a decade and has been approved by the National Institute for Health and Care Excellence (NICE):

Click here for link to NICE Website

There is less blood loss during and after the operation. It is safe to continue the procedure for much longer than a TURP, so larger prostates can be satisfactorily treated and a larger amount of prostate tissue can be removed. This means that TURis is as effective as the latest generation of laser prostate operations at treating larger prostates but with a lower risk of incontinence.

Summary of TURis:
- Bipolar energy
  • - Saline irrigation fluid
  • - Less blood loss
  • - Shorter time with catheter afterwards
  • - Suitable for large prostates but lower incontinence rate than laser surgery

www.olympus.co.uk/medical/en/Products-and-solutions/Products/Urology/Advanced-Bipolar-Energy.html

Aquablation

Aquablation Therapy

A robotic device precisely administers a water jet within the prostate. This is undertaken under anaesthetic with continuous monitoring using an ultrasound scan. Patients usually go home from hospital the same day or after one night. Side effects are minimised as heat and electrical current are not used to remove prostate tissue. The rate of incontinence and problems with erections and ejaculation are very low.

CLICK HERE - BPH Treatment with Lasting Relief - Aquablation® UK



Procept biorobotics

Rezum (steam treatment – water vapour therapy)

Rezum is a minimally invasive treatment which uses steam precisely delivered to specific areas of the prostate to destroy prostate tissue to relieve blockage caused by BPH. The procedure only takes a few minutes and men can go home the same day. A catheter is put in the bladder for a few days and symptoms gradually improve over the next couple of weeks. In the UK it has been approved by NICE as a safe and effective treatment for BPH. It does not affect sexual function and men can return quickly to normal activities. It is even suitable for men whose urinary symptoms are effectively treated with medication but would prefer not to continue taking tablets indefinitely. Click here for more information on our Rezum Treatments

Click here for Suffolk Urology Rezum Leaflet

Click here for link to NICE Website

UroLift (prostatic urethral lift)

UroLift is also a minimally invasive procedure to treat obstruction due to BPH in men with small- to medium-sized prostates. It involves placement of 2 to 6 (usually 4) small clips to lift the lobes of the prostate aside to relieve blockage. It has been approved by the National Institiute for Health and Care Excellence (NICE):

Click here for link to NICE Website

It is done under a short general anaesthetic and patients go home the same day without the need for a catheter. The chance of it affecting erections or ejaculation is extremely low.

Enlarged Prostate - An enlarged prostate can narrow or even block the urethra.
Step 1 - The UroLift Delivery Device is placed through the obstructed urethra to access the enlarged prostate.
Step 2 - Small UroLift Implants are permanently placed to lift or hold the enlarged prostate tissue out of the way and increase the opening of the urethra. The permanent Implants are delivered through a small needle that comes out of the UroLift Delivery Device and into the prostate.
Step 3 - The UroLift Delivery Device is removed, leaving an open urethra designed to provide symptom relief.

It may be suitable for men whose symptoms are well controlled with medication but would prefer not to have the dry ejaculation that alpha-blockers can cause and would prefer not to take a tablet every day. Also, men may prefer this procedure as it has a shorter recovery time and no requirement for a catheter afterwards

Summary of UroLift:
- Day case procedure
  • - No catheter afterwards
  • - Shorter recovery time
  • - No effect on erections or ejaculation
  • - Suitable for small- to medium-sized prostates

-

LASER prostate surgery

Over the years, several different laser prostate operations have been introduced to complete with TURP. Some have been left by the wayside because of side effects such as dysuria (pain on passing urine), or short-lived effect and requirement for repeat surgery after only a few years. Others have established advantages such as lower blood loss and short duration of hospital stay but at the expense of higher rates of early urinary incontinence.

Rather than LASER prostate surgery, Mr Yardy uses and recommends the TURis system as this has the advantages of lower blood loss and quicker recovery but without the increased risks of early urinary incontinence..

Prostate Artery Embolisation (PAE)

This is a sophisticated new technique involving precisely blocking small blood vessels to the prostate under X-ray guidance. The prostate subsequently shrinks and blockage is relieved. It is associated with few side effects and a quick recovery time. It is suitable for a particular group of men who accept that it may not be as effective in improving symptoms as other procedures and its effect may not last as long.

Pearly penile papules

Pearly penile papules (PPP) are tiny nodules on the head of the penis. They are quite frequently found and sometimes very prominent. People are often concerned that they may be caused by sexually transmitted infections but this is not the case. Mr Yardy is experienced in safe removal of PPP. This can be performed under local anaesthetic in his treatment room – you do not have to go to the operating theatre.

For more information:wikipedia.org/wiki/Hirsuties_coronae_glandis

TESTIMONIALS

I was very satisfied with all aspects of the care I received from Mr Yardy and particularly appreciated his intervention on my behalf to secure a single room at the Ipswich Hospital in view of my being a covid 19 'high risk patient' . I was also grateful that he liaised with my Haematology consultant regarding my regular medication prior to and after surgery.

Calm clear and friendly advice. Yes the procedure was not great but I was ready for it! The important thing is that I am now back to my old self and I am very grateful.

He took great care in explaining both the the situation and the options in a positive way.

Absolutely no pressure to undertake surgery or be rushed to have it done immediately.Once a plan was agreed it all happened very efficiently.

At all times he made himself availably if further information or consultation was need.

Excellent service from initial consultation through to surgery and follow up consultation. Correspondence from Wendy Gudgin (Secretary) was also excellent and very efficient.

I was very satisfied with all aspects of the care I received from Mr Yardy and particularly appreciated his intervention on my behalf to secure a single room at the Ipswich Hospital in view of my being a covid 19 'high risk patient' . I was also grateful that he liaised with my Haematology consultant regarding my regular medication prior to and after surgery.

The proceedure was carried out on my Grandson who needed to be circumcised due to medical reasons. He was treated with great understanding [George is 12] and information on the operation was explained in a clear manner. George had every confidence that this was going to be a safe and necessary.

Utterly professional and exudes confidence. As a patient he comes across as a safe and experienced pair of hands which is most reassuring.

Mr Yardy clearly explained the procedure before my operation and answered all my questions afterwards.

Explanation of possible causes of the problem was so in-depth and expertly explained and extremely reassuring.

Mr Yardy has monitored my prostate ever since an enlargement was identified 3 years ago. His approach to analysis of data is extremely thorough and his explanations are clear and concise providing sufficient detail for a layman to understand the diagnosis.

I have a further MRI scan which I hope will provide the 'all clear' but nevertheless it is my intention to continue to have regular examinations by Mr Yardy as this will give me peace of mind.

Very professional with an empathetic approach. Always willing to take the time to explain in details such things as options and possible outcomes. I would have no problem in recommending his services.

Mr Yardy and his colleague did a great job of putting me at ease before the start of the procedure. He indicated what the experience would be like in realistic terms but not such as would cause anxiety. The start of the procedure was as described. The view from the cystoscope on screen was mesmerising. Mr Yardy gave a commentary as he proceeded which was most helpful. There were a few twinges of discomfort but nothing severe. After the procedure we had a full and very helpful discussion about options and homed in on what I think is the best course of action for me. This was my second visit to the urology assessment suite (first for cytoscopy) and I have found all the staff very friendly and helpful.

Mr Yardy is kind and considerate and explains things so that I can understand. It cannot be easy talking to an elderley lady (that's me!) about the problems I present with! I was made to feel valid rather than a bit of a nuisance!

Mr Yardy was an amazing consultant who asked every detailed until he got to the bottom of my problem. With his amazing knowledge he has made made me better and i’m very great full he was my consultant.

I found Mr Yardy to be very professional and able to explain and reassure me with the problems that I presented him with.

Fantastic doctor who i trust.

My son was welcomed by two very confident happy and professional Drs..they made him feel very comfortable and at ease for a very private matter for a nearly 15 yr old. He felt at ease and was explained at every point of consultation what was happening especially his examination.

I found Mr Yardy a very pleasant man who was able to explain very clearly to me the different stages of the procedure I was considering to have done.

I found Mr Yardy to be an excellent Consultant. His manner was calming and reassuring. He was very good at explaining the procedure I was having and the outcome.

Overall my Rezum treatment has been very successful with a huge improvement in the symptoms previously experienced.

I would not hesitate to recommend Mr Yardy and his support team for the consultation and procedure that i undertook.

Mr Yardy was recommended by my oncologist following my diagnosis with advanced prostrate cancer. He handled our appointment with sensitivity and a clear picture of how we would proceed with the investigation. It was a very calming and assuring appointment after the shock diagnosis.His secretary was most helpful in keeping the process and appointments on time.

I am very satisfied with the treatment a received from George Y his explanation of what my options were on my consultation and with what will happen when i went for the TURP surgery was all very clear and easily understood.

I had been in real prostrate trouble for some time and had the prospect of a very long wait and much uncertainty in resolving this. Mr Yardy gave me very clear information extremely helpful advice and the attention and time to discuss my concerns fully. When I went into surgery I felt well prepared for the procedure and confident in getting the best care. Not only has the procedure proved very successful but throughout I felt Mr Yardy gave me his full personal attention both during the process and in the post-op recuperation and follow-up. I am truly grateful for the professional service I received and the individual care and attention offered to me as an individual.

Mr Yardy has been honest understanding and approachable. He has emphasized his willingness to be contatcted if I have felt uncertainty. I am very grateful for his understanding.

I found Mr Yardy very approachable and knowledgeable. He explained things in a way I could understand. He even managed to make me smile during a not very comfortable (but not painful) procedure. A very gentle man.

Very pleased from my first appointment to my last one with Mr Yardy. He listened to me was genuinely interested in my health and made me feel at ease throughout my consultations. As a result of Mr Yardy's advice care and treatment I am now back to full health. Thank you.

I have always found Mr Yardy to be friendly polite and very knowledge in all aspects of my experience with him.

Very good at explaining to both adults and my son (11) what would be happening and possible outcomes etc. This made the whole experience a very calm and productive one. Surgery was an excellent experience for hearing and the final result. All in all excellent.

Mr Yardy was both friendly and professional at all times. The only problem was in the level of pain experienced with the procedure which far greater than I had expected but that was probably due to my condition.

A delightful person. His manner was reassuring and so gentle. I did not feel that I was wasting his time.

"I had a telephone conference with Mr Yardy due to the Corona Virus. He came up with a clear treatment plan which he implemented with a clear and concise letter sent to relevant individuals a copy of which was sent to me.

Very easy relationship providing great reassurance when having concern initially. Appropriate checks swiftly arranged and followed up. Great confidence in his knowledge and ability during continuing monitoring. Discussions conducted in easily understood form and questions fully answered. Very appreciative of care given.

Excellent intermittent catheter (which proved to be excellent advice) and to explain steaming.


© Copyright - George Yardy. All Rights Reserved