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Urological innovations in prostate treatments
Dr Colin Teo highlights the advancements in the field
In recent years , we have seen the introduction of a wide spectrum of exciting new medical technologies for treating the prostate , the walnut-sized gland between the bladder and penis responsible for producing fluid that nourishes and transports sperm . These innovations are witnessing a rising trend of acceptance and preference among men ( both young and old ) as they ’ re minimally invasive and safe while providing personalised options that cater to the different needs of individual patients .
Many of the new procedures can be performed under outpatient or day surgery with or without sedation . This is in contrast to traditional options where one had to choose between either taking multiple medications that could lose their effectiveness as the disease progresses and have compliance issues and side effects or undergoing the alternative of more invasive or radical surgeries .
In the field of benign prostatic hyperplasia ( BPH ), which is a highly prevalent and bothersome benign condition in men resulting in an enlarged prostate , the exciting new innovations bring advantages of lower risk of complications with good preservation of sexual function important to many men . These innovations include :
• Prolieve Thermodilatation A truly outpatient procedure that can be done under local anesthesia , it shrinks the prostate using a microwave chip catheter with balloon dilatation creating a ‘ biological stent ’.
• REZUM water vapor therapy A procedure that shrinks the prostate with a simple 10-minute endoscopic day surgery procedure .
• Urolift A system that cleverly inserts clip implants that spread open the obstructing prostate and prevent it from blocking the urethra , thereby improving flow without shrinking the prostate .
• iTind ( Temporary implantable Nitinol Device ) An alternative implant device that only requires temporary placement , it remodels the prostate over one week , after which it is removed .
• Laser Ablation An endoscopic vaporisation of large prostates that minimises bleeding , yet ensures a wideopen channel of unobstructed flow .
• EXMINE Stent A creative device that gives patients the option of avoiding a urinary catheter . When inserted , it is unseen and hidden in the body without the need for an external urine bag that can be bothersome and socially awkward . The stent can be changed or removed outpatient when due .
Prostate cancer has largely been treated by the minimally invasive and safe keyhole DaVinci robotic surgery which brought operative technology to a new level of precision and dexterity with faster recovery times and functional outcomes . For suitable patients , the latest developments provide personalised options for targeted
BPH - REZUM Water Vapour Therapy
therapy either through high intensity focused ultrasound ( HIFU ) or cryotherapy where cancer treatment may be designed to remove half or a part of the prostate gland if a visible tumour can be localized and thus avoid the comorbidities of cancer surgery .
Although BPH and prostate cancers are not prevalent in younger patients , many suffer from chronic prostatitis , erectile dysfunction , and Peyronie ’ s disease . While medications do bring relief , many younger patients find persistent or worsening disease progression despite taking them .
Low intensity shockwave therapy , which is performed painlessly in an outpatient clinic setting , has been shown to be effective . Shockwave treatment has been used for many years in sports medicine and has a good track record with no significant known side effects . Research and clinical studies have shown that it can also promote prostate and penile tissue healing through the release of beneficial growth factors that promote better vascular flow , decreased proinflammatory activities , endogenous stem-cell recruitment , and nerve repair .
We are indeed enjoying this era of translational innovations that have delivered a wide armamentarium of minimally invasive and effective therapy options for patients . And there is no doubt that newer technologies will continue to make their way into minimally invasive prostate therapy .
Dr Colin Teo is a consultant urologist in Singapore . He ’ s an expert in urinary stone disease and urological cancers as well as minimally invasive and robotic surgeries .
BPH - iTind Prostate Remodelling Temporary Implantable Nitinol Device
Low intensity shockwave therapy , which is performed painlessly in an outpatient clinic setting , has been shown to be effective .
22 OCTOBER 2021 GlobalHealthAsiaPacific . com