Mayo Clinic offers new laser treatment for benign prostatic hyperplasia

Tuesday, August 10, 2004

Urologists at Mayo Clinic in Jacksonville are offering a new laser treatment option for symptoms of an enlarged prostate. The procedure destroys excess prostate tissue with a special laser threaded through the urethra, the tube that carries urine out of the bladder. Mayo Clinic urologists Dr. Gregory Broderick and Dr. Todd Igel perform the in-office procedure, called interstitial laser thermotherapy, under local anesthesia.

The prostate gland sits at the base of a man's bladder and surrounds the upper part of his urethra. During puberty, the prostate undergoes a growth spurt. It continues to grow slowly as a man ages. In their 40s, most men have a second prostate growth spurt. The gland then begins to compress the urethra and may cause troublesome symptoms, which include a weak urine stream, difficulty in starting urination, urine flow stopping and restarting during urination, frequent nighttime urination (nocturia) and the inability to completely empty the bladder. These symptoms of benign (non-cancerous) prostatic hyperplasia (BPH) may begin at age 50. By age 60, over half of all men will have symptoms.

Interstitial laser thermotherapy is one of several minimally invasive surgical therapies for BPH performed by Mayo urologists. It is an alternative for men with mild to moderate prostate enlargement who experience objectionable side effects from medications used to treat the condition. Surgery on the prostate requiring general anesthesia, and sometimes hospitalization, is normally recommended when the gland is severely enlarged, especially if the patient is experiencing bleeding or cannot urinate (acute retention).

Medical management of BPH is aggressively marketed by the pharmaceutical industry. Common side effects of various drugs used to treat BPH include headache, dizziness, nasal congestion, ejaculatory disorders, decreased libido and erectile dysfunction (ED). The drugs must be taken daily for the rest of the patient's life, and in some men they may become ineffective over time. "Most medications can't stop the natural changes to the prostate, without significantly interfering with the sexual hormone, dihydro-testosterone," Broderick says. "We are hopeful that early treatment with interstitial laser will free patients not only from daily medications, but also prevent the bladder changes in men which are typical with aging: urgency, frequency, nocturia and incomplete emptying."

Broderick says choosing a treatment is a matter of patient preference. Some men experience satisfactory symptom relief from medication and aren't bothered by side effects. Symptom relief after interstitial laser thermotherapy occurs over three to six weeks. Patients typically require catheterization for three to five days afterwards. The procedure carries a much smaller risk of bleeding, impotence or incontinence than surgical procedures for BPH.

Broderick says increased awareness of both BPH and ED may result in more men seeing their physicians earlier rather than later. "Men generally do not come to a physician unless they are symptomatic," he says. "Any medical doctor will tell you we lose years of valuable, potential treatment for men's hypertension and coronary artery disease, because they wait until they're really sick to come in."

Broderick says current international epidemiology studies show that BPH may be linked to ED and that ED is actually an early warning sign for developing significant cardiovascular disease. "Hopefully as these studies are confirmed and popularized, men will come into the doctor's office early and initiate a discussion of urinary and sexual symptoms," he says. "That will lead to the identification and treatment of elevated cholesterol, lipids, blood pressure and blood sugars."

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