Prostate cancer

24 May 2016

New procedure for severely enlarged prostate

A Johannesburg hospital has started performing a cutting-edge, minimally-invasive operation to shrink a severely enlarged prostate.

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A new cutting-edge procedure known as prostatic artery embolisation (PAE) has been introduced in Africa, offering a minimally-invasive solution to thousands of men who suffer from a severely enlarged prostate.

Valuable new weapon

Four PAE procedures were recently performed at Netcare Sunninghill Hospital in Johannesburg as part of a two-day workshop with live demonstrations, held to familiarise urologists and interventional radiologists from around the country with PAE.

The procedures were performed by radiologist Dr Andrew Lawson under the supervision of Dr Nigel Hacking, one of the world’s leading interventional radiologists performing this procedure.

Read: Screening for early diagnosis

Dr Stephen Cornish, a urologist who practises in Johannesburg commented on the importance of this new procedure:

“It is a valuable new weapon in the arsenal of treatments currently available for this condition.”

“Although we do not yet have the benefit of long-term international clinical trials, the treatment is showing promising results internationally. We believe it is important to introduce it to South Africa through a formal training programme.”

According to Dr Cornish, an enlarged prostate, or benign prostatic hyperplasia (BPH), is the most common non-cancerous prostate medical condition faced by men by the time they reach their 60s.

“PAE was introduced in Brazil and Europe some seven years ago and has since become an increasingly popular alternative around the world, to traditional surgery for enlarged prostate.”

How PAE is performed

The PAE treatment is minimally-invasive and is performed making a small incision in the groin area.

“As a result, there is a reduced risk of complications from the procedure and patients tend to recover much more quickly. They are usually treated as outpatients and are able to go home on the same day, as opposed to the one or two nights they would likely have had to spend in hospital after open surgery.

"In addition, and importantly, erectile function is preserved,” says Dr Cornish.

Read: Robotic prostate surgery reduces erectile issues in prostate patients

“The procedure is undertaken by means of a small flexible tube called a catheter, which is inserted through the puncture wound in the groin and guided toward the arteries supplying blood to the areas of the prostate that are most affected.

"The entire procedure can take up to three hours, but the patient remains awake at all times. There is no pain associated with the procedure itself,” says Dr Lawson.

“Once at the site, we inject tiny particles which block the blood flow to the prostate, causing it to shrink. This is known as embolisation. Over a number of months, the prostate shrinks down to approximately 40% of its original size, resulting in a meaningful reduction in symptoms,” notes radiologist Dr Farrell Spiro.

Recognising the signs of an enlarged prostate

The male prostate tends to enlarge with age in response to hormonal changes in the body, however in some men the prostate continues to grow to a point where it may interfere with the flow of urine.

According to Dr Cornish symptoms of an enlarged prostate may include:

  • An ongoing urge to urinate;
  • Frequent need to urinate, particularly at night, which can severely disrupt sleep;
  • Inability to empty the bladder properly; and
  • Slow, interrupted, or weak urinary stream with leaking or dribbling.

If the prostate becomes so swollen that it completely blocks the flow of urine, emergency surgery may be required, as backed-up urine in the bladder caused by the obstruction could result in infections.

Read more:

Symptoms of enlarged prostate

Treatment of enlarged prostate

Prevalence of enlarged prostate