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Spending Less Time in the Men's Room

No man should accept urinary problems as a fact of life.

Regular bodily functions shouldn’t be a big concern. But for many men over age 50, simple urination becomes troublesome. They have difficulty emptying the bladder, or they find they need to go so frequently that it’s a nuisance. The culprit is often an enlarged prostate, known medically as benign prostatic hyperplasia (BPH). It affects roughly half of all males in their 50s, and 90 percent of those over age 80. But there are a number of effective treatments.

The prostate, about the size and shape of a walnut, is located below the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine from the bladder out through the penis. The prostate’s main function is to produce semen, but if it becomes enlarged, it can squeeze down on the urethra, causing those urination difficulties.

BPH runs in families, but simple aging is the primary risk factor. “The vast majority of men with this condition have mild symptoms and live perfectly well without any treatment,” says Muhammad Choudhury, M.D., Director of Urology at Westchester Medical Center. “Those with moderate symptoms can be treated with medications to open the urethra or shrink the prostate.”

For those rare, severe cases in which medications don’t work and urination is extremely difficult, surgical treatment is available. And fortunately, recent advances in the standard surgical option have made this treatment safer and reduced its side effects.

In this procedure, known as transurethral resection of the prostate (TU RP), a combined visual and surgical instrument called a resectoscope is inserted through the tip of the penis into the urethra. The surgeon then trims away excess prostate tissue that’s blocking urine flow and increases the size of the opening to allow easier emptying of the bladder.

Unfortunately, traditional TU RP can occasionally bring unpleasant side effects, including bleeding and low blood sodium levels that cause confusion and fatigue immediately after surgery. That’s because the resectoscope usually requires the use of a low-sodium irrigation solution that can lower the body’s sodium levels, increasing the risk of those side effects.

“Everyone has been looking for surgical alternatives for years to avoid those problems,” Dr. Choudhury explains.

Happily, an alternative has been found. Switching from “monopolar” to “bipolar” current—that is, using a generator with two poles, including both active and return electrodes—can make it possible to use a simple saline solution for irrigation, which the body can absorb without the danger of those side effects. The bipolar approach also lowers the risk of bleeding.

Bipolar technology can cost a bit more, and that, says Dr. Choudhury, may be why some facilities don’t offer the bipolar approach. But at Westchester Medical Center, surgery for BPH enjoys the advantages that bipolar TURP brings.

For one thing, recovery is quicker than with traditional TURP. “The catheter can be removed the next day instead of after two to three days,” says the doctor. “The hospital stay is also shorter—the patient goes home the same day or next day instead of staying two to three days.” And the improvement in symptoms, he says, is the same as or better than what is achieved with traditional TURP.

“After this procedure, men can urinate more easily and with less frequency and can go off the medications,” says Dr. Choudhury. (He adds that there is a small risk of incontinence— less than 0.5 percent.)

Dr. Choudhury and his colleagues, John Phillips, M.D., and Sean Fullerton, M.D., have substantial experience using bipolar TU RP. They suggest that men familiarize themselves with the symptoms of BPH (see above) and discuss all treatment options with their urologist— so that going to the men’s room can be a mere occasional necessity, not a lifelimiting concern.

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