This brief summary reflects Dr Phillip Katelaris’ view, based on over 30 years’ experience managing lower urinary tract symptoms using a multitude of technologies and innovations.
Lower urinary tract symptoms remain a common cause of patient inconvenience and general practitioner consultations. More sever cases of bladder neck obstruction can lead to urinary tract infections, bladder stone formation, and urinary retention.
It is Dr Katelaris’ view that a proposed treatment should significantly and objectively relieve bladder neck obstruction and not just result in a positive outcome on a patient completed questionnaire pertinent to symptoms.
The following is a brief explanation, the pros and cons of commonly used therapies for bladder neck obstruction. Contemporary treatments either definitively remove obstructive urinary symptoms and cause retrograde ejaculation or alternatively incompletely relieve urinary obstruction and variably preserve antegrade ejaculation.
New technologies need to be carefully evaluated and only utilised if they genuinely improve patient care.
- Medical management
- Rezum water vapor therapy
- Bladder Neck incisional surgery
- Green Light Laser Ablation of the prostate
- Transurethral resection of the prostate
5a-Reductase inhibitors in combination with selective alpha blockers (Duodart) are the mainstay of medical management.
Result: incomplete resolution of obstruction, long-term daily dosing required.
Side effects include postural hypotension, nasal congestions, retrograde ejaculation related to the alpha blockade and a possibility of diminished libido and sexual dysfunction variably reported by patients.
Small implantable “Staples” that aim to pull apart the bladder neck and proximal prostate tissue. The UroLift treatment is suitable for small prostate glands only without a middle lobe.
Result: a very modest-only relief of obstructive urinary symptoms; some men no benefit at all. There are no reported cases of retrograde ejaculation.
A newly marketed technology that involves the use of high-pressure steam injected into the BPH tissue. The patient may require catheterisation for one week and may not see an improvement in obstructive symptoms for weeks.
Result: a modest only improvement in obstructive symptoms with a mean in increase in flow rate of 4mL/sec only.
Retrograde ejaculation rate yet to be determined in the marketplace, most likely around 10% or perhaps higher.
Green Light Laser Ablation of the Prostate
BPH tissue is vaporised in order to create a channel. The form of treatment aims to relieve bladder neck obstruction; no tissue will be obtained for pathological analysis. There has been high rates of retrograde ejaculation associated with Green Light laser ablation.
“The data reported herin reflect what urologist have found in their own clinical experience. Long-term results are probably not as good as with electrosurgical resection, leading to higher than previously reported failure rates…The jury has spoken, and GreenLight laser seems to be a fading technology.”
– JUROL 2018;200:5 – Editorial Comment.
Remains the gold standard therapy especially when performed with bipolar diathermy. Tissue will need to be obtained for pathological analysis, with a good durability of over 15 years. Again this form of therapy has been associated with a high rate of retrograde ejaculation.
The issue of retrograde ejaculation and its impact on a man’s sexual pleasure is very variable. The majority of couples state that it does not concern them. Younger men may choose tp have therapy that preserves antegrade ejaculation until that as an issue is no longer pertinent to them.
A man who feels that he may wish to have children in the future should not undergo a therapy that causes irreversible retrograde ejaculation.
Speak with a trusted urologist from Katelaris Urology. Dr Phillip Katelaris is an award-winning urological surgeon who specialises in bladder obstruction treatment. He can provide you with sound medical advice and effective treatment for urological problems, such as prostate enlargement or cancer, kidney stone, bladder cancer, erectile dysfunction and incontinence.
Schedule an appointment with Dr Katelaris, call us today at (02) 9477 7904.