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Minimal invasive management for the relief of LUTS (lower urinary tract symptoms)
Why is it done?
- This procedure is performed when the prostate gland is causing LUTS and you want an alternative to medication without the complications of a permanent procedure.
- Symptoms include a weak stream, nightly urination, frequent urination, inability to urinate, (LUTS) kidney failure due to the obstruction, bladder stones, recurrent bladder infections.
- Medication such as Flomaxtra, Urorec, Minipress etc. should always be given as a first resort.
- This is alternative to medication where the ejaculatory function is to be preserved.
- Prostate cancer first needs to be ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
- Usually, a trial of alpha-blockers would be attempted
- Prostate sizes up to 80-100 cc with NO mid lobe.
How is it done?
- Patients will receive general anaesthesia, unless contra-indicated.
- A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigant fluid.
- The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
- The device is placed through the cystoscopic sheath.
- Prostate lobes are drawn apart similar to opening a curtain.
- Occasionally a Bladder Neck Incision may be done if the bladder neck is too narrow.
- Prophylactic antibiotics will be given to prevent any infections.
Complications
Side–effects
- Ejaculation will not be affected as with medication, TURP and TUVP, therefore no retrograde ejaculation, thus preserving sexual function
- Fertility is not guaranteed. If it is an issue, DON’T DO IT!.
- No Stress incontinence especially in the elderly and the diabetic patients
- May experience a slower stream initially due to swelling
- Some urgency symptoms
- Possible infection due to cystoscopy (<2%)
- Rare cases of stone formation on clips.
- Further enlargement of prostate lobes within 3-5 years requiring a definite procedure.
- NB! Each person is unique and for this reason, symptoms vary!
Copyright 2019 Dr Jo Schoeman