56-year-old Man with Enlarged Prostate Causing Urinary Problems Treated at New York Urology Specialists

by Alex Shteynshlyuger MD

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Please note:  Names and age have been changed to protect patient privacy.  Treatment success varies. Not every patient experiences benefit from treatment.  Please talk to your doctor.  This is for informational/educational purposes and is not intended to replace a patient-doctor relationship.

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BPH Treatment: 56-year-old Man Treated at New York Urology Specialists

EY is a 56-year-old man with complaints of frequent urinary urges to urinate over the past 3 years worse in the past 1 year.  He had to wake up 3-4 times a night until about 6 months when the symptoms have improved and now he wakes up 2-3 times per night to urinate.  He reports that he needs to look for a toilet within 30 minutes of drinking coffee.  He was prescribed tamsulosin (Flomax) in the past but experienced problems with ejaculation but minimal benefit in terms of urination.

Physical exam revealed enlarged prostate, 50 ml. AUA Symptom Score of 21.  Uroflow revealed poor flow with a peak flow of 12 ml/sec and an average flow of 5 ml/sec.  Post-void residual volume in the bladder measured 60 ml.

Treatment options were discussed.  The patient decided to try medications again. Uroxatral was prescribed.  The patient experienced no side effects and his symptoms improved but continued to be bothersome. The patient reported a 20% overall improvement in symptoms with a better urinary stream and less frequent urination. 

Treatment options were discussed with the patient including the addition of finasteride (Proscar), bladder relaxant (oxybutynin or Myrbetriq).  After extensive consideration, the patient did not feel that he wanted to use multiple medications and preferred to undergo a one-time treatment.  

Cystoscopy revealed moderately-to-severely obstructing lateral lobes of the prostate and a slightly obstructive median lobe.  Prostate ultrasound revealed a 43 ml prostate.  

The patient elected to undergo the Urolift procedure. The patient was given a choice of having the procedure under general anesthesia (fully asleep) or under local anesthesia in the office. He chose to undergo the procedure in the office under local anesthesia.

The advantages of local anesthesia include no need for preparation, excellent pain control, and no risks of general anesthesia. By having the procedure under local anesthesia he is also saving a significant amount of money by avoiding the cost of co-insurance for a surgical center facility fee as well as anesthesiologist fee.

Follow-up Appointment – Urolift Procedure

The patient presents for the Urolift procedure under local anesthesia.  He had a typical breakfast.  The patient was previously advised that he can eat and drink normally before and after the procedure since it is being performed under local anesthesia.

A prostate block with bupivacaine was given to induce local anesthesia and numbness of the penis and prostate. Urethral lidocaine was administered to numb the bladder and the urethra.  Once the pain medications started to work, the patient underwent the Urolift procedure. At the end of the procedure, he reported minimal discomfort during the procedure with a pain score of 3 out of 10 (1 being no pain; 10 being the worst pain if his life).

The patient was able to urinate after the procedure and did not require a urethral catheter.

Follow-up Appointment – 3 weeks after Urolift procedure

The patient came back 3 weeks after the procedure. 

He reports no significant pain after the procedure but experienced some burning for the first 2 days after the procedure.  He had increased urinary frequency which has subsided.  He had blood in the urine for about 2-3 days after the procedure. He feels that his urine stream has improved.  He was advised to stop Uroxatral.

Follow-up Appointment – 2 months

The patient returned 2 months after the Urolift procedure. He reports significant improvement in urinary symptoms.  Some nights he does not wake up and other nights he wakes up once per night. This is better than previously when he woke up 2 to 3 times per night.  He also reports that urgency is now rare.  He reports an overall 70-80% improvement in symptoms after the Urolift procedure. He is very satisfied with the outcome of the Urolift procedure.

AUA symptom score has decreased from 21 to 6 suggesting a significant improvement in the quality of life and a significant decrease in bothersome urinary problems.