63-year-old Man with Urinary Problems after Prostate Cancer Radiation (IMRT) Treated With Urolift – Real Stories

by Alex Shteynshlyuger MD

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Real Stories. Real Patients.

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.

Only your doctor can advise you on a course of treatment that is appropriate for your needs.

BPH Treatment after Radiation Therapy (IMRT) for Prostate Cancer: 73-year-old Man Treated at New York Urology Specialists

SL is a 63-year-old man with a diagnosis of prostate cancer treated with external beam radiation therapy with IMRT 2 years ago. 

He complains of a slow urine stream, a need to urinate frequently and urge to urinate.  He was previously treated with multiple medications including Rapaflo, tamsulosin, and Myrbetriq without significant benefit.  He was advised TURP (transurethral resection of the prostate).  He is hesitant to have TURP and wants to explore alternatives.  

AUA symptom score of 19.  

A thorough evaluation was performed which included bladder and prostate ultrasound, uroflow measurement, and bladder post-void residual urine volume measurement. The patient was found to have a large prostate, 73 ml;  peak urinary flow of 6 ml/sec, and a mean flow of 3 ml/sec.  He had an elevated post-void residual of 186 ml.  

Cystoscopy revealed lateral lobe hypertrophy of the prostate (moderately obstructing prostate) and a small but obstructive median lobe;  Urodynamic studies revealed very high-pressure voiding and small bladder capacity. 

Treatment options were discussed with the patient given that he failed treatment with medications. The patient was given a choice of a minimally invasive procedure performed in the office under local anesthesia shows such as UroLift procedure or Rezum procedure.  The other alternative is a hospital-based surgery performed under general anesthesia such as laser enucleation of the prostate (HOLEP) or bipolar TURP. The patient was informed that if a minimally invasive procedure does not result in a significant improvement of his symptoms, he has an option to undergo a hospital-based surgical procedure.

The patient decided to undergo a Urolift procedure.

Follow-up – Urolift Procedure

The patient presents for the Urolift procedure 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.  The Urolift procedure was performed, which took less than 20 minutes to perform.  Additional maneuvers were made to address obstruction from the median prostate lobe, which was successfully pulled away from the urethra using Urolift.  At the end of the procedure, the patient 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 given a catheter given the size of his prostate and history of radiation.

Follow-up Appointment – 4 days after Urolift procedure

The patient came back 4 days after the procedure for catheter removal.  He had minimal blood in his urine. The catheter was removed and he was able to urinate.

Follow-up Appointment – 6 weeks after Urolift procedure

The patient returned 6 weeks after the Urolift procedure. He reported significant improvement in urinary symptoms.  He reports that his urine stream is as good as it was 20 years ago.  He can go 3-4 hours before he needs to urinate.  He still has to urinate soon after drinking fluids or coffee.  

His AUA symptom score is 11, compared to 18 prior to the Urolift procedure.  

Because he has a small bladder capacity, he was started on Cialis daily and Myrbetriq 50 mg.

Follow-up Appointment – 3 months after Urolift procedure

The patient returned 3 months after the Urolift procedure.  He reports that he can drink freely and can hold urine for 5-6 hours if needed.  He has no side effects to Myrbetriq.  He is very satisfied with the outcome of the Urolift procedure. He reports a significant improvement in symptoms.