September 26, 2023
September 26, 2023

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Q&A With Dr. Yosef Golowa

Dr. Yosef Golowa MD, FSIR, shares some of the latest treatments for men with enlarged prostates.

What are some of the symptoms of an enlarged prostate?

An enlarged prostate is the most common cause of urinary problems in men as they get older. Possible symptoms include:

a weak urinary flow

a feeling that your bladder hasn’t emptied properly

difficulty starting

dribbling urine after you finish urinating

needing to urinate more often, especially at night

a sudden urge to urinate

Can you tell us what Benign Prostatic Hyperplasia (BPH) is and why it is important?

Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate, a condition that affects most men at some point of their life. In fact, it affects about 50 % of men over 50 and becomes more common as they age. The prostate gland sits underneath the urinary bladder and as the gland enlarges, it can press on and obstruct the outflow to the bladder, which can make emptying the bladder more difficult.

When should men seek treatment for BPH?

As the prostate enlarges, it can cause symptoms that can affect quality of life. Patients can lose sleep because they wake up at night to use the bathroom, they can have urinary hesitancy, weakened flow or delay in starting. If left untreated, as the bladder does not completely empty, men may be at risk of developing urinary tract infections, bladder stones or even complete blockage of the bladder. Long standing obstruction can cause injury to the bladder and severe cases can even cause kidney damage. If you have these symptoms you should be evaluated by a doctor.

How is BPH treated?

For patients with mild symptoms, some medications can relax the muscle tone of the prostate or decrease its size somewhat over time. Medication, however, is limited in the amount of improvement one can expect and is generally used to treat mild symptoms. As this condition progresses, an intervention may be necessary. Many conventional treatments involve surgery to cut or burn the prostatic tissue, which can be invasive and result in unwanted side effects. One of the more novel treatments that we have had success with is Prostate Artery Embolization, or PAE, which does not involve cutting or instrumentation of the prostate.

How does Prostate Artery Embolization (PAE) differ from surgeries and other treatments?

As the prostate enlarges, it recruits extra blood vessels for blood supply. The strategy behind PAE is to reduce this extra blood flow to the prostate, which then allows it to shrink back closer to normal size without needing surgery or cutting of prostatic tissue.

The procedure is performed through a needle puncture into a blood vessel at the top of the leg, not much larger than an IV line. Through this needle puncture, a thin tube, about the size of a spaghetti, is guided under X-Ray into the blood vessel. An arteriogram (an X-ray in which dye is injected into the blood vessels) is done to map the blood vessels feeding the enlarged prostate. Tiny gel microspheres are then injected through the catheter to block off some of the small blood vessels that feed the prostate, reducing its blood supply. There is no cutting or bleeding after the procedure.

Following this procedure, the prostate begins to shrink and soften, relieving and improving symptoms in the days to weeks after.

PAE has a lower risk of urinary incontinence and other unwanted side effects when compared to more invasive procedures such as a TransUrethral Resection of the Prostate (TURP), Rezum, Urolift, and Aquablation.

What piqued your interest to help men with this condition?

I was first exposed to the PAE procedure in 2013 along with a group of doctors from leading medical centers across the US who flew to São Paulo, Brazil to train with one of the pioneers of this technique. We brought this procedure back to the US and were able to offer this non-surgical treatment to patients with excellent outcomes and high patient satisfaction. It is undoubtedly gratifying to be able to offer an outpatient procedure which takes about an hour in the office to men who were originally offered only invasive surgery. a. It can really change their life for the better.

Is PAE an established procedure covered by insurance?

There are several randomized controlled trials demonstrating PAE to be as effective in reducing symptoms compared to more invasive TURP (conventional treatment) with fewer complications. The microspheres used for this procedure have an FDA indication specifically for PAE, and the procedure is covered by Medicare and most insurance plans as it has met rigorous standards as a safe and efficacious treatment.

Does Prostate Center offer patients advantages they may not find elsewhere?

As the saying goes, you get good at what you do often. We focus much of our practice on the treatment of BPH and we are one of the most proficient practices in the region for PAE procedure. I work alongside an experienced urologist and we assess patients for BPH among other potential causes of symptoms. We can treat any urologic issues and offer men a range of BPH treatments, including medication or other minimally invasive treatments. Focusing our efforts on this disease process allows us to continually optimize and refine our skills to create a cater treatment plan for individuals walking through our doors.

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