Happy Valentines Day…From Mr. Prostate?

Posted on by John McHugh

Dr. Fabrizio Dal Moro is an assistant professor of urology  in Padova, Italy. He is a connection of mine on Linkedin. He creates interesting anatomic drawings that pertain to the particular surgery  he may doing that day. Below is today’s submission by him. You can visit his website and see other drawings by him. Happy Valentines day from your little friend…the prostate!

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Tomatoes and prostates? A tomato a day will keep the urologist away.

Posted on by John McHugh

The apple ain’t got nothing on the tomato!

download-2-toma

 

Article Reviewed: Lycopene Inhibits Disease Progression in Patients With Benign Prostate Hyperplasia. Schwarz S, Obermuller-Jevic UC, et al: J Nutr; 2008; 138 (January): 49-53.

Lycopene Inhibits Disease Progression in Patients With Benign Prostate Hyperplasia.

Schwarz S, Obermuller-Jevic UC, et al:
J Nutr; 2008; 138 (January): 49-53

Background: Lycopene is a carotenoid found in a variety of healthy foods such as tomatoes, watermelon, and pink grapefruit. It has garnered interest in the area of prostate cancer prevention, but has yet to receive adequate attention in the area of benign prostate hyperplasia (BPH). Objective: To determine the serologic, tissue, and clinical impact of higher plasma lycopene levels in patients with histologically proven BPH. Design/Methods: This was a randomized trial of 40 patients who received 15 mg per day of lycopene from a dietary supplement or a placebo for 6 consecutive months. Patients completed 4 visits at the medical practice during the 6-month period at baseline, after 1 month, after 3 months, and after 6 months. The primary end point was the reduction of increased PSA levels. Results: The mean patient age was 67 years and body mass index was 26 (slightly overweight). PSA levels decreased significantly in the lycopene group after 6 months from 6.6 mcg/L to 5.8 mcg/L, and there was no PSA change in the placebo group. Progression of prostate enlargement did not occur in the lycopene group compared to placebo as assessed by transrectal ultrasonography (TRUS) and digital rectal examination (DRE). Disease symptoms according to the International Prostate Symptom Score questionnaire significantly improved in both groups, but to a greater degree with lycopene. However, the placebo group experienced significantly greater reductions in LDL cholesterol compared to the lycopene group.

Conclusions: Lycopene at a dose of 15 mg/day may inhibit the progression of BPH.

Reviewer’s Comments: Lycopene from diet and supplements has not experienced impressive data as of late in the area of prostate cancer research. Perhaps the earlier use of lycopene in healthy patients with BPH was a more ideal opportunity to test the impact of this supplement. The most impressive finding was not the reduction of PSA by lycopene, but that both groups reduced their intake of overall calories to a large degree during the trial. In the Prostate Cancer Prevention Trial (PCPT), men in the placebo arm that reduced their caloric intake also reduced their PSA velocity. In other words, is the lycopene supplement responsible for the favorable impact in this study, or the fact that men reduced caloric intake, which may have also caused the LDL and PSA reductions? (Reviewer–Mark A. Moyad, MD, MPH).

Prostate problems? Visit Georgia GreenLight Laser for more information re: the laser treatment of prostate enlargement.

Or if you prefer enter your number below and we’ll contact you with an appointment.

 

What is the verumontanum and why is it important during GreenLight Laser procedure?

Posted on by John McHugh

 

There are four features of the prostatic urethra seen immediately below. Furthest from view is the median lobe of the prostate which is positioned horizontally. Proximal to this is the bladder which cannot be seen due to the obstructive components of the prostate. Closer to the viewer are the median lobes of the prostate which come in to the channel of the prostate on the left and right and in addition to the median lobe cause the obstruction of urine flow. Then in the foreground is the verumonatum which is raised area in the prostate and where the seminal vesicles empty fluid from the seminal vesicles and testicles.

The significance of veru is that this represents the point of the prostate where the urologist stops the resection or laser treatment. Beyond the veru is the external sphincter and if this is resected or damaged then there is a risk of incontinence.

If you look closely at the veru you can see the small opening from which the above mentioned fluid emanates.

 

At the end of this GreenLight performed by Dr. McHugh, you’ll see the opened channel for the prostate from the bladder to the veru and the veru intact which means that the resection did no proceed beyond the point of compromising incontinence.

 

What is the Rezum vapor treatment of prostate enlargement?

Posted on by John McHugh

This form of prostate enlargement will soon be offered at Northeast Georgia Urological Associates. It can be performed in both the office setting and in our ambulatory surgery center. Steam is used to shrink the prostate away from the prostatic urethra (the tube through the prostate through which the male urinates) and improve voiding in the male with prostate enlargement. Even though it is a new modality the skills necessary to perform this procedure are used commonly by the practicing urologist.

Rezum Website

If you have questions about this new form of treatment or have an interest in a prostate enlargement treatment that can be done in an office setting please leave your number and we’ll call you with the appointment.

BPH 101-An animation

Posted on by John McHugh

Our nurse practitioner Christie Woodruff found this info-cartoon and thought it would be a helpful in understanding prostate enlargement…in a fun way.

The urologists of Northeast Georgia Urological Associates treat BPH commonly and use both medical and minimally invasive surgical procedures to correct this male issue. You can contact us 24/7 by leaving your number and we’ll call with an appointment.

Does surgical treatment of BPH (benign enlargement not prostate cancer) cause sexual dysfunction?

Posted on by John McHugh

normal-bph-bladder-diagram

Patient’s will commonly confuse the side effects of the surgery of prostate enlargement (difficulty voiding, frequency, small and slow stream, getting up at night) with that of prostate cancer surgery (leakage of urine and deterioration of sexual function).

This is not surprising as in general terms a surgical therapy is being done to the prostate and you’d think the side effects would be similar. However, in cancer surgery the entire gland is removed and in prostate enlargement the channel through the prostate where the urine flows is opened. As a result in BPH surgery (TURP, Button vaporization, GreenLight Laser) opens the channel to improve voiding but does not affect the continence mechanism or the nerves that impact potency. Surgery of the prostate for enlargement does cause retrograde ejaculation (the fluid at time of ejaculation does not come out at all or not as forcibly) but this was not found to have any impact.

The following study confirms this.

Surgical Management of BPH Does Not Reduce Sexual Function

Urology – August 1, 2006 – Vol. 21 – No. 12

Surgical management of BPH does not result in poorer sexual function, nor is there a difference between HoLEP and TURP.

Article Reviewed: Impact on Sexual Function of Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results of a Prospective, 2-Center, Randomized Trial. Briganti A, Naspro R, et al: J Urol; 2006; 175 (May): 1817-1821.

Impact on Sexual Function of Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results of a Prospective, 2-Center, Randomized Trial.

Briganti A, Naspro R, et al:
J Urol; 2006; 175 (May): 1817-1821

Background: Mixed data exist in the literature on the effect of surgical intervention for benign prostatic hyperplasia (BPH) on sexual function. Design/Objective: This randomized, controlled trial compared the impact of holmium laser enucleation (HoLEP) and transurethral resection of the prostate (TURP) on sexual function. Participants/Methods: 120 patients with BPH and lower urinary tract symptoms were randomized to either HoLEP or TURP (60 patients in each group). The patients were followed up and completed the validated sexual function inventory in the International Index of Erectile Function (IIEF), as well as a series of global assessment questions at 12 and 24 months postoperatively. The patient groups were matched for International Prostatic Symptom Score (IPSS) and quality of life (QOL) scores at baseline (21 and 4.5, respectively). The HoLEP group had a larger prostate volume (73 g) than did the TURP group (58 g). The baseline erectile function scores were similar between the 2 groups (21.8 vs 22.1; >25 indicates no erectile dysfunction [ED]), with approximately 50% of patients in both groups having some degree of ED preoperatively. The pharmacological treatment profiles prior to surgery were similar for both groups. Results: At 12 and 24 months after intervention, there was a slight, but statistically insignificant, increase in IIEF erectile function domain score in both groups (approximately a 1.5-point increase), with no difference in scores or degree of improvement between either surgical group. Furthermore, there was no difference in the incidence of retrograde ejaculation between groups. Of note, orgasm function (as scored by the IIEF) was decreased in both groups to a similar extent. There was a strong positive correlation between postoperative IPSS and QOL scores and the erectile function improvement, suggesting that the improvement in urinary function may be integral to sexual function improvement. Conclusions: Surgical intervention for BPH in the forms of HoLEP and TURP had no significant negative effect on erectile function, and no difference was found between the 2 surgical modalities. Reviewer’s Comments: This excellently conducted study sheds significant light on the fact that surgical treatment of BPH likely has little impact on sexual function. Indeed, in some men, function may improve. The inclusion of a validated questionnaire is a major strength of this study. Of note, the reduced orgasm function domain scores are most probably indicative of the nature of orgasm assessment using the IIEF. The questionnaire has only 2 questions on orgasm, one of which pertains to ejaculation. Thus, after surgical management of BPH, the IIEF would not be considered an adequate assessment tool for orgasm. It is worth noting that 50% of men had ED at baseline; therefore, it is conceivable that, in a population of patients with full erectile function at baseline, these results might be different, perhaps even a greater postoperative improvement in erectile function. (Reviewer–John P. Mulhall, MD).