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New hope for an old problem.


Trivia question of the month: What is the most commonly performed surgical procedure covered by Medicare? For us males in the second half-century of our lives, the answer is not trivial: prostatectomy.

For the male who suffers from an enlarged prostate gland (not present in females), there hasn't been much choice in the past - either get up several times in the night to urinate or have the miserable thing treated surgically. And the annual cost is incredible - up to $3 billion annually. Moreover, the operation may have to be repeated after a number of years, and there may be such undesirable side effects as incontinence or impotency.

The problem lies with the prostate gland's anatomical position just below the bladder and surrounding the urethra. More than 60 percent of males age 50 or older develop prostate enlargement that compresses the urethra and restricts urinary flow. The symptoms can be merely annoying - slow starting and prolonged urination because of flow obstruction - but the blockage may become so severe as to produce urinary retention and consequent bladder or kidney infection. Although prostatic cancer can cause similar symptoms, it is not likely prostatic enlargement itself causes cancer.

The usual surgical procedure is transurethral prostatectomy - removal of some of the prostatic tissue by means of an electrical instrument inserted through the urethra. In a few cases, an abdominal approach is required. Newer methods of relieving the obstruction are now available, however, and although none has been in use long enough to clearly demonstrate its superiority to the standard surgical procedure, these methods appear very promising.

The most promising procedure thus far is a balloon device that goes into the urethra and is inflated so as to open up the urinary passage. Some 2,000 cases have been thus treated in the past two years, with satisfactory results in most. If the balloon alone does not do the trick, some tissue may be removed by a laser before the balloon procedure is then repeated. Other procedures involve using ultrasound to pulverize the tissue before sucking it out, or microwaves to shrink the tissue.

Researchers are currently testing a number of drugs for their abilities to shrink the enlarged prostate without any surgical intervention. Most of those tried in the past have had undesirable side effects - decreased libido or impotency, for example. However, final clinicaltrials are now being carried out by Merck and Co. of West Point, Penn., on Proscar, a drug that shrinks prostatic tissue without side effects. Unfortunately, about three months of treatment are required before enough shrinkage occurs to relieve symptoms. Another drug, Hytrin, produced by Abbott Laboratories, North Chicago, Ill., relieves prostatic pressure almost immediately, but it often produces dizziness and fatigue. In severe cases, however, the patient may find these preferable to the symptoms or surgery. Once approved by the FDA, these drugs are expected to have a profound effect on the amount of prostate surgery performed in this country.

Meanwhile, the problem narrows down to whether the patient's symptoms are sufficiently severe to justify surgery. If you are contemplating prostatic surgery, ask your doctor to provide a detailed description of both the available options and the risks of each - and seek a second opinion.
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Title Annotation:enlarged prostate
Publication:Medical Update
Date:Apr 1, 1990
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