On May 2, 2015, Bob Colman got the shock of his life.
“I couldn’t urinate,” said the 66-year-old Plantation insurance broker. “I didn’t know what to do. I was frightened to death.”
After visiting his urologist, Colman was diagnosed with benign prostate hyperplasia or an enlarged prostate. It is a condition where the enlarged prostate may squeeze or partially block the urethra, the tube that carries urine from the bladder out of the body, causing men to have problems urinating.
In Colman’s case, his doctor told him his prostate was nearly three times the normal size, making it impossible to urinate.
“I was told I would have to wear a catheter forever,” said Colman, who is married with two adult children. “That didn’t sit well with me.”
Enlarged prostate is a common condition that occurs in all men, said Dr. Nicolas Muruve, an urologist and program director for urology and oncology at the Cleveland Clinic in Weston. It usually doesn’t become apparent until men are in their 50s. Symptoms include weak urinary stream, difficulty starting to urinate, trouble completely emptying the bladder, a frequent and urgent need to urinate, dribbling of urine and the need to stop and start urinating several times.
“It is like standing on a garden hose and trying to water the lawn,” Muruve said.
In some severe cases, such as Colman’s, a man may not be able to urinate at all. Colman didn’t recognize the symptoms until it was too late. He later recalled being slow to begin to urinate and getting up once or twice at night to urinate.
“Everyone I knew my age had the same symptoms I did,” Colman said. “I assumed it was due to old age and made accommodations for it.”
Benign prostate hyperplasia, the most common benign neoplasm in American men, is a chronic condition that is associated with progressive lower urinary tract symptoms and affects almost three out of four men during the seventh decade of life, according to the U.S. National Library of Medicine National Institutes of Health.
The risk increases every year after age 40. It is present in 20 percent of men in their 50s, 60 percent of men in their 60s, and 70 percent of men by age 70, according to the Prostate Cancer Foundation.
Benign prostate hyperplasia affects men in different degrees and can’t be prevented, Muruve said. Some men have minimal symptoms while others have significant concerns.
“Guys think [benign prostate hyperplasia] is a precursor to cancer,” Muruve said. “It is not. It is completely unrelated. If BPH affects your lifestyle, seek treatment. If not, don’t be talked into getting anything done for it.”
One form of treatment is alpha blockers, which are pills that relax the muscles of the prostate and bladder to reduce blockage and improve urine flow. However, the pills do not reduce the size of the prostate.
Patients can also be prescribed 5-Alpha reducatase inhibitors, which are pills that block the production of dihydrotestosterone, a male hormone that accumulates in the prostate and may cause prostate growth. These drugs increase urine flow and shrink the prostate.
A patient can also undergo transurethral resection of the prostate, a minimally invasive surgery where the excess prostate tissue around the urethra is removed. Risks may include heavy bleeding, scar tissue and retrograde ejaculation, when a man ejaculates and semen shoots into his bladder, Muruve said.
Colman went with another option, prostate artery embolization, a new minimally invasive procedure for this condition. Small microbeads are inserted through a small incision in the groin area to shut off part of the enlarged gland’s blood supply. Patients see shrinkage and normal prostate function restored within two to four weeks, often with no side effects. The FDA has approved the procedure to be done as part of clinical trials in the United States.
The ideal candidate for prostate artery embolizationis a patient with an enlarged prostate who has failed to respond to medication, said Dr. Shivank Bhatia, a radiologist with UHealth – the University of Miami Health System, which performs the procedure. The procedure can also be an alternative for patients who do not qualify for conventional surgery due to health conditions such as poor heart function or significant vascular disease, Bhatia said. There are virtually no long-term side effects such as sexual dysfunction, retrograde ejaculation or incontinence, he added.
Prostate artery embolization was a success for Colman, who had the procedure done at UM. About a month after undergoing the surgery in June, he had complete urinary control.
“My body functions like the clock was set back 20 years,” Colman said. “Now during dinner with friends I am the only person that doesn’t have to get up to urinate.”
Symptoms of benign prostate hyperplasia or an enlarged prostate
▪ Weak urine flow
▪ Dribbling of urine
▪ The need to stop and start urinating several times
▪ Trouble starting to urinate
▪ The need to push or strain to urinate
▪ Feeling that the bladder is full, even right after urinating
▪ A frequent and urgent need to urinate