HJAR May/Jun 2023

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2023 53 Timothy Goodson, MD Arkansas Urology The UroLift system treatment The UroLift system treatment is a revolu- tionary, minimally-invasive procedure that lifts or holds enlarged prostate tissue out of the way, relieving BPH and lower urinary tract symptoms (LUTS). Contrary to other procedures, there is no cutting, heating, or removal of prostate tissue, and UroLift does not result in bleeding or sexual side effects. Patients may experience urinary discomfort for two to four weeks, as well as an increase in urinary frequency, a burning sensation during urination, and mild pelvic pain. Aquablation therapy Aquablation therapy is another minimal- ly-invasive procedure designed to reduce the size of the prostate. An image-guided robotic instrument is inserted into the ure- thra and uses ultrasound tomap which areas of the prostate are safe for removal and will provide the most relief. Then, water jets on the robotic instrument release room tem- perature, saline water. Excess prostate tis- sue is removed by the jets with precision, diminishing blockage and providing relief without the need for surgical incisions. Pa- tients experience little to no pain from the procedure and typically stay overnight in the hospital. Aquablation is a popular choice for physicians because the procedure doesn’t require heat or harsh substances near the prostate and does not affect the ability to urinate or engage in sex. Transurethral resection of the prostate (TURP) Transurethral resection of the prostate (TURP) is recommended when the prostate doesn’t respond to medicinal treatment. By using a resectoscope, urologists and sur- geons can directly enter the urethra with- out need for incisions. A loop of wire on the resectoscope, which is heated by an electric current, is used to remove excess prostate tissue. Afterward, a catheter is inserted into the urethra and pumps fluid into the bladder to flush out the removed tissue. Some men experience sexual side effects, such as the loss of the ability to ejaculate and erectile dysfunction, alongside increased risk of UTIs. Alternatively, providers can recommend transurethral incision of the prostate (TUIP) for individuals with a small or slightly en- larged prostate, especially when other sur- geries are deemed too risky. During the TUIP procedure, a surgeon inserts a scope into the urethra and makes two small incisions on the prostate gland, allowing urine to pass more freely. This is commonly an option for younger men who are concerned about fertility. As BPH treatment options advance, so does your responsibility to the patient. Stay informed and stay on the leading edge of treatment options. Your patients’ futures depend on it. n Timothy Goodson, MD, joined Arkansas Urology in 2002 after practicing with Urology Associates of Texarkana in Texarkana, Texas. Goodson completed training in general surgery and urology at the Univer- sity of Arkansas for Medical Sciences. He earned a medical degree fromUAMS and a bachelor’s degree fromOuachita Baptist University.Goodson has a spe- cial interest in the treatment of prostate cancer and serves on theMedicalAdvisory Board of theArkansas Prostate Cancer Foundation.He has been instrumen- tal in bringing new prostate cancer treatments to the centralArkansas area.He is certified by theAmerican Board of Urology. BPH symptoms include: alpha-adrenergic blockers, 5-alpha-reductase inhibitors, an- ticholinergics, beta-3 agonists, and phos- phodiesterase-5 inhibitors. Alpha blockers relax muscles in the pros- tate and bladder neck, reducing outlet resis- tance and increasing urinary flow. In studies, up to 60% of men taking 5-alpha-reductase inhibitors and alpha-adrenergic blockers see improvement in symptoms, typically within a few days. When choosing the right drug for your patient, it’s imperative that you consider tol- erability, receptor subtype specificity, and adverse-effect profile. If medicine doesn’t work, more and more providers are turning to innovative, mini- mally-invasive surgical treatments that re- duce and relieve BPH symptoms. Minimally-invasive surgery to treat BPH As Arkansas urologists and physicians learn more about prostate health, treatment recommendations adapt and shift. Care- fully reference your patient’s condition and symptoms, as well as potential risks, before recommending treatment. If symptoms are severe, it’s time to consider surgery. The GreenLight PVP laser procedure GreenLight laser therapy uses a thin, flex- ible fiber, called a cystoscope, to enter the urethra and remove excess prostate tissue. Removal of the tissue allows urine to pass freely through the urethra and reduces the effects of BPH. Most individuals that un- dergo GreenLight laser therapy don’t need an overnight stay at a hospital and see more normal urine flow return within 24 hours.