Case study ( 77 views as of September 24, 2023 )
James is a 78-year-old retired psychologist with three children. Although he remains active and physically fit, he has been experiencing urinary troubles progressively for the past 3 years. He presented to his family medicine MD to be evaluated and had otherwise normal blood work. After being told he may have an enlarged prostate, he was initiated on Flomax medication to relax the prostate. The relief was minimal and James continued to have a markedly slow stream and continued to wake up 2-3 times per night. He was offered other medications to potentially shrink the prostate (Proscar) however being still sexually active, he did not want some of the potential side effects of these prostate medications, notably a reduced libido and ejaculatory dysfunction. As such, James was referred to see a urologist.
Upon urology consultation, non-invasive studies were conducted to objectively assess the urinary flow rate (Uroflowmetry) and ultrasounds to assess the residual urine volume in the bladder along with the prostate size/volume/dimensions. Since medications were no longer an option for the enlarged prostate, surgical treatments were discussed. While there were several to consider, from the gold standard technique of TURP to office based, minimally invasive procedures (including iTind and REZUM), James was most impressed with the most advanced technique of Aquablation.
Aquablation has the unique merger of ultrasound imaging to help personalize and customize the treatment contour. After creating a real-time map of the treatment prostate area, the robot system utilizes high pressure water to ablate obstructive prostate tissue. Furthermore, such a precise treatment of BPH helps preserve critical apical anatomy to conserve full urinary continence and ejaculation. These were most important for him to remain physically active and continue with his sexual life.
Now 4 weeks following his Aquablation, James is relieved of all of his obstructive lower urinary tract symptoms and no longer continues on any medications. He has full erections and unchanged ejaculation functions. James is now an advocate that sexual parameters are essential to be discussed for BPH (benign prostate hyperplasia) enlarged prostate discussions. All so often overlooked, most men globally are receiving TURP for the BPH surgery with >80% likelihood loss of ejaculation from such surgery.Author: Dr. Kevin Zorn