The tiny plastic beads that could revolutionise prostate surgery – and end post-op impotence
21:00 GMT, 11 August 2012
Men facing prostate surgery could avoid post-operative impotence with a simple new treatment that uses microscopic plastic beads.
The procedure – called Prostate Artery Embolisation – is set to revolutionise how men with an enlarged prostate or benign prostatic hyperplasia (BPH) are treated.
At the moment, the standard treatment is to cut out a section of the swollen prostate. But complications are common following this operation, and every year thousands are left suffering with sexual dysfunction, incontinence, infection and bleeding.
Benign prostatic hyperplasia is common as men age – half of over 50s will have some prostate overgrowth, and three-quarters of 80-year-olds
The new procedure can be done under a local anaesthetic using a catheter (a small plastic tube) to inject tiny plastic particles no bigger than a grain of sand into the blood vessels that feed the swollen prostate.
Radiologists pinpoint where to deposit the tiny spheres by watching on an X-ray television monitor as they insert the catheter through the thigh’s right femoral artery and into the tiny blood vessels that branch off it.
These spheres ‘plug’ these blood vessels, reducing the blood flow to the prostate and forcing it to shrink by as much as a third. The remaining blood supply allows the prostate to function at a healthier level.
‘With a faster recovery, reduced symptoms, improved urination and fewer potential side effects, it could lead to changes in accepted prostate therapy,’ say researchers.
Clinical trials in Portugal and Brazil have indicated that the procedure is effective and safe, with minimal side effects and no risk of incontinence or impotence.
Most of the 200 cases involved in the studies went home within four to six hours of treatment.
Complications are common following the operation, and every year thousands are left suffering with sexual dysfunction, incontinence, infection and bleeding
In particular, one trial, conducted at the University of So Paulo, Brazil, showed that there was an average 30 per cent reduction in the size of the gland after treatment.
Another, based on 84 men who were followed for nine months after the operation, reported a 98.5 per cent success rate, with 91.7 per cent of patients saying they had extreme improvement in their symptoms.
Currently, half of all men will show tissue change associated with benign prostatic hyperplasia (BPH) by the age of 50 – a figure that increases to 75 per cent among 80-year-olds.
Although not life-threatening, the condition sees the prostate – a walnut-sized gland surrounding the urethra, which carries urine out of the body – swell so big that it causes an obstruction. Symptoms include poor urine flow, more frequent urination, urinary tract infections and an inability to empty the bladder.
There are a number of surgical techniques, with Trans-Urethral Resection of the Prostate (TURP) considered the standard treatment.
In this procedure, carried out under general anaesthetic, sections of the prostate are shaved off to ease the blockage.
Conventional drug treatments include alpha-blockers, which work by relaxing the muscles at the neck of the bladder and in the prostate, and alpha-reductase inhibitors, which block production of a hormone called DHT, which contributes to prostate enlargement.
Some drug therapies are associated with side effects including dizziness and headaches.
But prostate artery embolisation could side-step such issues. And it has already been used in cases of advanced prostate cancer complicated by intractable bleeding.
Dr Nigel Hacking, consultant radiologist at Southampton University Hospitals NHS Trust, said: ‘In the overseas cases reported so far, complications were rare, mostly arising from minor bruising in the groin area where the incision was made.’