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Lynn Della Grotta Spring 2013 Biomaterials. Pertinent Physiology. Urethra Prostate gland Surrounds urethra Secretes fluid that mixes with sperm to make semen. http://www.umm.edu/graphics/images/en/10053.jpg. Benign Prostatic Hyperplasia (BPH). - PowerPoint PPT Presentation

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  • Lynn Della GrottaSpring 2013Biomaterials

  • Pertinent PhysiologyUrethra

    Prostate glandSurrounds urethraSecretes fluid that mixes with sperm to make semen

    http://www.umm.edu/graphics/images/en/10053.jpg

  • Benign Prostatic Hyperplasia (BPH)Benign (non-cancerous) cell growth of prostateGrowth of microscopic nodulesHormonal changes: DHT(dihydrotestosterone): stimulates cell growth in prostate lining(glandular epithelium) during pubertyEstrogen: testosterone decreases as male ages, higher ratio of estrogen levelsLate cell growth activationpresses on and can block urethrahttp://www.neotract.com/forpatients_ous-q10085-c10048-BPH_Overview.aspx

  • Symptoms of BPHFrequent urinationWeak/slow streamDelay/Difficulty in beginning urinationUrinary stream that starts and stopsPainful or burning sensation with urinationFeeling that bladder has not completely emptiedUrgent need to urinate and difficulty postponing urination*Size of prostate enlargement is not correlated to the severity of the symptomsMay have BPH with few or no symptomsSymptoms collectively known as LUTS: Lower Urinary Tract Symptoms

  • Scope40% of men in 50s70% of men in 60s80-90% of men >70 years old~33% of men with BPH have symptoms that disrupt their lifestyleRisk factors: age, family history, obesity, high blood pressure, low levels of HDL cholesterol, diabetes, peripheral artery disease

  • Treatment OptionsIf mild symptoms- monitorLimit alcohol, caffeine, excessive fluid intakePelvic floor muscle trainingAvoid antihistamines, decongestants, and diureticsIf treatment deemed necessary:Medications:Alpha blockers5-alpha-reductase inhibitorscombinationSurgery:Transurethral Resection of Protstate (TURP)Thermotherapies: Laser Resection of the Prostate, TUMTUroLift

  • 5-Alpha-Reductase InhibitorsFinasteride (Proscar) dutasteride (Avodart)Blocks conversion of testosterone to DHTBetter with significant prostate enlargementIncrease urinary flow, shrink prostate6-12 months before full benefits; continuous useSide Effects:Erectile dysfunctionLowered libidoDecreased semen during ejaculation

    Relax smooth muscles (bladder, urethra neck, prostate)Often first line of treatmentBenefits in days/weekContinuous dosage neededImprove urine flow, but dont shrink prostateSide Effects:Hypotension, headacheStuffy, runny noseDecreased ejaculateintraoperative floppy iris syndrome (IFIS)- selective

    Selective:tamsulosin(Flomax)alfusozin (Uroxatral)silodosin(Rapaflo)

    Nonselective:terazosin (Hytrin)doxazosin (Cardura)Alpha Blockers

  • Transurethral Resection of Prostate (TURP)

    Resectoscope inserted into urethra through penis and trim away excess prostate tissueSpinal or general anesthesia4-6 weeks recovery (1-2 days in hospital); catheter for 4-7daysComplications: heavy bleeding, erectile dysfunction, UTIAdditional procedures 5-10 years laterGold standard in surgery for treating BPH

  • ThermotherapiesLaser Resection of the ProstateVisual scope and laser inserted into urethra through penis; prostate tissue removedRisks: UTI, retrograde ejaculation,erectile dysfunction, narrowing of urethra(scar tissue formation)Transurethral Microwave Therapy (TUMT)Outpatient procedure: small microwave antenna inserted into urethra up to prostate. Microwaves heat up and destroy tissue.Risks: damage to genitals, UTI, retrograde ejaculation, erectile dysfunction, narrowing of urethra, need for re-treatment

  • Why UroLift?Medications are usually tried before UroLift consideredOver 25% of patients on medications discontinue use because of side effects or inadequate effectiveness Medication are short term treatmentsOnly 2.7% of BPH patients elect for surgeryComplications: sexual functionInvasive, risksUroLiftWhen medications arent effective or too many side effects and want less invasive surgeryPreserves sexual functionLess invasive, less risksQuicker symptomatic reliefProstate less than 100cc

  • UroLift DeviceIn post-market study in U.S.; available for use in Canada, Europe, and Australia

    http://www.neotract.com/formedicalprofessionals_ous-q10100-c10095-UroLift_Devices.aspxImplant:Nitinol capsular tabStainless steel urethral end pieceSize 0 polyethylene teraphthalate (PET) nonabsorbable monofilament

  • UroLift ProceduresLocal, general, or spinal anesthesiaCystoscopy: telescope inserted into rigid sheath of UroLift system; advanced through urethra up to bladderTelescope replaced with UroLift delivery deviceplace device at targeted area of obstruction, unlock needle safety lock, depress trigger to fire spring-loaded 19 gauge needle, retract needle to leave a tab on prostate capsule attached to polyester filament, depress release button to install urethral end pieceEach implant length is tailored to the various prostates and prostate locationsNo contact with lateral lobes until ready to deploy implant; compress lobe before deploying implantNumber of implants determined by surgeonMost critical target area is that of the urethra just distal to the bladder neckmovie: http://www.neotract.com/formedicalprofessionals_ous-q10096-c10095-Animation.aspxhttp://www.neotract.com/formedicalprofessionals_ous-q10095-c10049-UroLift_System.aspx

  • Recovery ProtocolsSpecifics decided by surgeonNo extreme exercise and no sexual activity for 2 weeksSometimes catheterization needed: on average about 1.5 daysRefrain from alcohol after surgeryReport any fever to physicianCan climb stairs, go to bathroom

  • Expected ImprovementsSymptomatic improvement within 1 day or 2; return to normalcy within 1 week40% mean improvement in IPSS(International Prostate Symptom Score) and urinary flow at 2 years48% improvement in QoL(Quality of Life) score at 1 yearNo reports of erectile dysfunction or retrograde ejaculationImprovements are comparable to the TURP surgery

    Pre-ProcedurePost-Procedurehttp://www.neotract.com/formedicalprofessionals_ous-q10095-c10049-UroLift_System.aspx

  • Expected ComplicationsMost common adverse events: dysuria, hematuria, and frequencyTypically resolved in 2 weeksIn 64 man study, reported serious events: Urinary retention(3), epididymo-orchitis(1), rigors(1), myocardial infarction(1)Resolved with standard treatment

  • Cost and InsuranceUnited Kingdom:Consultation: 210.00 ($315)Self-Pay: Surgery(surgeons fee, hospital fee, anaesthetist fee, follow-up consultation): 7,000 ($10,500)Insurance(Code M7080): 575 ($863) for surgeon and 240 ($360) for anaesthetistAccording to Bristol Urology

  • ReferencesBarkin, Jack. UroLift System for Relief of Prostate Obstruction Under Local Anesthesia. The Canadian Journal of Urology. April 2012. Web. 27 April 2013. .Prostate Laser Surgery. Mayo Clinic. Mayo Foundation for Medical Education and Research, 22 July 2011. Web. 23 April 2013. .Simon, Harvey. Benign Prostatic Hyperplasia. University of Maryland Medical Center. UMMC, 8 July 2009. Web. 22 April 2013. .Transurethral Microwave Therapy (TUMT). Mayo Clinic. Mayo Foundation for Medical Education and Research, 11 May 2011. Web. 23 April 2013. .Transurethral Resection of Protstate (TURP). Mayo Clinic. Mayo Foundation for Medical Education and Research, 10 May 2011. Web. 23 April 2013. .Transurethral Resection of Protstate (TURP). Wikipedia. Wikipedia, 28 February 2013. Web. 23 April 2013. .UroLift. Relief. In Sight. NeoTract, 2011-2012. Web. 22 April 2013. .

    The prostate gland is an organ that surrounds the urinary urethra in men. It secretes fluid that mixes with sperm to make semen. The urethra carries urine from the bladder and sperm from the testes to the penis.DHT= dihydrotestosterone stimulates cell growth in prostate lining (glandular epithelium); accounts for enlargement during pubertyRatio of Estrogen levels increase as testosterone decreases as male ages- may trigger prostate growth