Selected Podcast

Urolift

Dr. Jaspreet Singh discusses what urolift is and who would be a candidate for this procedure.
Urolift
Featured Speaker:
Jaspreet Singh, DO
Dr. Jaspreet Singh is a board certified urologist. He obtained his medical degree from the New York College of Osteopathic Medicine and completed his clinical internship at Brookdale University Hospital and Medical Center followed by general surgery and urologic surgical residencies at Albert Einstein Medical Center, and Hahnemann University Hospital. Dr. Singh has also completed clinical externships at Memorial Sloane Kettering Cancer Center and the Children Hospital of Philadelphia during his residency.  Dr. Singh pursued additional fellowship training at Thomas Jefferson University Hospital in PA. His training includes experience and proficiency with minimally invasive robotic and laparoscopic procedures. He has a special interest in the diagnosis and treatment of ED (erectile dysfunction) prostate, bladder and kidney cancers, and urinary incontinence. Throughout residency and afterwards, Dr. Singh has sought to further advance his knowledge and surgical skill by continued training under the nation’s leading urologists and gynecologists.
Transcription:
Urolift

Melanie Cole: Welcome to Doc Talk presented by Montefiore St. Luke's Cornwall. I'm Melanie Cole, and today we're discussing the UroLift procedure for prostate issues. And joining me is Dr. Jaspreet Singh, he's a Board Certified Urologist with Montefiore St. Luke's Cornwall. Dr. Singh, it's a pleasure to have you join us again today. Tell us a little bit about BPH, the prevalence and general prostate issues that you see?

Dr. Singh: BPH is benign prostate hyperplasia or a normal benign growth of the prostate. As a man gets older. It is part of the aging process. It affects about 40 to 50% of men by the time they're 50 to 60. And as one gets older, the likelihood of having BPH increases, and as the prostate enlarges, there are definitely urinary changes that a man can experience that they start noticing. Now, the one thing Melanie, that prostate enlargement occurs over a long period of time. And so, as I tell my patients, it's like gaining weight. If you don't check your weight every month and you jump on a scale a year later and say, Oh my God, where did those 10 pounds come from? Prostate enlargement is very similar. So you can't look at urinary changes of how they've been over the last few days or weeks or months. It's how have they been over the last couple of years?

Host: Well, that's a good point. And certainly one for men and their partners to take into account that that means they should be coming in seeing their urologist on a regular basis for their yes, digital exam and their PSA. Correct? So, let's talk about if it's left untreated, if you've determined that somebody does have an enlarged prostate, are there any long-term risks? What are some of the complications?

Dr. Singh: Right. So prostate enlargement, as we just talked about, occurs over a period of time. So, a yearly or annual physical exam, as you've mentioned, the digital rectal exam is important. Now, a lot of times medical doctors can do that. I've been starting to see a lot of patients that are sent to me that their medical doctors don't examine the prostate. So finding a urologist, at least once a year to examine the prostate is very important because the changes of the prostate can be then compared to on an annual basis. And touching base with your urologist once a year to review urinary symptoms is also important and prostate enlargement can affect men in many different ways. So it can be annoying. In regards to that, one may feel that it's difficult to start that urination there's hesitancy, that they may find that the stream itself is weak, that they're hovering over this toilet.

Or sometimes I've seen men where it gets so weak that they're sitting on a toilet to urinate, and it just takes them so much longer. So weak stream hesitancy as they're urinating, perhaps it's a stop and go or intermittency to the stream. What really drives most men to come see me as they wait. Most guys will say, well, as long as they're urinating, that's okay, doc, it's coming out. It's fine. I realize it's weak, but it doesn't bother me. But when men start waking up at night, two, three, four, I've had men wake up every half an hour to 45 minutes because they're not emptying the bladder, causing them to urinate more frequently. That waking up at night is finally what drives them in. And you don't want to wait till that point. So as a surgeon, as the urologist here, definitely there are some things that we want to avoid. One being in a position where a man can't urinate and a disease or a diagnosis that we call urinary retention.

So, I've had men that wake up in the morning or in the middle of the night, all of a sudden, they find that they can't urinate. So everything's just blocked. So you don't want to wait till that point. What else is important in making sure that a man is urinating well? When you're not emptying the bladder, a man is at risk for developing urinary tract infections, stones within the bladder. And then finally that pressure of the bladder and storing the urine, starts to then get transmitted or pushed back up into the kidneys. And then men over a period of time can start experiencing kidney problems or an entity where the kidney swell up called hydronephrosis. And so we want to avoid these kind of terminal problems. And so picking up on urinary symptoms early is very important. Now, not everybody needs treatment, but at least a discussion that there are changes. And to recognize these changes and let your urologist or medical doctor guide you on when to intervene is important.

Host: It's so important. And I know there are things that you try before you discuss surgery, but seeing as how we're talking today about UroLift, why don't you tell us about this treatment option for men with BPH and what it is, what it means? Tell us what's involved Dr. Singh?

Dr. Singh: Right. So most men that are struggling with urinary changes that take the time to discuss with their medical Doctor, may have been started on medications and not to say that medications have been for many decades, a starting point in allowing our patients to start experiencing an improvement in their urination fairly quickly. These medications include tamsulosin or Flomax, rapid flow Cilladosin. And so these medications that are taken on a daily basis can help improve urination. And those symptoms of week stream, hesitancy, frequency, urgency should start to improve within a week to two weeks of starting the medication. The downside to medications are the fact that compliance is needed, right? So you have to be able to take a medication on a daily basis. There are side effects to medications, and a lot of the side effects to these medications that are meant to treat prostate problems, include dizziness, lowering the blood pressure, especially if you're going from a seated or laying down position to standing up an entity called orthostatic hypotension.

And a lot of times there are interactions to these medications, to other medical problems that patients are taking medicines for. And so for many men that either have side effects, don't want to take medications, or clearly may not even offer an improvement. We use the term surgically, but I look at it more as a procedure. Most men that think about surgery, I think about going to the operating room, having to be put under general anesthesia and having a somewhat invasive procedure. And most men recognize either talking to their friends or their fathers or their brothers. What had been, always discussed as the only surgical intervention was to go in and scrape the prostate out, a transurethral resection of prostate or TERP. As many of my patients referred to as the rotor rooter. Well, the UroLift procedure has allowed an improvement of urination without some of the needed steps that were required in a man to undergo a major invasive procedure like a TERP.

And so, a UroLift procedure is a unique way, and what we're doing is often done in the office or at an ambulatory center. It procedure that's done within 15 minutes under mild sedation, very similar to like a colonoscopy anesthetic, where we go in through the urethra, the tube that men urinate from a special instrument that goes in and the tissue of the prostate that squeezing the urinary channel, right? So the urinary channel that runs from the bladder out outside world has to travel through the prostate. And so as the prostate enlarges that pushes or squeezes that urinary channel. So what we're doing is we're reshaping the prostate. We're not cutting, we're not burning, we're not using any sort of heat. All we're doing is reshaping it by pushing the prostate to the side. And we keep it pushed to the side, by putting a stitch on the inside or an implant.

And that's what the UroLift device or UroLift procedure is. And so it's very important that you find a surgeon that has enough of an experience because the placement of the implants are very critical. And so the advantages that already described is that we don't have to go to the operating room. The physical recovery is much quicker, whereas often the rotor rooter or the TERP procedure would require a day or two in the hospital and a catheter in the bladder for several days. Men go home the same day and won't require a catheter perhaps for more than overnight and comes out in the office the next day. But immediately the relief of urination is noted. The stream gets better. The urgency, the frequency, all the symptoms we talked about that men struggle with, starts to improve almost immediately.

Host: That is amazing. And what a great explanation, Dr. Singh, you are such a great guest. Tell us a little bit about the outcomes that you've seen. You mentioned the benefits. You mentioned how quickly it can work. What do men say about it now? Maybe a year later after they've done.

Dr. Singh: Great question. I have been doing this now for many years. In fact, working with the hospital in the mid Hudson Valley here, I have been familiar with this procedure for well over years now and have now become a center of excellence. So I've developed this recognition from the company in recognizing that we are a center that not only delivers a consistent improvement in improving the life of men, but also in a safe fashion. And so I have had men who have had this intervention for now five to six years and are doing great. And the long-term studies, both the European studies, as well as the US data are long-term. The US data is five years outcome and European data, seven-year follow-up. And in both studies, roughly 85% of men at the end of five or seven years, respectively are urinating without the need of another procedure. So here we're offering an intervention that is relatively quick with minimal sort of investment, but yet the long-term benefit is seen. Now, I wish I could share longer data in Europe, we've been doing it for 10 years, but in all honesty, the likelihood of them making a 10-year follow-up is unlikely. And the reason is most patients, what is the tenure data?

Well, the challenge is that studies are expensive and the industry standard. So we look at all the other procedures that are out there for prostate management, including medications. The long-term studies are only 12 months to three years. So already they've demonstrated a long-term follow-up. So I've had men that enjoy limiting the side effects of some of the other invasive procedures, whether the roto rooter or using laser or heat, energy like resume. And the one thing that we don't see with the UroLift procedure is that there is no incidents of any erectile dysfunction or worsening of erections. There is no effect on stealing the ejaculation away, see medications and anything we do to disturb the prostate anywhere from 30 to 90% of men will experience the loss of ejaculation with climax or orgasm. We don't see that with this procedure. So especially men that are perhaps a little bit younger yet are looking to maintain their sexual function. This is a great intervention.

Host: Well, what a great point that you made, because I think that when men think of having anything done for prostate issues, that's probably top of mind as we wrap up and such an interesting topic, Dr. Singh give your best advice to men listening. As you began, you mentioned the importance of getting these things checked out every year by urologist or your primary care provider, give a little bit more of a shove to men and the people that love them and why it's so important that they visit a urologist and that they keep track and that they know their numbers and they know what's going on and they are their own best health advocate.

Dr. Singh: Right. I think you stated at Melanie, perhaps I can have the listening audience think about it a bit differently. All of us know how important is to take care of your car. All of us recognize the fact that we need to change the oil and the engine every three to 5,000 miles, that becomes a habit, a clockwork. Now, could you go longer without changing the oil in the engine? Of course, could you go long time without having to rotate the tires and so forth? Yes, but we do it because we want to make sure that when we turn that ignition, that engine runs and that we are able to get from point A to point B safely, we take care of our cars better than sometimes our health. And so most men recognize the fact that, Hey, I'm having these urinary changes. Yes, I recognize as part of aging, my friends have, are having the same problem, but that doesn't necessarily mean that's normal. And ultimately you can keep driving that engine until it gets to 20,000 miles and not change the oil, but it may not turn. But the difference is you can get another engine, but you can't get another, you can't get another life so that we only have this one life to keep up with.

Host: We certainly do. And thank you so much, Dr. Singh for this great information about the UroLift procedure at Montefiore St. Luke's Cornwall that concludes this episode of Doc Talk presented by Montefiore St. Luke's Cornwall, head over to our website at montefioreslc.org, for more information, and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Montefiore St. Luke's Cornwall Podcasts. I'm Melanie Cole.