Minimally invasive procedure “an important new treatment option”
A cutting-edge procedure to treat the symptoms associated with a severely enlarged prostate, a common medical condition that negatively impacts the quality of life of thousands of older men, is being introduced to the African continent for the first time.
Dr Stephen Cornish, a urologist who practises at Netcare Sunninghill Hospital in Johannesburg, says that prostatic artery embolisation (PAE) is an important new treatment option for patients who suffer from a severely enlarged prostate and its often debilitating associated symptoms. “It is a valuable new weapon in the arsenal of treatments currently available for this condition,” he adds.
“Although we do not yet have the benefit of long-term international clinical trials, the treatment is showing promising results internationally. We believe it is important to introduce it to South Africa through a formal training programme.”
Four PAE procedures were recently performed at Netcare Sunninghill Hospital in Johannesburg as part of a two-day workshop with live demonstrations, held to familiarise urologists and interventional radiologists from around the country with PAE. The workshop was organised by Dr Cornish and interventional radiologists, Dr Farrell Spiro and Dr Andrew Lawson, who also practise at the hospital.
The procedures were performed by Dr Lawson under the proctorship of Dr Nigel Hacking. Dr Hacking is an international proctor for PAE and currently one of the world’s leading interventional radiologists performing this procedure. As proctor, his role was to be present during the procedures, offering advice and guidance to the operator where needed, and assistance to ensure the patients’ safety at all times. Dr Cornish says that the patients’ progress is being closely monitored and they are responding well to the treatment.
According to Dr Cornish, an enlarged prostate, or benign prostatic hyperplasia (BPH), is the most common non-cancerous prostate medical condition faced by men by the time they reach their 60s.
“PAE was introduced in Brazil and Europe some seven years ago and has since become an increasingly popular alternative around the world, to traditional surgery for enlarged prostate.”
“Among the reasons why PAE is proving so popular among patients internationally is that it is minimally invasive; it does not require large surgical incisions to be made, just one small puncture wound in the groin.
“As a result, there is a reduced risk of complications from the procedure and patients tend to recover much more quickly. They are usually treated as outpatients and are able to go home on the same day, as opposed to the one or two nights they would likely have had to spend in hospital after open surgery. In addition, and importantly, erectile function is preserved,” says Dr Cornish.
The male prostate tends to enlarge with age in response to hormonal changes in the body. Often symptoms are mild, however in some cases the prostate grows to a point where it severely blocks the flow of urine from the bladder, causing a range of uncomfortable and sometimes even debilitating symptoms.
According to Dr Cornish symptoms of an enlarged prostate may include:
- an ongoing urge to urinate;
- frequent need to urinate, particularly at night, which can severely disrupt sleep;
- inability to empty the bladder properly; and
- slow, interrupted, or weak urinary stream with leaking or dribbling.
If the prostate becomes so swollen that it completely blocks the flow of urine, emergency surgery may be required, as backed-up urine in the bladder caused by the obstruction could result in infections.
Dr Spiro and Dr Lawson will be the principal interventional radiologists involved in offering this service at Netcare Sunninghill Hospital. They share the view that PAE should be a team effort involving both the radiologist and the urologist, as well as the nursing support team. The procedure is only indicated when patients have a significantly enlarged prostate with severe symptoms.
“The procedure is undertaken by means of a small flexible tube called a catheter, which is inserted through the puncture wound in the groin and guided toward the arteries supplying blood to the areas of the prostate that are most affected. The entire procedure can take up to three hours, but the patient remains awake at all times. There is no pain associated with the procedure itself,” says Dr Lawson.
“Once at the site, we inject tiny particles which block the blood flow to the prostate, causing it to shrink. This is known as embolisation. Over a number of months, the prostate shrinks down to approximately 40% of its original size, resulting in a meaningful reduction in symptoms,” notes Dr Spiro.
“In less severe cases, the condition may be treated conservatively with medication or may not require treatment at all. Alternatively, surgery called transurethral resection of the prostate [TURP] may be recommended to treat acute symptoms. However, some men who have this surgical procedure experience problems with sexual functioning as a result of the surgery.”
Dr Lawson says that PAE is an intricate procedure that requires a high degree of skill to master. “For this reason, we felt that it was vital to partner with local specialists with expertise and experience in interventional work. We also decided to introduce PAE through a proper training programme, which gives local doctors the opportunity to develop the necessary skills which will enable them to become thoroughly familiar with this new treatment approach.”
Dr Lawson says that a follow-up workshop with the international proctor is planned for August 2016. Once this workshop has been completed, the procedure will be formally offered at the hospital.
Netcare Sunninghill Hospital general manager, Pieter Louw, praised Dr Spiro, Dr Lawson and Dr Cornish for their initiative. “Not only have they introduced an important new treatment for enlarged prostate in South Africa, but have put in a considerable effort to contribute to enhancing local medical skills. We are proud that these three highly enterprising medical practitioners are associated with our hospital,” he concludes.