by Carol Davis
PUBLISHED: 18:55 EST, 30 July 2012 | UPDATED: 18:55 EST, 30 July 2012
Around 60 per cent of men over 60 have benign prostate growth, which can mean you need to use the loo frequently.
Ken Willett, 59, a retired civil servant from Southampton, underwent a new procedure.
‘Sometimes I’d have to go (to the toilet) up to ten times a night,’ said Ken Willett
When I was in my late 40s, I started needing to go to the loo in the night.
I’d rush there, but produce so little I’d wonder what all the fuss was about — then five minutes later I’d need to go again.
Sometimes I’d have to go up to ten times a night, which left me a dragon at work the next day.
My father had the same trouble, so I assumed it was just part of getting older and didn’t bother telling my GP.
I cut out drinks after 7pm, but over the next decade it got worse.
It started happening in the day. too.
I’d avoid motorways because I’d worry I wouldn’t find a loo.
It was miserable, though my wife Evelyn was sympathetic.
He diagnosed an enlarged prostate, which he said happens to many men as they age.
He explained the prostate is wrapped around the urethra, the tube that carries urine from the body, and when the prostate grows it can start to compress the urethra.
The bladder can’t empty properly, so you feel you need to go, but can’t.
A blood test ruled out prostate cancer and I was prescribed a drug called tamsulosin, which relaxes the prostate, but I was still needing to go urgently.
I saw a urologist in January, who said the next step was to operate through the urethra to laser or cut away part of the prostate to stop it pressing.
But I was put off by the side-effects, including a small risk of impotence or urinary incontinence, and it meant up to five days in hospital and a recovery of up to three months.
Then, in May, my urologist mentioned a new procedure called prostate artery embolisation.
Tiny particles, the size of grains of sand, would be put into the arteries supplying the prostate to partly block the blood supply, so over time it would shrink naturally.
I saw Dr Nigel Hacking three weeks later.
Benign prostatic hyperplasia is common as men age – half of over 50s will have some prostate overgrowth, and three-quarters of 80-year-olds
He explained that like the traditional operation it could take two to three months before an improvement in symptoms, but I was keen because there was no risk of impotence or incontinence.
I had the procedure on July 3, without even being sedated — just a local anaesthetic spray.
Dr Hacking made a tiny puncture in my groin, then released the grains through a catheter. all I felt was the weight as they put pressure on to close the puncture.
I had to lie still for four hours, then my son James collected me. I had a bit of tenderness, and the nurse gave me paracetamol.
I’m now going to the loo only a couple of times a night and things are getting better already.
The great thing is I can take out my five grandchildren, and I’m looking forward to getting a good night’s sleep, too.
I’m so glad I made the right decision.
Dr Nigel Hacking is an interventional radiologist at Southampton General Hospital. he says:
Benign prostatic hyperplasia, or benign overgrowth of the prostate, is common as men age — half of over 50s will have some prostate overgrowth, and three-quarters of 80-year-olds.
Doctors do not fully understand why the prostate goes on growing; age is the main factor, but obesity, diabetes, high cholesterol and genetics also seem to play a role.
as the prostate — which adds fluid to semen — surrounds the urethra, when it grows it means men can have difficulty emptying their bladder.
Around half of men with this condition suffer symptoms.
This can be incredibly disruptive and, in extreme cases, can block flow completely, which means being rushed to hospital and having a catheter put in.
Men can try limiting their fluid intake before bedtime or take medication, including alpha blockers that shrink the prostate, or 5-alpha reductase inhibitors that affect testosterone, which is likely to be feeding this growth.
Medication is effective in most cases, but some men dislike these drugs because they can cause erectile dysfunction, low libido and other side-effects.
If the prostate continues to grow despite full drug treatment, the gold standard is transurethral resection of the prostate — which means cutting away part of the prostate with a hot wire or laser.
Yet this can cause impotence or incontinence — and in 10 per cent of men it needs to be repeated within ten to 15 years. Since it often causes bleeding, you also need to stay in hospital for up to three days.
Artery embolisation is a procedure that’s been used for more than three decades for conditions such as fibroids — benign growths in women that cause heavy bleeding.
It involves blocking off the blood supply in the arteries so the growth shrinks naturally. it was first done for prostate enlargement in Brazil in 2009 and studies have shown it is effective in 80 per cent of cases.
I’ve brought this to Britain to collect evidence for health watchdog the National Institute for Health and Clinical Excellence and my team has treated nine men since April.
The biggest advantage is that the patient avoids major surgery: it’s done with local anaesthetic and as there is no bleeding and little pain, you can go home four hours later.
Evidence from abroad shows 10 per cent of men have a recurrence of symptoms within three years, but as it’s done as an outpatient procedure, this possibility doesn’t put off men.
The procedure takes around two hours under X-ray guidance — we inject a dye so arteries are visible.
First, I make a 1.5 mm puncture in the main artery in the groin and feed a catheter through it up to the arteries supplying the prostate.
I then put another catheter just 1 mm in diameter through the first one — this releases tiny plastic particles, around a tenth of a millimetre in diameter, so they gradually dam up each artery.
I usually block two to three arteries, so the prostate will shrink, but have enough blood supply from other arteries to keep it alive.
Evidence shows it shrinks by about 30 per cent, so while it will still be slightly enlarged it should be much more manageable.
Then I withdraw the catheters, we press on the puncture to stop bleeding, and the patient has antibiotics, painkillers and anti-inflammatories.
Most men see a reduction in night-time frequency within a few weeks, though at three months there should be real improvement.
This could help many thousands of men, but until we know whether it is as effective as we hoped, it is too soon to offer it to all.
It is suitable for men for whom medication didn’t work or who found the side-effects of drugs unacceptable, or who have a large prostate with severe symptoms.
It may not always be suitable for men over 80 because the arteries can be too difficult to work with.
We are training at other hospitals — there are 100 centres doing fibroid embolisation, and I would estimate the same number doing prostate artery embolisation over the next five to ten years as the procedure becomes established.
The procedure will cost the NHS around