Dr. Jeffrey Rosenblum, M.D.

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Publications: Philadelphia Inquirer

Advances In Urology Lead To Less Invasive Procedures
February 24, 2005

By Jeffrey Lee Rosenblum, MD.
Urologic Surgeon

As a urologist, I deal with disorders of the male and female urinary and genital systems. Rapid advances in the field of urology have resulted in improved care for patients. There is a trend toward minimally invasive treatments. This article will focus on two such treatments. One of these is a new minimally invasive treatment for prostate problems. The other is a less invasive type of vasectomy. Both procedures are performed In the office.

The prostate is a walnut-shaped gland that sits below the bladder and wraps around the urethra in men. BPH is benign prostatic hyperplasia, a noncancerous enlargement of the prostate. As the prostate grows it can restrict the flow of urine from the bladder by squeezing the urethra. BPH usually occurs in men over age 50 and affects millions worldwide.

BPH symptoms include the need to urinate more often, especially at night; urgency or the sudden sensation that you will wet yourself; a sensation of incomplete emptying of the bladder; a weak urine stream; and the need to strain or push when beginning to urinate. BPH symptoms can cause discomfort, embarrassment, sleep disruption or unwanted lifestyle changes. If the symptoms are allowed to progress, more severe consequences may ensue. These include urinary tract infections, blood in the urine, bladder stone formation, the inability to urinate and kidney failure.

BPH can be diagnosed by your physician. BPH and its symptoms have historically been treated with medications or surgery. The drugs either loosen up the tightness of the prostate or shrink it down in size. Medication therapy may not be effective and can have side effects limiting its tolerability. Medication expense is also a factor for many patients. Surgery can consist of TURP or transurethral resection of the prostate. Here an instrument is passed into the urethra and electrocautery is used to scrape out pieces of the prostate to create an open channel. Various lasers may also be utilized to treat BPH. Surgery involves a hospital stay, recuperation and the possibility of bleeding.

This is where an exciting, minimally invasive one time treatment for BPH comes in – TUNA (Medtronic Corporation, Shoreview, Minn). TUNA, which stands for transurethral needle ablation of the prostate, is a nonsurgical treatment for symptomatic BPH. The procedure is performed in-office with a local anesthetic. The TUNA device is inserted into the urethra to deliver low-level radio frequency energy directly into the prostate. This energy shrinks and destroys the prostate tissue, relieving the constriction on the urethra and improving symptoms of BPH.

The procedure usually takes less than 30 minutes. Most TUNA patients quickly return to normal daily activities. Generally, patients see improvements in their symptoms in two to six weeks. Improvements may continue over two to three months. Sexual side effects, such as impotence and ejaculation problems, are extremely rare. Incontinence with TUNA has not been reported.

Vasectomy is a minor surgical procedure to cut and close off the tubes (vas deferens) that deliver sperm from the testes; it is usually performed as a means of contraception. Vasectomy is nearly 100-percent effective, safe and does not interfere with sexual pleasure.

Urologists perform vasectomy procedures. A number of techniques are available. One that has grown in popularity with doctors and patients is the No-Scalpel Vasectomy (NSV). Both the traditional method and the no-scalpel technique are performed in the doctor’s office, under local anesthetic, and are safe and effective in experienced hands.

The traditional vasectomy is a minor surgical procedure and is usually completed in under 30 minutes. The surgeon uses a scalpel to make one or two incisions in the skin of the scrotum to access and expose the tiny vas deferens tubes from each testicle. The vas delerens is lifted, cut, tied, clipped, a section removed and often cauterized. The cut tubes are returned to the scrotal sac and the incisions are closed with a few sutures (stitches).

In the early 1970’s a new procedure known as “no-scalpel vasectomy” was developed in China by Dr. Li Shunqiang. Key to NSV are the special instruments that allow the procedure to be done with less manipulation of the patient’s tissues. A surgical clamp is used to hold the vas deferens while a puncture is made in the skin of the scrotum with special forceps. The forceps are opened to stretch the skin, making a small hole through which tile vas deferens is lifted out, cut, tied, clipped, a section removed, cauterized and then put back in place. The puncture does not require suturing. Some urologists recommend the no-scalpel method because they find it is quicker and minimizes postoperative discomfort and the risk for bleeding and infection. This results in faster recovery. Recently, as encouraging studies are reported, more vasectomies are being performed using this approach. During the past few decades, over 15 million no-scalpel vasectomies have been performed.

If you would like more information about the TUNA procedure, no-scalpel vasectomy, or other urologic issues, call Dr. Rosenblum at 610-594-5444, toll-free 877-MD-URINE, or visit www.rosenblumurology.com.

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Copyright © 2006. Dr. Jeffrey L. Rosenblum, M.D.
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