Symptoms And Treatment For Enlarged Prostate With Dr. Steven Thoma

This video is from a patient educational seminar about benign prostatic hyperplasia (BPH) better known as an enlarged prostate, its symptoms that present for men, and the variety of treatment options, including a minimally invasive procedure that has had great results for men. Presented by Steven Thoma, MD, urologist at MercyOne North Iowa, Urology at Mason City Clinic.

BPH is very common, affecting nearly 40 million Americans and 500 million men worldwide. More than 40% of men in their 50s and more than 70% of men in their 60s have BPH. While BPH is a benign condition and unrelated to prostate cancer, it can greatly affect a man’s quality of life.

Many men do not understand what their prostate does and how it can impact their lives.  The prostate is a small gland that is about the size and shape of a walnut that is located below the neck of the bladder. The urethra runs through the center of your prostate, letting urine flow out of the body.

If you or someone you know is suffering from an enlarged prostate, contact the Mason City Clinic Urology Department to schedule a consultation at 641-494-5280.


Carol Gifford:

Well, welcome everyone this evening to our patient seminar, really appreciate you registering and attending. My name is Carol Gifford, and I will be your facilitator this evening. Our featured speaker is Dr. Steven Thoma, who is a board-certified Urologist at Mercy One North Iowa, Urology Specialty Care at the Mason City Clinic. And he is going to be talking with you about a very common health issue that men have, especially as they age called benign prostatic hyperplasia or BPH and he will walk through what the symptoms of BPH are, how it gets diagnosed and the variety of treatments that are available.

So, I just want to remind everyone that this seminar is being recorded. And if you have any questions as Dr. Thoma is going through his presentation, please just type them in at the bottom of the window there’s a Q &A and there’s also a raise your hand so either one will work. Then, when we get to the end of the presentation, Dr. Thoma will answer all those questions, so without further ado, you can take it away Dr. Thoma.

Dr. Steven Thoma:

Great! Thank you, Carol. Thank you, Alicia. Thank you all for joining us here today for this webinar. Really kind of wish we could do these things in person, but sometimes it’s easier with technology, but I hope to meet everybody in the future that that wants to talk more about this. If you feel like any of these things apply to you and if you feel like you would benefit from any of the things that we talked about. So again, I am Dr. Steven Thoma. I’m based here in Mason City, Iowa at the Mercy One North Iowa Specialty Clinics at the Mason City Clinic.

We’re going to talk about BPH tonight.

Here we go, so this is just saying that I have no conflicts of interest, you know disclosures that sort of thing, I’ll leave it there for just a second, so you all can read it, but it’s basically saying that I’m not being paid by anybody, other than my personal practice, but no product companies or anything have any sort of financial interest in this.

So, what are we going to want to talk about tonight is the prostate and the importance of it. What is BPH, benign prostatic hyperplasia or enlarged prostate, how do we go about diagnosing it and kind of determining how you know. How bothered by it the patient is or how worried about it, we should be, and then, last but not least, what everybody’s probably most interested in are some treatment options that are available.

So, I see a raised hand from Carol Gifford, I’m not sure if that was just a test.

Carol Gifford:

Yeah just a test, sorry about that.

Dr. Steven Thoma:

Very good, so we’ll continue.

So the prostate it is around the size of a walnut for most guys, though they can get much, much larger than that in significant cases of enlarged prostate. And it surrounds the urethra, and so my understanding is you all can’t see my pointer so we’ll just look over here at this picture and you can see, the prostate lives right underneath the bladder.

And so I usually tell my guys that it’s almost like a doughnut, there’s a channel right down the middle of it. And the urine has to pass from the bladder down the middle of the prostate to get to the rest of the urethra and into the outside world.

And that is where we can run into problems because if that prostate enlarges, you know if it enlarges outwards kind of like who cares it’s not going to cause a lot of trouble, but if it enlarges inwards, it kinks that or blocks that too. However you want to think about it, but it creates that resistance and that urine can’t get out of there as well as you, as your bladder would like and it causes all those symptoms that come from the trouble from our prostate. And so a lot of guys say well what’s the prostate for? Why do I even need it? Just take that thing out of there.

Well the real use of it or the real purpose of it, I should say, is that it does produce fluid that transports sperm during ejaculation. So it has a reproductive role. It doesn’t really have a role in our urination other than causing some problems potentially if it enlarges.

So these are some of the more common prostate conditions. First one, prostatitis, that is infection or inflammation of the prostate. And, like most tissues when they are inflamed that can be painful. The tissue swells both outward and inward and that can cause a lot of urinary symptoms. But that’s not enlarged prostate.

The next one, there is enlarged prostate kind of the main focus of the talk today, and that is a benign, meaning non-cancerous and that’s very important, but benign enlargement of the prostate gland.

And last but not least, prostate cancer that’s a very common cancer most common cancer in men. Thankfully, typically very slow growing. That has absolutely nothing to do with the size of the prostate. You can have a huge prostate that has no cancer, you can have a tiny prostate that’s just awful with cancer.

Prostate cancer has nothing to do with size of prostate and a lot of men worry that some of their urinary symptoms indicate that they have prostate cancer. The answer is yes, it can but it’s only in very advanced prostate cancer and usually those aren’t even the symptoms that come with prostate cancer. So most of the urinary troubles that men have are going to be from enlarged prostate not from prostate cancer.

So the prostate grows over time, usually two phases here. The process typically grows to a normal size during the teenage years and then, as we start to get older usually in a late 30s but definitely the 40s and beyond, we really start to see enlargement of the prostate.

So this just shows some of the incidences of enlargement of the prostate so at around age 50 around 60% of guys will have some degree of difficulty from enlarged prostate and it just kind of gets worse as we get older. That prostate continues to enlarge, and we accumulate the kind of effects of an enlarged prostate and those symptoms just worsen and get exacerbated the older we get.

So what exactly is BPH, benign prostatic hyperplasia? That’s just a medical term for a big prostate and enlarged prostate and again non-cancerous, so it is not an indication of eventually developing prostate cancer. And a lot of men know about the PSA, that’s the prostate specific antigen that everyone associates with prostate cancer, we only use it as a marker to screen for prostate cancer. PSA is a normal component found in the blood. The technical role of PSA is to liquefy semen, so that you know the semen and the sperm can make it where it needs to go for conception.

So it’s not that if you have prostate cancer, then you get a PSA. All men that have a prostate have a PSA. We just know that as it rises that can sometimes be an indication of prostate cancer. But you can also see that rise in BPH and a few other non-cancerous issues so PSA very important, but it is not immediately indicative of enlarged prostate or prostate cancer, necessarily, for that matter.

So, as our prostate gets bigger, as we mentioned before, pressure gets put on the urethra, kinks the urethra or clogs the urethra or however you want to think about that, but it causes our urinary troubles. Imagine a pipe that is clogged up, you’re not going to get good flow through there, things back up, it causes trouble so size does correlate to a degree, with issues from the prostate and severity of symptoms but not always a one to one because I mentioned very early on that if you have a large prostate that enlarges outwards, it doesn’t really cause trouble because it’s not clogging that urethra or that pipe. And so you can also have a relatively small prostate but if all the enlargement is coming inwards, that guy is going to have a lot of trouble.

So here are these two pictures – here on our left normal prostate anatomy. You can see that the urethra in the prostate is pretty wide open. When that bladder squeezes, the urine is going to be able to flow through their relatively unobstructed. That guy’s not going to have too much difficulty from his urination. I also want to draw attention to the bladder itself and in particular the room there, so that’s … that bladder is kind of sliced down the middle, it is a cross section, but that’s the wall of the bladder, the bladder is a big ball of muscle.

And on the right side of the screen over here, we have a bladder that is very affected by this prostate. This prostate is clogged up, it’s obstructed, and as a compensating measure that bladder has thickened, that muscle has enlarged. And I always kind of joke with my patients, especially when we see things like this and then that, those thick muscle bands, that those big muscles, that’s great when it’s in your chest or your biceps – bodybuilders, you know that’s a great thing. You don’t want that in your bladder. That is a sign that your bladder is suffering, and that is a compensatory mechanism to cut up, squeeze as hard as it can to force the urine through a clogged prostate, half-blocked or obstructed prostate.  The bladder is a pump. If you have a pump that is pumping against a closed or clogged valve, that pump’s going to fail, eventually, and that is exactly what can happen with our bladder.

Eventually, our bladders just give up, they say no more, I’m done, I’ve run my course and it just doesn’t squeeze any longer. And the unfortunate thing is sometimes there’s no coming back from that. If that bladder fails, you could take that whole prostate out, remove all of the obstruction but if that bladder doesn’t squeeze any longer, that guy’s not going to be able to recover that urinary function. So the goal, the strategy, the impetus is to try to intervene on these things early, kind of you know a lot of guys think about it, like their car preventative maintenance – you try to get ahead of any problems that could come about down the road.

So what are some of the symptoms of BPH? Most guys know these all too well, but the frequent need to urinate day or night, the need to suddenly rush to the bathroom, or difficult or painful urination. You know if you have burning, stinging, that often we think about infection. But sometimes guys at the initiation of urination will have some discomfort because that bladder is squeezing so hard and building pressure to kind of finally force it through that prostate, and that could be uncomfortable.

A weak or slow urine flow, incomplete elimination of urine, or otherwise saying you just don’t empty your bladder very well. And then intermittency – stopping and starting of the flow. You get a little out and you got to stop and then you push some more and you get a little out and you just keep going back and forth like that.

And so the last four there are, excuse me, the last three or four are the kind of quintessential big prostate symptoms. Those first two: the frequent need to urinate, the sudden urge to urinate – yes those absolutely can come with enlarged prostate, but when I talk about those symptoms specifically, I often explain that you know if a woman came to my practice and said, “Hey I have to go urgently, I have to go frequently.” I would say okay that sounds like overactive bladder because women don’t have prostates, so they don’t have these other issues that we’ve been talking about. And so, the reason I bring that up is men absolutely can have both – they can have overactive bladder and they can have enlarged prostate. But they are sometimes related and a bladder just gets very affected and very angry by a big blocked up prostate and you get it kind of becomes spastic and you get these irritated complaints – frequency and urgency.

And sometimes by fixing the prostate issue, that all gets better. Sometimes we have to do a little more work on those specific symptoms. But as I said before, those last three: the weak urine flow, the incomplete emptying of the bladder, the starting and stopping, the hesitancy to having a wait for it to get going, those are all the quintessential prostate-type symptoms.

And then on the left side of the screen there, this is just a graphic showing that this doesn’t just affect us, it affects our partners as well. And so, in this particular study it mentions that only 8% of men, when they were asked about when they get up at night, whether it bothers them, they say no, it’s okay I go back to sleep. But their wives, their partners, whomever they say it bothers them and it impacts their sleep. So it’s not always just about us, it can affect others as well.

And so what kind of effects on your quality of life, can you have? Well you know, you guys probably know it better than I do, it disrupt your sleep patterns, now you have to kind of plan around where the bathroom is, everywhere you go you’re scoping out where that restroom is. Interruption of leisure activities, we have guys all the time tell me, “Hey, I’ve got my favorite tree on hole number four that I know every time I’m hitting the golf course that I’m going to have to go to it,” and it just really kind of cramps their style, so to speak.

And then, using a bathroom stall instead of urinals. Sure, you know, some guys, it’s such a process to urinate that they just have to go and sit down and that’s not bad, but it’s obviously not ideal, and so it just kind of illustrates that this can really affect our quality of life.

So, what happens if your BPH is not treated and I alluded, a little bit to this before with the idea of kind of preventative maintenance. What these pictures are showing here are the visual effects that you can see from a bladder that is suffering. So on the left there’s a healthy bladder that looks great, the little red squiggles, those are little blood vessels. But the tissue itself, the inner lining that’s called the urothelium, it’s very smooth. It looks as it should.

And in the middle, that’s kind of a middle stage bladder there, you start to see these ridges. Those are those muscle fibers, the muscle bundles, that we kind of saw on a previous diagram. Those muscle bundles are thickening and growing so that they can squeeze harder to get the urine out. You don’t want that. The technical term for that is trabeculation.

And then the last one, that’s severe. Sometimes you’re looking at a guy’s bladder and it literally looks like there’s cobwebs in there. These muscle bundle bundles have thickened so much that you get these pockets all throughout the bladder that are almost like little balloons that stick off the bladder. Those are called diverticula, or diverticulum is the singular, or cellules, but these are basically just little pockets, where little stones can form or urine gets trapped in there, all these different things. But that on the far right, that’s an end stage bladder. That guy is suffering. And if his bladder hasn’t given up yet, it’s about to, so if he still has the ability to get treated, that guy absolutely should.

So how do we go about diagnosing? The first is just the patient interview, we talk about your symptoms. One way to further quantify and qualify symptoms, is the IPSS questionnaire, the international prostate symptom score, that is a validated questionnaire, where you just answer some questions. And I think there’s another slide coming up that kind of talks about the questions that it asks you. But it just goes through all the parameters of urination, and you put it on a scale of one to five, of how often, you are affected by that particular issue. And then you tally up the scores, and you can stratify a guy into you know low, moderate, and severe categories of bother, essentially, and we’ll get to that in a second. I’ll continue that thought here shortly.

But the other things that we look at are uroflowmetry, so that’s just what it sounds like, we have a guy urinate into a machine and it tells us just how fast his flow is. A digital rectal exam, every guy’s favorite thing, that’s the finger test in the bottom. That is not the best way to assess the size of a prostate, it is kind of notoriously inaccurate.

The better way to get a view down there is the Transrectal Ultrasound. That is an ultrasound of the prostate that will calculate the total volume, just how big around that prostate is. A bladder scan can tell us how well a guy empties his bladder, pressure flow studies that kind of goes with that first uroflowmetry but it’s a little more involved a little more information comes out of pressure flow studies. And then the very last one is cystoscopy, so that’s a scope in the bladder that is done with a flexible tube – very small, very thin, again, flexible. In my practice we numb up guys ahead of time before we do that. We use some Lidocaine jelly, that procedure takes 60 seconds.

And a lot of guys, when I tell them hey, we need to run a scope through your urethra to take a look around, they look at me like I have three heads. And I get it. It sounds awful. I promise you, it is not. Almost every guy when we’re done says, I don’t want to do that again, but that was not near as bad as I thought it would be. And so that is a very important test, because that is how we were able to see these pictures, these are from cystoscopy. So in my practice the usual thing is the bladder scan, the Transrectal Ultrasound most of the time, the cystoscopy always. But those are all procedures that take less than 60 seconds, they’re done in the office, they are no big deal.

So the IPSS, as I mentioned before, here are the symptoms that they ask you about – incomplete bladder emptying, frequency, urgency intermittency, weak stream, straining, nocturia means getting up at night to go to the bathroom and, at the end asks you about your quality of life. Just kind of how happy, are you, with your symptoms, if you had to be the way you are the rest of your life.

And so you know, I get guys that they come in with numbers all over the board, you know, usually they’re higher moderate to severe. But I never … I always tell the guys, you know I’m never going to show you your numbers, say oh, you’re a 25, you’re in a severe category, that means you have to have something done. Absolutely not.

What this score does is it puts it in front of a guy to show them kind of how bothered they are. Because a lot of guys, they kind of … they’re so used to the way things are, they downplay it a little bit. They say sure, I’ve got a little bit of this, a little bit of that, but it’s no big deal. My wife thinks it’s worse than it is, but I think it’s fine. And then you show them, hey your score, you know, puts you in a severe category there’s obviously some room for improvement. It kind of, that light bulb goes off and they say yeah, you’re right, I guess, it is a little worse than I thought it was. But I would never show a guy his number and say you have to do something. This just starts the conversation.

And, more importantly, it establishes a baseline. So if we do do a treatment of some sort, whether it be medications or procedures, you can then compare down the road to see how much ground you gained, how much improvement you saw there.

So what are the treatment options here? So starting all the way on the left – watchful waiting. That just means do nothing. We just check up on you, we kind of make sure that your symptoms aren’t worsening, that we’re not seeing any evidence of further effects that could cause more issues like urinary tract infections or severely poor emptying of the bladder which can sometimes lead to kidney damage over time if it’s truly severe. But just we’re just watching, we’re waiting to see if things worsen.

And then there are medications and supplements. Every guy comes in and asks me about super beta prostate. Those guys, they are great marketers. There’s other prostate supplements out there as well, and my usual take on that is you have to be careful. One because there is no regulatory body that is looking over those supplements to ensure that what they say is in those supplements is truly there. Most of these companies are reputable, they’re usually pretty safe but you can’t know for certain. And then the other thing is, those supplements, those ingredients, while there is some sparse data, some anecdotal evidence that they’re helpful they’ve never really panned out in large trials, big research studies to actually do what they say they do.

So I have some guys that swear by them. And I say, okay, if you think it helps you and it doesn’t hurt your pocketbook, your wallet because they can be pretty expensive sometimes, then I have no problem with them. Go for it, if you think it helps you. But I would never have a patient come to me for enlarged prostate issues and say hey, let’s start you on a supplement first because there’s just not enough evidence-based data to support the use of those.

But then medications, there are. A lot of guys have heard of medicines like Flomax or Uroxatral or Rapaflo, those are called alpha blockers and they’re great medicines. They help the prostate open up and relax during urination so the urine can flow better, you can empty better I like to say, they just kind of smooth out the process of urination. They’re good medicines. They’re not great medicines for a few different reasons. They do have some side effects, thankfully, not that often, but they do. With the Alpha blockers, we worry about dizziness. So obviously for, especially for some of our older patients, definitely want to be careful with that because of falls, we have to be very careful there.

The other thing that a lot of guys don’t like about them is they can cause what’s called retro grade ejaculation. That’s a fancy term for during ejaculation when a time comes for the semen to shoot to the outside world, the semen will actually go backwards into the bladder, and the reason for that is the prostate is supposed to kind of clamp tight during ejaculation so that the semen shoots to the outside world, well, as I mentioned before these medicines kind of relax the prostate a little bit, so it stays open just a touch and when the pressure builds up it goes backwards into the bladder. Doesn’t cause infections, doesn’t cause erectile dysfunction, doesn’t cause a change in sensation, it’s just going into the bladder to be urinated out later on.

The whole reason that we even explain it to guys is if you didn’t, they would say what the heck is going on, where did everything go, you know, and they would freak out, understandably. So I always tell my guys, 10 to 15% of guys will have that issue – it’s not dangerous, but it’s obviously very bothersome for some guys and their partners.

The other big thing is, there is a lot of data coming out – these medicines, these alpha blockers, have been around for decades. And the longer medicine’s around, the more data we are able to accumulate on them and we’re starting to see increased risks of dementia with these medicines. Now thankfully, it’s not a huge risk. But it is more than zero, it’s higher than zero. It says that these guys are at higher risk than men that have not been on these medicines and so for that reason, especially, I at least tell my patients about this.  I would be irresponsible if I didn’t. And there is now a bigger kind of a push to do some of these other treatment options a little earlier; one, to avoid those medicines, and two, to avoid that deterioration of the bladder that we saw before on those pictures.

The other main bladder medications are called 5-alpha reductase inhibitors. Some of those are finasteride, dutasteride, Proscar. Those are usually used as a second line treatment behind the alpha blockers, so we kind of add those on top of the alpha blockers if guys still need help. The biggest issues with those is that it takes a very long time for them to fully kick in. It takes four to six months it to reach full effectiveness. And so most of my patients that choose to go on those we get six months down the road and they say sure it’s a little bit better but I’m still really bothered, and then we’ve just burned six months. And so I do offer them to my patients but usually I kind of steer away from that just because they usually just don’t cut the mustard, so to speak.

And the other issue is there are some side effects with those. There are some very increased risks of depression with those medicines, some other metabolic conditions there’s higher rates, with a 5-alpha reductase inhibitor. So in the grand scheme of medicines, the alpha blockers, the 5-alpha reductase inhibitors they’re pretty safe, but they are a medicine and they have potential side effects they have definite downsides. And so there is a big push now to look at procedural intervention. And thankfully what has been developed are some minimally invasive options that it’s not a big surgery, it’s not a big downtime. It’s not a big ordeal for those patients, but you can avoid medicines, and you can really improve those symptoms.

And so one of those options here in the middle is Urolift and then there’s others that get more invasive, some of the thermotherapies, those are going to be things like you all may have heard of Resume and then laser or surgery that’s more towards the TURP, some guys call it the roto rooter. So those two on the right there, thermotherapies, laser surgery – those destroy tissue. You’re cutting tissue away, you’re removing tissue, you’re burning. As opposed to Urolift, where you are moving tissue out of the way but you’re not destroying tissue. So it’s kind of a mechanical solution for a mechanical problem.

And we’ll talk a little bit more about that here, in just a second. So this is just kind of a matrix that compares the different treatment options, all the way from watchful waiting, medicines, Urolift, water vapor therapy, laser, TURP.

One of the biggest things about this, a lot of guys worry about catheters so with the water vapor therapies, with the laser TURPs, 100% catheter for several days afterwards. You have to use them. With a Urolift, it’s about a 10% chance of needing a catheter for about 24 to 48 hours afterwards. So saying that a different way, it’s about a 90% chance that a guy will leave the operating room without a catheter. Operating room, office, wherever the procedure is performed – rapid relief, with a low risk profile sure. Durable results, but just one treatment. That’s where these procedures are playing a big role.

And then it talks about cutting, heating, or removing of tissue. So that’s one of the advantages from the Urolift, as I mentioned before, is that there’s none of that, we’re just moving tissue out of the way.

Preservation of sexual function, that is a big one. So the water vapor therapy, the TURP, transurethral resection of the prostate, those will cause a couple of different potential sexual dysfunction results. So one is retrograde ejaculation, we just talked about that a minute ago. With the medications, I quoted 10 to 15% with the medicines, it’s 100% with the TURP. With the way that the procedure is done, the anatomic changes of it is 100%, guys will have retrograde ejaculation afterwards. So we always have to explain that to men and even then, sometimes it doesn’t fully sink in and they come back afterwards and they’re really upset about that. And it’s a big deal for some guys and their partners. Some guys they don’t care at all, but for others it is a big deal so it’s absolutely something that those men need to understand will happen with a TURP. It will not happen with the Urolift because of the way that the procedure is done and the way that the anatomy is handled.

The other sexual function aspect is erectile dysfunction, possibly even a bigger issue than the retrograde ejaculation. With the TURP, with the medications, with the water vapor therapy, all of those run a risk of erectile dysfunction, difficulties with erections afterwards. The Urolift procedure, while it will not improve erections, I get that question every now and then, it will not improve erections, but it will absolutely not worse erections.

And then we go to some of the side effects we talked about; the dizziness, headaches, lack of energy that comes with some of those medications. And then, it talks about no ongoing BPH medications required and that’s a big selling point. The vast majority of men have a procedure, whether it’s the Urolift, water vapor therapy, TURP, the vast majority will be able to stop their medicines. So they can avoid those potential side effects, keep some money in their pocket, that sort of thing.

So this is just a summary screen of how you all can contact us … actually, I want to go back just a second just to talk a little more about, in particular, the procedure that I offer in my office is the TURP, kind of the most aggressive and the Urolift. And when I talk to guys about their options, their best option is often dictated by their personal anatomy and their goals. So that goes back into how we diagnose BPH and investigate, that’s that cystoscopy, the scope in the bladder and the ultrasound of the prostate. Because some guy’s prostates are so large that they don’t have all their options, they have to go with some of the more aggressive options, like the TURP. But thankfully, that’s only about 10% of guys. About 90% of guys have all options available to them, because their prostate is big but it’s not humongous.

And then the other kind of consideration is the experience, the patient experience. So with a TURP, they’re typically … you have to stay overnight in a hospital, you have a catheter for several days. There’s kind of a one-to-two-week recovery. You can have blood in your urine for weeks, there’s risks of infections and scarring and things like that.

And so it’s a great procedure, I still do a lot of them, but because of those potential downsides, I have started incorporating minimally invasive options and my preferred option is the Urolift system. I’ve done about 150 of them at this point and I’m getting really good results. And what’s great about it is it’s in and out, so you don’t stay overnight in the hospital, it can be done, even in the office, though the majority of the ones that I do are done in an operating room setting just with some very minimal sedation. So it doesn’t require general anesthesia, it requires or I like to use kind of very minimal sedation, almost like a colonoscopy so it makes you feel sleepy to where you don’t care what’s happening, but you’re not all the way out. And that way, those guys can get up and get out of there much quicker, there’s less recovery. And so, then you go home, and you just take it easy for a few days afterwards, three to four days. You just kick your feet up. You don’t go play golf. You don’t go to the gym. You don’t tinker in your garage and pick up you know engine blocks or anything crazy, you just take it easy for a few days.

But after that, then you go back to doing whatever you want to do. What most guys can expect afterwards as far as pain, not so much just pure pain, but there can be some burning with urination for a couple of days, afterwards. So I give them medicine to go home with to help with that. You might see blood in your urine for a couple of days afterwards, though it’s typically self-limited and just there for 24 to 48 hours. And honestly, the biggest one, the biggest bother of the whole thing is urgency and frequency of urination. That can really flare up temporarily after you’ve kind of kicked the hornet’s nest, it gets angry and then it gets better very, very quickly. So I always warn guys, hey, three, four, maybe five days you’re going to have a lot of that frequency and urgency. Just don’t make any big plans. Don’t plan a road trip, you know don’t plan a family reunion, just hang out at the house and take it easy because you might want to be close to your toilet. But after those few days it gets better very quickly, and guys see a really rapid improvement of all of their urinary symptoms.

So that’s just a little bit of kind of what you can expect from a Urolift type of procedure, if that is something that is of interest to you guys and between that guy and his urologist, if they feel like that’s a good option for him. And so, if any of you all eventually want to talk more about any of these things with me, I’m happy to, you know in our consultation, kind of go more in depth about all of these options here. So going one more time to this last screen here, this is how you can contact us.

We have our website there, our phone number. You do not need a referral from your primary care provider. You can just call and say hey, I want to meet with Dr. Thoma or there are three other urologists here at the Mason City Clinic. Only one other one, Dr. Timothy Mulholland, he does offer Urolift as well. So you’re welcome to see him or myself to talk more about Urolift, but we all treat enlarged prostate, so you’re in good hands with any of us.

So with that, I think that ends my presentation here. Happy to take any questions that anybody may have.

Carol Gifford:

Great! So I’m looking, if anyone has any questions just click on that Q & A box at the bottom of the screen and type in your questions for Dr. Thoma. I do have one question, though, so you have done several of these Urolift procedures and I imagine you’ve seen the patient’s months after, what did they say back to you about their symptoms?

Dr. Steven Thoma:

Sure, so I’ve done about 150 of them at this point. Their response are … have been fantastic. A lot of guys ask how long is this going to last? None of those surgical options are going to necessarily last for forever. Even the most aggressive ones, like TURP, that tissue can regrow over time. But typically, on a 10-year scale, the retreatment rate for a Urolift is somewhere around 15%.

Carol Gifford:

So I have a few questions here, the first one is will Medicare approve the Urolift?

Dr. Steven Thoma:

Yes, so Medicare and every major insurance provider covers Urolift. This is not some sort of experimental procedure. So with all insurances there are often co-pays, deductibles, things like that so you always have to take that into account, but as far as it being covered by insurance, it is absolutely.

Carol Gifford:

Next question is from … she is watching this webinar for her husband and he’s not available, so she wants to know if she can replay this for her husband. Absolutely. We’re recording it right now and we will email it out to everyone who registered for this seminar, and it will also be posted on the Mercy One North Iowa website, as well the Mason City Clinic website under the urology specialty area. So there will be many different opportunities for you to be able to access this wonderful webinar that Dr. Thoma just presented so I just wanted to assure her that she can play it for her husband.

Dr. Steven Thoma:

Great that’s great to know so, are there any other questions from our attendees it’s going to wait a couple minutes.

Carol Gifford:

Thank you everyone for attending this evening, and thank you, Dr. Thoma for a wonderful educational seminar on enlarged prostate and ways to get treated for that, and I think everyone’s excited about being able to not have the symptoms that you described, so thank you for your presentation.

Dr. Steven Thoma:

Perfect. Thank you all for attending, thank you for having me, I hope you all have a great night.

Specialty care close to home

Up-to-date. Down-to-earth. Close to home. Lots of great reasons to make Mason City Clinic
your first choice for all your family’s specialty healthcare needs.

250 S. Crescent Drive, Mason City, IA 50401

Tel: 641.494.5200

Toll Free: 800-622-1411

Fax: 641.494.5403

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2440 Bridge Avenue, Albert Lea, MN 56007

Tel: 641.494.5200

Fax: 641.494.5403

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