Urologist Explains Treatments for Enlarged Prostate
by PAUL CATALA
Like many men, John Sutphin first began to notice he was having a bit of difficulty urinating when he was in his 40s, but he didn’t consider it serious enough for medical treatment.
The 72-year-old retired Kissimmee police chief says he had a urinary catheter put in during triple bypass in January 2021 and experienced difficulty urinating after it was taken out.
A urinary catheter again was inserted following another three-week hospital stay, and this time he had it for four months.
That’s when Sutphin, who spent 30 years in law enforcement, says he contacted Dr. Kenneth Essig, a Winter Haven urology specialist.
“I got out of the hospital with the catheter. I went through tests, bladder tests, and a urodynamic test in March 2021 – they all showed my prostate wasn’t working,” he says. “I went a few weeks later for a cystoscopy, and that’s when I realized I was going to have (prostate) surgery.”
It wasn’t long after that the Lake Wales resident joined the approximately 50 percent of men in their 50s and 75 percent of men in their 70s who have benign prostatic hyperplasia (BPH), or enlarged prostate.
“After the prostate laser surgery, about four or five days later, they took the catheter out and I was able to pee right then and I have not had a problem since. It’s like nothing ever happened to me,” he says. And that’s the result Essig of BayCare Medical Group strives to attain with all his patients.
Essig, 61, who began practicing in Winter Haven in 1997, began working in urology because of the variety of patients he treats and the ability to “fix things definitively” with solutions rather than just managing medical problems. He says preventing prostate problems, particularly regarding BPH, is almost impossible and “it’s a natural function of aging. Prevention is not really something the medical community has a handle on yet.”
Still, Essig adds there is a selection of ways to minimize the impact and the long- and short-term problems associated with BPH. Among those are a slow stream of urine; starting and stopping while urinating; the inability to empty the bladder completely; bladder irritation or discomfort; waking up multiple times at night to urinate; and the inability to control the bladder.
Essig says when a patient visits, he discusses symptoms with him and looks first for the simplest solution. He says sometimes the problem is as simple as a man is just consuming too many fluids or caffeine before going to bed, which then causes him to wake up several times a night to try to urinate.
“If they’re drinking so many fluids that their bladder and body can’t keep up with it, I just suggest to people to moderate their food, liquid, and caffeine intake. Once people do that it often takes away symptoms they thought were from an enlarged prostate, when in fact, those symptoms were just from too much caffeine and too many fluids,” says Essig, who attended the University of Cincinnati medical school from 1983 to 1988 and did his residency training there. He finished his residency at the State University of New York at Syracuse.
If the problem continues, Essig says he then begins behavioral or fluid modification before proceeding to drug treatments. He says he generally prescribes alpha-blockers, such as Tamsulosin or Rapaflo, that relax the involuntary muscles around the prostate.
“They can do wonders within a couple of days,” he explains.
Other drugs for BPH include Finasteride, which shrinks the prostate. However, those take about six months to become effective, and a patient has to be committed to taking for months or years.
If medicinal treatments aren’t as effective as they should be, Essig recommends GreenLight Laser Therapy (GLT) or UroLift. GLT is an outpatient procedure that uses laser technology to remove overgrown prostate tissue and can restore natural urine flow sometimes within 24 hours of the procedure. That can be contingent on a patient’s medical history and overall health condition.
UroLift utilizes tiny implants to lift and hold enlarged prostate tissue out of the way so it can’t block the urethra. Among the advantages of this treatment: There is no cutting, heating, or removal of prostate tissue.
Essig says to determine what treatment is best for a patient, he uses a scope to look at the bladder and inside the prostate and makes measurements to determine whether a UroLift or GLT procedure is best. He says he’s found UroLift to be 70 percent to 80 percent effective, and GLT to be about 80 percent to 90 percent effective.
The treatments, which take about 30 minutes, are done on an outpatient basis with general anesthesia. Side effects include possible burning, irritation, and blood in the urine for about a week.
“Very soon after, you should notice significant benefits to the symptoms associated with an enlarged prostate,” Essig says. “They’re some of the most common procedures. I’ve done thousands of them.”
Another procedure Essig and other urologists use for BPH is implantable InterStim Therapy, designed mostly for those who feel the need to the bathroom too often, such as five to seven times per night, every hour. Although mostly used for females, it can be used on men. InterStim Therapy targets the bladder using a device that sends mild electrical pulses to the sacral nerves to reduce symptoms of bladder control problems.
In addition to drugs and surgical procedures to relieve BPH and problems associated with it, Essig says some diet modifications also can help, such as diets high in lycopene such as tomatoes, guavas, watermelon, papaya, and pink grapefruit.
“They may reduce the likelihood of prostate cancer. But the science on that is very vague right now,” he adds.
The bottom line for men such as Sutphin is if you find yourself with a weak urine stream, getting up frequently at night to urinate or going to the bathroom during the day due to the feeling of an incompletely empty bladder, it’s time for a check-up.
“If those are issues, then understand that’s not something that you have to tolerate and just live with. In fact, there’s medical therapy and minimally invasive outpatient procedures that can address or even cure those kinds of problems,” says Essig.