Doctors and staff at the prostate artery embolisation (PAE) centre at Netcare Sunninghill Hospital in Johannesburg — which offers the minimally invasive PAE procedure as a treatment option for men who suffer from severe symptoms related to enlarged prostate — recently celebrated a milestone with the completion of 100 procedures.
“It is a significant achievement in the treatment of enlarged prostate, or benign prostatic hyperplasia [BPH], a relatively common condition which negatively impacts the quality of life and health of many older South African men,” comments Netcare South West regional director, Sandile Mbele.
“Since it was introduced at Netcare Sunninghill Hospital in 2016, the PAE procedure, which involves injecting a special substance into the enlarged prostate to reduce its size, has proved highly effective in diminishing the debilitating symptoms often associated with BPH in many patients,” adds Mbele.
“The entire procedure is performed via a needle inserted into the artery of the leg at the level of the groin, the procedure has also been a popular alternative to more major surgical options.
“Urologist, Dr Stephen Cornish and interventional radiologist Dr Andrew Lawson were the prime movers behind the establishment of the PAE unit at Netcare Sunninghill Hospital. The centre, which has been internationally recognised, was the first of its kind to be established on the African continent.”
Dr Andrew Lawson, the principal interventional radiologist at the centre who has completed all of the 100 procedures, says BPH is the most common non-cancerous prostate medical condition to develop in men by the time they reach their 60s.
“Thousands of older South African men with BPH live with uncomfortable symptoms, including trouble passing urine properly and/or a frequent need to urinate, particularly at night. BPH may also increase the risk of urinary infections and in serious cases may completely block the urinary tract and become a medical emergency,” he explains.
“Both internationally and locally at our centre, PAE is achieving pleasing clinical outcomes for patients and has proved itself to be an invaluable treatment option for this condition. It has been a great privilege to have been able to work with Dr Cornish and Netcare to introduce this treatment option in South Africa, and to have assisted so many men with BPH over the past couple of years.”
A recent patient, who asked not to be named, says that the procedure was the “obvious” choice for him. “It was that or TURP [transurethral resection of the prostate], which has been the traditional treatment of enlarged prostate, and entails major surgery,” he noted.
“I developed a major problem with my prostate, which was exacerbated by me being intolerant to wheat and lactose. These would cause my prostate to swell to such an extent that I couldn’t urinate for two days and I had to have a catheter inserted by my doctor to bring me relief.”
“After the embolisation procedure, it took about three weeks for my prostate to reduce in size, and my symptoms are now completely resolved. I am delighted to have gone this route. For me, the procedure itself was completely painless, I was up and about the day after and never once had to take painkillers.”
Dr Lawson says that PAE reduces the blood supply to the prostate and its size by between 30 and 50%, thereby resolving, or at least meaningfully reducing, the symptoms of BPH. “Not all BPH patients can be treated with, or will respond to PAE, although most of those suffering severe symptoms are finding that it brings significant benefit,” he observes.
“The specialist urologist plays a key role in determining the most appropriate treatment approach for each individual patient, and in ascertaining which patients are likely to best respond to interventions such as PAE. As the interventional radiologist, I perform the procedure and have built up significant experience in this regard.”
Dr Cornish observes that, while most older men are likely to go on to experience some symptoms associated with an enlarged prostate, these are usually relatively mild, not likely to require major medical intervention, and can be effectively self managed. He says the following can assist men to manage the milder symptoms of BPH themselves:
• Undertake pelvic strengthening exercises as these can help strengthen the bladder muscles and improve urinary control.
• Stay hydrated by drinking smaller amounts of liquids more often rather than large amounts at a time.
• Try to urinate when you feel the urge and avoid holding it back for long periods of time.
• Exercise and follow a healthy diet while reducing alcohol and caffeine intake.
• Discuss any medications you are taking with your doctor to ensure that these are not exacerbating symptoms. As far as possible, try to avoid medicines such as antihistamines and decongestants.
Netcare Sunninghill Hospital general manager, Pieter Louw, says Dr Cornish and Dr Lawson have not only worked tirelessly to establish the PAE centre, but also to spread awareness of the new treatment approach to colleagues, for example through organising an educational symposium on BPH and PAE at the hospital in 2017.
“We are pleased to be able to offer this groundbreaking treatment option to our BPH patients, and delighted with the clinical outcomes that have been achieved. The PAE team at the hospital deserves every recognition for introducing the PAE procedure in South Africa and for attaining this milestone,” he concludes.