Men who go through prostate surgery often experience serious and mostly unspoken side effects such as bleeding, erectile dysfunction and ejaculation disorders.
But a new non-surgical urology procedure that was successfully performed at Cape Town’s Tygerberg Hospital, which only takes 10 minutes, is set to revolutionise how prostate surgery is performed in future.
Last week medical specialists from the hospital and Stellenbosch University performed the procedure, called Rezūm water vapour therapy, to relieve male urinary problems in a patient with benign prostatic hyperplasia (BPH) – an enlargement of the prostate characterised by a weak urinary stream, which in some cases can lead to infection, bladder stones and reduced kidney function.
The traditional treatment for this condition includes medication that relaxes the bladder or shrinks the prostate — or surgery. Up to 40% of patients with symptomatic BPH require surgery.
Led by Stellenbosch University’s head of urology Prof André van der Merwe, the procedure uses the natural energy stored in steam to remove excess prostate tissue that is pressing on the urethra.
It is the first non-surgical treatment option for BPH patients in SA whose medical treatment has failed or who don’t want to be on medication for life. It has been used in Europe and the US with great success over the past five years.
Van der Merwe, a renowned urologist who performed the world’s first successful penis transplant in 2014, along with his colleagues on five patients at Tygerberg Hospital, said what makes the new procedure revolutionary is that it can be done in just 10 minutes or less in an outpatient setting.
Van der Merwe and his colleagues performed the first five procedures at Tygerberg’s urology day-theatre complex last week.
Dr Pieter Spies, a urologist from Stellenbosch University who performed the procedure with Van der Merwe, described the experience as “extremely positive”.
He said it proved that the procedure could be performed successfully in a resource-constrained environment in a day theatre-setting.
“The longest procedure took 10 minutes. We used general anaesthesia just to be safe, but from now on we will use conscious sedation. We also kept the patients overnight to be on the conservative side, but from now on they will be discharged on the same day.”
Spies said it took him and Van der Merwe a few years to convince Boston Scientific, the company responsible for the technology internationally, to bring the product to SA and to get it registered with the South African Health Products Regulatory Authority (Sahpra). The two urologists, and five specialists from the private sector, were trained by Boston Scientific and received their accreditation.
A second set of procedures will be performed by private specialists next week.
“The long journey to finally be able to bring the product to SA was worthwhile and the result of last week’s procedures has been beyond our wildest dreams. We regard it as the answer to our enormous waiting list problem. We could help five patients within the space of two hours, compared to the hour-and-a-half per patient required for surgery.
“It will especially be beneficial for older people who cannot undergo surgery, patients who are dependent on medication and older people with catheters. We can free them from catheters without the risk of anaesthesia and surgery,” Spies said.
Up until now, the most common surgeries performed for benign prostatic hyperplasia are transurethral resection of prostate (TURP) and laser enucleation/resection of the prostate. They are performed under spinal or general anaesthesia and usually require the patient to remain in hospital for two to three days.
The waiting time for these procedures in public hospitals is up to three years, mainly due to a shortage of hospital beds and constraints on theatre time. Tygerberg Hospital has about 320 patients on its surgery waiting list. Surgery is associated with serious side effects, however, including retrograde ejaculation, bleeding and erectile dysfunction.
Van der Merwe said trained surgeons will be able to perform the new procedure with ease, but there was a cost associated with it. Boston Scientific sponsored the first five procedures.
“A cost analysis of last week’s procedures will give us a good idea of how this can really work in public hospitals. Although the procedure made financial sense and would cut on costs such as the regular replacement of catheters, visits to specialists, the use of antibiotics, at the end it had to fit to public hospitals’ budget, such as the Tygerberg Hospital.
“Boston Scientific will have to look at its costing model to make it acceptable for state hospitals and we might have to concentrate on volume,” said Van der Merwe.
Dr Matodzi Mukosi, CEO of Tygerberg Hospital, said “the performance of this revolutionary prostate procedure by our team is a testimony of the top-class expertise we have here. It is part of our quest to deliver quality healthcare and improve patient experience.”