Relieve Yourself From Urinary Urgency

Minimally invasive procedure shrinks enlarged prostate, addresses flow woes.

According to Ernest Wohlenberg, people often think of geographers as “professional tourists.” He swears that’s not the case, but the 30 years Ernest spent working as a professor of geography at the University of Indiana did allow him and his wife, Emilie, to travel the world.

My condition has gotten better and better over the weeks since I had the embolization. - Ernest

My condition has gotten better and better over the weeks since I had the embolization. – Ernest

“We’ve been to many places, including French Polynesia and Hawaii,” Ernest reveals. “We visited Sulawesi, an island in Indonesia, and some countries in Southeast Asia as well as China. We also took a cruise around Cape Horn, from near Santiago, Chile, to Buenos Aires, Argentina.”

“Ernest spent a year in Malaysia, and Singapore is right there, too,” Emilie interjects. “He also spent a fair amount of time in the United Arab Emirates in the Middle East. And we’ve visited several European countries as well as Alaska and many places in Canada. It’s been fun.”

Ernest retired 20 years ago, and he and Emilie moved to Florida to be near their daughter, who works as a coral reef specialist. They continue to travel, but a few years ago, a health issue made such journeys and even everyday life difficult for Ernest. He was waking up multiple times each night to urinate and was experiencing an urgency to relieve himself that interrupted his daily routine.

“When you’re traveling, that’s quite bothersome,” Ernest observes. “If you’re in the car 200 miles away from anywhere or on a boat, you want to be able to function the way you should.”

Like nearly 90 percent of American men older than 80, Ernest suffers from benign prostatic hyperplasia, or BPH, a condition otherwise known as an enlarged prostate. With BPH, the expanded prostate presses against the urethra, the tube that runs from the bladder to the body’s exterior, causing symptoms of frequency, urgency and a weak urine stream. 

To treat the condition, Ernest’s primary care physician referred him to Brian L. Dunfee, MD, a board-certified vascular and interventional radiologist at Interventional & Vascular Center in Melbourne. Dr. Dunfee and his partner, board-certified vascular and interventional radiologist Robert J. Kennedy, MD, use minimally invasive, image-guided techniques to treat conditions such as BPH. 

“Mr. Wohlenberg spoke to me about his issues with urination,” Dr. Dunfee recalls. “He was getting up five times or more every night to urinate. He was unable to hold his urine, but when he used the bathroom, he couldn’t get a full stream and would dribble. It was starting to affect his daily life. He was taking medication, but it wasn’t working very well. 

“We performed an ultrasound of his prostate, which showed it was significantly enlarged — about three times normal size. We spoke about minimally invasive treatment options and decided on prostate artery embolization, which shrinks the prostate.”  

No Age Discrimination

“It is very common for older men to get BPH,” Dr. Dunfee asserts. “Pretty much every male is going to have an enlarged prostate as he gets older. Before prostate artery embolization was developed, there was no way to shrink the prostate. Urologists only had procedures to carve a hole in the gland or lift it up off of the urethra.”

One procedure used to treat BPH is transurethral resection of the prostate, or TURP. During TURP, a thin metal tube with a light on its end is threaded through the urethra and into the prostate gland. An electric loop on the tube cuts away some of the prostate tissue to reduce its bulk and improve urine flow.

“There are potential complications to the TURP procedure, such as bladder injury, bleeding, infection and trouble urinating, and it does not address the whole prostate,” Dr. Dunfee contends. “It simply makes a bigger doorway for the urine to get out. But prostate artery embolization shrinks the entire prostate.”

Prostate artery embolization is an endovascular procedure, meaning it is performed through the blood vessels. It is minimally invasive and done on an outpatient basis. 

During a prostate artery embolization procedure, doctors insert a long, skinny tube called a catheter into an artery, typically in the groin. Under fluoroscopy guidance, the doctors navigate the catheter through the arterial system into the arteries that feed the prostate.

“There are two prostatic arteries, the right and left, one on each side of the gland,” Dr. Dunfee describes. “Once we’re in these arteries, we inject small gelatin-like beads that block blood flow to the prostate gland. Blocking blood flow doesn’t kill the prostate but it causes atrophy, which causes it to shrink very slowly over time.

“As the prostate shrinks, it pulls away from the urethra. And as the blockage is reduced, patients start to urinate the way they did when they were young with a normal sized prostate gland.”

Dr. Dunfee stresses that age is not a limiting factor for determining candidacy for a prostate artery embolization procedure.

“We’ve seen patients in their 70s who’ve been told they’re too old for procedures, and medication is their only option for treating BPH,” the doctor discloses. “But we treat patients in their 50s as well as patients in their 80s. We’ve discovered that if we can fix the problem and get patients off medication, they fare better. Earlier treatment also prevents long-term damage to their bladders, that cannot be fixed.

“Mr. Wohlenberg, who is 85, has experienced an extremely good result from the embolization procedure. We treated him in June, and during his follow-up visit in August he reported that he was only getting up once or twice at night instead of five or more times. Improvement from the treatment continues for about four or five months afterward, so we expect that his final results will be even better.”   

“Very Noticeable Change”

Ernest is delighted by the results he’s achieved to this point. 

“Since the procedure, there’s been a very noticeable change in the feeling of urgency and in how many times I need to use the bathroom,” Ernest enthuses. “And I have a normal urine stream now. My condition has gotten better and better over the weeks since I had the embolization. It’s gotten progressively easier for me to urinate.”

Ernest and Emilie are as happy with Dr. Dunfee and his Interventional & Vascular Center staff as they are the results of Ernest’s surgery.

“The staff is very friendly and helpful,” Ernest confirms. “From the moment you walk in the door, you feel a warmth from everyone, so my experience at Interventional & Vascular Center was excellent.” 

“We really like Dr. Dunfee,” Emilie shares. “He knows what he’s doing and he clearly cares. He explained things very well to both of us. We’re quite pleased with the care Ernest received.” 

© FHCN article by Patti DiPanfilo. Photo courtesy of Ernest Wohlenberg. mkb
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