Steven Black could not urinate. The pain sent the Cedar Park man to the emergency room for treatment.
That November in 2019, Black, then 58, spent five days in the hospital, where doctors determined he suffered from an enlarged prostate, a benign condition known as prostatic hyperplasia.
Black found help thanks to a procedure called HoLEP, holmium laser enucleation of the prostate, a treatment not available locally until Dr. Lawrence Tsai of Texas Urology Specialists moved to Austin five years ago. Before his arrival, Austin and Central Texas residents either traveled to Baylor Scott & White in Temple, where Tsai trained, or opted for ongoing care locally.
Tsai and other urologists are now looking at this procedure as a way to solve urinary issues in patients with prostate cancer. It also could prevent future urination problems that happen when the prostate swells as a reaction to radiation treatments for cancer.
They also can use the HoLEP in men prophylactically when there is an enlarged prostate and the bladder is showing signs of wear and tear, Tsai said. They can treat before the prostate interferes with urination, he said.
Prostate growth is normal
How large a prostate grows can be related to genetics, Tsai said. Sometimes patients recall their father or grandfather had undergone a "Roto-Rooter" procedure or had a drainage tube placed.
By age 60, half of all men will have BPH. By age 85, it's 90%, a Harvard study noted.
What are some of the symptoms of an enlarged prostate?
Men don't notice this growth until they have symptoms. These include:
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Not being able to urinate, lacking a steady urine stream or taking a long time to urinate.
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Frequent trips to the bathroom, including at night.
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Feeling that your bladder is never empty.
If you think of the bladder as a funnel, the prostate sits around the bladder neck and urethra, where the funnel narrows. An enlarged prostate can squeeze that narrow part, making it difficult for urine to pass.
What can help improve an enlarged prostate?
Traditionally, doctors would perform a procedure called a TURP, or transurethral resection of the prostate. Some people call this the "Roto-Rooter" procedure. A doctor would go in either robotically or through an incision in the stomach to trim out prostate tissue blocking the path of the urethra.
Recovery from the TURP often required a hospital stay and drains. The TURP is sometimes repeated when the tissue grows back.
A different kind of prostate surgery
Black turned to Tsai for the HoLEP procedure.
Tsai threads a sheath up the urethra to get to the prostate along with a laser and camera. Surgery typically takes 90 minutes to four hours, depending on the size of the prostate. A normal prostate is about 25 cubic centimeters. The largest prostate Tsai worked on was 400 cubic centimeters. He now does about 100 of these surgeries a year.
The procedure is able to remove about 90% to 95% of the prostate, Tsai said. That tissue does not regrow.
An easier recovery
Patients post-HoLEP usually go home the next day without a catheter. For about a week or two while recovering, there will be an urgency to urinate, temporary incontinence and even some blood in the urine. The body has to get used to the sphincter muscle that controls the urine stream again because it is not relying on the prostate to stop the flow, Tsai said.
The surgery does not affect erectile function.
Black's recovery after his March 2020 surgery was complicated by a bleeding disorder. He said he had no pain but needed a catheter occasionally for a few months after the surgery to manage blood clots.
By May 2020, he was fully healed. He now compares his urine stream to that of a 22-year-old.
He's returned to swimming, which he wasn't able to do while wearing a catheter. "The first time I swam after this, it was a big emotion. ... It was like a religious experience," he said.
Black tells men who are considering the HoLEP to "get it done." He also encourages men to talk to their doctors if they are having symptoms of an enlarged prostate.
He said to Tsai: "You performed a miracle on me."
This article originally appeared in the Austin American-Statesman.