07 Apr 2011
By LEE HUI CHIEH
Retiree Low Yat Tuck, 64, had a procedure to shrink his enlarged prostate last year, and he did not have to leave his doctor’s office to get it done.
Normally, this procedure, called a transurethral needle ablation of prostate gland, is done in an operating theatre, but some National University Hospital (NUH) patients have been able to get it done in a doctor’s consultation room since early last year. This saves patients about $1,000 in fees.
The day surgery procedure, which NUH has offered since June 2008, costs $5,500. Having it done in the clinic costs $4,500.
But it can be done this way only for those whose condition is mild or moderate.
As men head into their 40s, the prostate – a walnut-sized organ producing fluid that makes up semen – begins to grow in size for reasons unknown.
As it enlarges, it presses into the urine-storing bladder located above it, as well as the urethra, which empties the bladder.
This causes symptoms which affect 14 per cent of men in their 40s, including having to wake up at night to urinate, incontinence and a feeling of not having emptied the bladder. The problem becomes more common with age, affecting 24 per cent of men in their 50s and 43 per cent of those in their 60s.
Most patients can be treated with medication, but about 10 to 20 per cent require a procedure to remove part of the prostate squeezing the urethra, doctors say.
Help available
A slew of procedures are available for different types of patients.
The most established procedure is the transurethral resection of the prostate (Turp). This involves inserting a metal loop, charged with an electrical current, into the urethra to scrape out the swollen parts of the prostate around it.
This is used for severe conditions, when the urethra is totally blocked and the patient cannot urinate, or if the patient has urinary tract infection, bladder stones and kidney failure, said Associate Professor Chia Sing Joo, senior consultant urologist at Tan Tock Seng Hospital (TTSH).
Men who have less swollen prostates can opt for needle ablation, in which a device inserted into the urethra emits radiofrequency waves to shrink the parts of the prostate around it.
They may wish to do so if they are unwilling to pay for long-term medication, which can cost more than $1,700 a year for those who need two types of pills, said Dr Chua Wei Jin, consultant at NUH’s urology department.
Besides, medication does not always work and has side effects such as decreased libido and enlarged breasts, he said.
The needle ablation can preserve sexual function, which is often lost after Turp, the standard procedure. It also causes less bleeding, so it is sometimes used to ease the symptoms for patients whose advanced age or underlying diseases make the standard procedure too risky for them. Because it is inherently less risky, it can be safely done in a clinic setting.
The needle ablation has nearly as many good outcomes as the standard procedure, with a re-treatment rate after five years of about 15 per cent, close to the 10 to 12 per cent for standard surgery, Dr Chua said.
Since 2008, NUH has carried out 32 needle ablations, half of which were done in the operating theatre and the other half in the clinic.
Other hospitals, however, are less keen on the procedure. TTSH does not offer it to many patients and the procedure is done in the operating theatre, said Prof Chia.
The Singapore General Hospital (SGH) does not offer it at all, as its long-term results are not as good as Turp’s, said SGH’s senior consultant urologist, Dr Tan Yeh Hong.
But for Mr Low, it helped when medication no longer could.
After he was diagnosed five years ago, he started on the drug treatments, which helped ease the symptoms, such as getting up more than three times a night to use the toilet, but they came back more intensely than before after two years.
Stronger medication was prescribed and he took that for more than a year but, at $1,200 a year, the solution was pricey for him.
So he agreed to Dr Chua’s suggestion to have the needle ablation in February last year.
He said: “I feel better after the procedure. Only when I wake up do I need to go to the toilet. And I don’t have to take medicine all the time, which is troublesome.”
Email: huichieh@sph.com.sg
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