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NONSURGICAL TREATMENTS FOR BPH: BALLOON DILATION
Balloon dilation is one of the newer treatments used at larger medical centers. This technique was first developed by radiologists and cardiologists to perform a coronary angioplasty: a small balloon is inflated inside a blocked coronary artery, "squishing" the blockage and thus widening the vessel, allowing more blood to bring vital oxygen to the heart. The balloons used for enlarging a constricted urethral passage are larger than the ones used by cardiologists.
The technique involves passing a catheter through the urethra, which is being squeezed by the enlarged prostate gland that surrounds it. When the device is positioned at the site of obstruction, the balloon is inflated to push back the prostate tissue and allow the urine to flow more easily through the urethra.
Positioning of the catheter must be precise, for when the balloon is inflated it exerts enormous pressure. If it is inflated inside the bladder, it is simply ineffective. But if it is inflated below the urinary sphincter, incontinence or impotence can result.
This procedure can be done under fluoroscopic control, which is a form of radiation physics, with the patient sedated and with local anesthesia in the urethra. Urologists who use the technique favor it because the local anesthetic makes it easier to perform and places less stress on the patient. It is cost-effective and carries a lower risk of retrograde ejaculation than the TURP procedure. Patients are often able to return to their normal occupation the day after the procedure, which is a big plus. For many patients, however, a catheter has to remain in place for another two days.
At an American Urological Association meeting in 1991, a discussion of various studies on balloon dilation was presented, illustrating the many and varied opinions of urologists who use this technique. It appears that the safety of the procedure has been confirmed but its efficiency has not. According to Hospital Practice magazine, the reputation of balloon dilation among urologists has fallen considerably from its early heights, and its use appears to have diminished considerably.
German doctors using die process were of the opinion that balloon dilation seemed to lose its effectiveness over time. Fifty-four percent of patients were satisfied with results after six months. Only 34 percent were satisfied after a year. Only 31 percent saw urine flow increase into the normal range, and pressure in the bladder—that urgency to urinate—was rarely reduced.
In another investigation, seventy-four balloon dilation patients were followed for a year or more and had an overall increase in urine flow of only 40 percent. It appeared that younger patients had the best results. A similar result was noted by University of
Iowa physicians who followed thirty-four patients for a year and reported that urination improved right after dilation but the benefits tapered off by the end of a year.
Balloon dilation is not for everyone, and patient selection is important. Men with very large prostates (weighing over 30 to 40 grams) are not good candidates; it is generally agreed that only men with a relatively small prostate gland are good candidates. This technique appeals to patients who do not want to opt for surgery, and the procedure can be very useful for older men and for those with medical conditions that make them poor candidates for conventional surgery.
Many urologists do not recommend this procedure, as it may need to be repeated—about 50 percent of balloon dilation patients experience a return of symptoms within a year. If they do not experience problems within this period, however, there is a good chance that this treatment will have worked for them. The long-term success of this procedure does not appear to approach that of surgery. There is also a 4 percent risk of impotence, a 3 percent risk of incontinence, and a 5 percent risk of retrograde ejaculation.
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