Good Health

DEAR DR. ROACH: I am a 66-year old male, who is healthy with a very active life, both physical and sexual. Like many men my age, I have an enlarged prostate that my doctor monitors during annual visits. It doesn't impair my life, with the small exception of being annoying (waking up nightly to a weak or slow urinating stream), and it doesn't bother me too much during the day, except once in a while when I have to urinate a little more than usual. Every now and then I'll try an over-the-counter prostate supplement, but they never work. I will NOT go for a surgery because it's not really necessary.

I just read about a new revolutionary treatment option called a prostatic lift device, which is supposed to "lift and remove the prostate tissue out of the way so it no longer blocks the urethra (the passageway that the urine flows through)." It says, "Tiny implants are placed to hold the tissue in place, like tiebacks on a window curtain, leaving an unobstructed pathway for urine to flow normally again." They go on to say that treatment typically takes under an hour, preserves sexual function, doesn't require cutting, heating or removal of tissue. Compared with other BPH surgeries, this system is supposed to have a strong safety profile with minimal side effects. Have you ever heard of this? Do you think it's safe? It sounds great. However, the thought of tiny implants being placed inside of me and staying there scares me. — V.A.

ANSWER: The prostatic urethral lift procedure is yet another option for men with symptoms of an enlarged prostate. The procedure does involve the placement of small implants. The procedure is said to be easy to perform (easy for a urologist, that is), and improves quality of life and measures of urinary flow.

In a study of 206 men, none developed sexual troubles after the procedure. It has significant benefits over traditional surgery: Recovery is faster and has less risk of sexual side effects, but traditional surgery improved urinary flow and complete bladder drainage more than the urethral lift procedure. Also, 14% of men who had the lift procedure needed the traditional surgery within five years. The implants seem to be safe and do not affect the ability to do surgery if necessary.

I wouldn't recommend this procedure nor a surgical procedure -- or even an alternative procedure like laser, microwave, plasma vaporization or water vapor ablation -- without a trial of prescription medication first. Most men do very well with an alpha blocker like tamsulosin (Flomax), a dihydrotestosterone blocker like dutasteride (Avodart), or a combination of the two. I'm not sure you have tried that.

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DEAR DR. ROACH: Simple question: Why can't I hear well when I am having a big yawn? Is this normal? — J.C.A.

ANSWER: This is normal; in fact, it's a universal finding with a yawn that hearing decreases (but doesn't go away entirely). This is because the Eustachian tube closes, and there is a pressure difference inside versus the outside of the eardrum, reducing the ability of the ear to transmit sound.

Interestingly, after a big yawn, hearing may be improved; when the Eustachian tube reopens after the jaw position changes, it can equalize the pressure and improve sound transmission.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.  (c) 2020 North America Synd., Inc.  All Rights Reserved

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