In recent years St. Luke's Cornwall Hospital has been increasing education and engagement across all areas of Urology care. One such condition is benign prostatic hyperplasia. It is the most common disorder of the prostate, and the most common diagnosis made by urologists for men in age group of 45-74.
Joining the show to discuss benign prostatic hyperplasia, and treatment options available to help with bothersome symptoms is Dr. Praneeth Vemulapalli. He is a board certified urologist and Co-Chair, St. Luke's Cornwall Hospital Urology Services.
Selected Podcast
Treatment Options for BPH (Benign Prostatic Hyperplasia)
Featuring:
Learn more about Dr. Praneeth Vemulapalli
Praneeth Vemulapalli, MD
Dr. Praneeth Vemulapalli is a board certified urologist. He received his medical degree at Tufts University School of Medicine, graduating with Research Honors. He completed his surgical and urological training at SUNY Stony Brook University Medical Center. He joined Premier Medical Group and the St. Luke’s Cornwall Hospital medical staff directly from Ohio State University Medical Center where he was awarded the prestigious Clinical Fellowship in Robotic Urologic Surgery for 2011-2012. Dr. Vemulapalli treats all areas of urology, with a keen interest in minimally invasive and endoscopic surgery of the kidney, bladder, and prostate. He has contributed to abstracts, papers, and textbook chapters in the field of urology and minimally invasive surgery. He joined the practice in 2012.Learn more about Dr. Praneeth Vemulapalli
Transcription:
Melanie Cole (Host): Benign prostatic hyperplasia or BPH is the most common diagnosis made by urologists for men in the age group of around 45-74 and it’s also the most common disorder of the prostate. My guest today, is Dr. Praneeth Vemulapalli. He’s a board-certified urologist and the co-chair of St. Luke’s Cornwall Hospital’s Urology Service. Welcome to the show Dr. Vemulapalli. So, what is BPH and at what age do men start to develop an enlarged prostate?
Dr. Praneeth Vemulapalli, MD (Guest): Well first Melanie, thanks for having me. BPH as you mentioned stands for benign prostatic hyperplasia. It’s a common condition that affects many men, typically more so as they become older in age. Statistics indicate that approximately 10% of men in their 30s have symptoms and it progressively increases to about 20% of men in their 40s to almost around 50% of men in their 50s and up between 60-70% of men as they get into their 60s and 70s and progressively more so and that’s based on autopsy studies that approximately 80% of men in their 80s have signs of this condition. It usually presents with symptoms of difficulty urinating. It could be something as simple as feeling you have to go to the bathroom more frequently, feeling that when you do go, that you don’t empty yourself completely or sometimes you feel yourself getting up more at night to pee. But those are all common symptoms that patients will notice.
Melanie: So, how would you even diagnose, because men don’t necessarily want to come to see a urologist. Their partners have to kind of get them in there to see them and if you are doing your PSA or your digital is that where you are going to find this?
Dr. Vemulapalli: Yeah, and a lot of times it happens just from a conversation. You know as you mentioned, a lot of men might be reticent to come in and get seen by a doctor, it might their spouse that kind of gives them a little push to say heh, honey you know you are getting up more at night or we are stopping on the roadside more often to go to rest areas if we are taking long car trips, maybe you should get this checked out. A lot of times, that conversation might happen with their primary care doctor and through their course of their investigation if they have more urinary difficulties, the primary care doctor might refer them to a urologist such as myself and during our conversation we will have a lot of those talks about what symptoms they are having, what are the bothersome urinary complaints that they are noticing and it’s usually on digital exam. We as urologists really examine many prostates and we have an idea of what is normal growth, what is abnormal growth, what is enlarged, what is normal sized, and it is usually with a combination of the discussion that we have, with regards to symptoms as well as our physical examination, which usually entails a digital rectal exam as well.
Melanie: Does BPH mean cancer? Do they go together? Please clear this up for men.
Dr. Vemulapalli: No, BPH is a common condition. It’s not related to cancer. It’s usually just defined as a benign growth of the gland which can be just hyperplasia which means that the gland typically grows as men get older, whereas cancer, prostate cancer is a totally different ballgame. Patients with prostate cancer may also exhibit urinary symptoms and difficulty due to the growth of the cancer tumor, but they are two separate entities.
Melanie: Doctor, if you determine that a man has an enlarged prostate, what’s the first line of defense?
Dr. Vemulapalli: Typically, we – we have what is called an international prostate symptom score that is a survey that men will typically complete, but when we speak to them and that goes over a whole host of symptoms with regard to urinary frequency, sensation of incomplete bladder emptying, the force of their urinary stream, whether they are getting up many times at night and through just them being able to complete that survey with their own symptomatic profile; we are able to get an idea of where and what degree of obstructive symptoms that they are having with regard to BPH as well. We have a quality of life score which they are able to complete indicating how bothersome those urinary symptoms are to them and that helps us to stratify how bothersome these complaints are. Initially if it is just something where they might feel that they are going to the bathroom more frequently, we might do a little scan to see how much volume is left over in their bladder after they have voided, and it could be something simple as just doing timed voiding to try to make sure that they are able to keep that leftover volume as low as possible. If that’s not really helpful enough, or if they are having more irritative complaints or bothersome complaints, then we might switch to a medicine. There are a lot of medicines that we have available. One of the primary medicines that we use are called alpha blocker medications and they block smooth muscle receptors within the prostate that helps to relax the gland and allow patients to urinate a little bit easier. And that could be of mainstay of therapy and it’s a lot of what patients would use, and they might not need anything more than that. There are alternatively other medicines that men see advertised on TV that are designed to shrink the prostate gland. Those tend to block what are called 5 alpha reductase enzymes and receptors in the prostate and that will over time typically help men to have a decreased size of the prostate gland. And when we are talking about decreased size, we are talking about maybe a 15-20% reduction in the size, but often those medicines take many, many months to have any sign of efficacy, so patients might be on those medicines for anywhere from six to twelve months before they might notice a symptomatic change. But those are the first two-line medications that many urologists would use.
Melanie: Are there any complications if a man decides just to do the watchful waiting or not to have treatment of any kind? Is there something like erectile dysfunction or something that can start to happen as a result of not treating BPH?
Dr. Vemulapalli: Typically, not as a result of BPH, men don’t get any erectile problems or things of that nature. But sometimes these symptoms do progress and we see many men as they get older, they tend to have problems that they were initially just symptomatic, heh doc I was getting gup more times at night and that was reasonable but now, for example, I am getting bleeding and that’s more concerning or they are getting infections or things like that. So, oftentimes if patients aren’t able to void adequately, and save larger residual volumes, they might be set up to form stones in the bladder and such from poor bladder drainage and those can have secondary effects that really have more onerous symptoms for patients that now often they come in to get those symptoms addressed.
Melanie: So, when do you start discussing some sort of surgical intervention with the patient?
Dr. Vemulapalli: Well I think most of us, we would review medical options first with patients, see how they respond to it. Some patients don’t really like the idea of taking daily medications and those patients or if they tried medicines and the medicines really haven’t proved to be very efficacious, in that case, we would consider surgical options and we have a whole host of things that we do that really can deliver a good durable result for patients. Sometimes we do what are called TURP procedures and that stands for – it’s an acronym that stands for transurethral resection of prostate and these are procedures that have been done for many years. Nowadays, we also have more technologically advanced procedures such as laser therapies, myself because I also do a lot of robotic surgery, we are also able to offer patients robotic procedures where if they have really large glands that might not be amenable to transurethral procedures that we can attack those robotically. Sometimes as I mentioned, patients can get stones in the bladder, we might need to open up the bladder to deliver those stones if they are quite large. Really, the surgical intervention really is tailored to what the patient is experiencing and the anatomy of their gland and condition. So, there is a whole host of things that we can do but it really depends on what the patient has and how we can try to alleviate their symptoms.
Melanie: And if you use one of these surgical interventions, such as TURP; do they last then for the life of the man? Do they ever have to be redone?
Dr. Vemulapalli: I think it depends on how much tissue that the patient has. For the large majority of men, I think usually one procedure would really be a durable result. But sometimes, just like no two men are the same; sometimes their genetics can be different and sometimes some patients do get regrowth over time, over many years and that there is a small percentage I would say of patients that might need a repeat intervention. But by and large, I feel if you have been able to give the patient a diligent procedure and are able to give them a durable result, it does tend to last. But there are a few patients that for anatomic reasons or for genetic conditions might have a gland that really grows larger over time. It really depends on when their initial intervention was and over the length of how long a patient might live. I had a patient that had really terrible complaints when they were in their 50s and then 10 or 15 years later, they had another complaint and you look inside and they might have some have some regrowth. It is possible that they might need another intervention. But it’s usually not as common.
Melanie: Dr. Vemulapalli, people assume that this type of technology, they associate it with big city hospitals. Tell us a little bit about your team at St. Luke’s Cornwall and how you use advanced robotic and laser surgery options.
Dr. Vemulapalli: Well our team here at St. Luke’s, we really worked hard to identify one particular team in our urology division that is able to really do a lot of these procedures so you have one dedicated team that really just works in urologic procedures and whether it is for BPH or for cancers or things of that nature and we do a lot of the gamut of procedures from the traditional transurethral resection procedures to cystoscopic removal of stones with lasers to laser therapy for the prostate to doing more advanced robotic procedures. We have done the entire gamut and I think the real benefit with us is that we have one dedicated team so it’s the same nursing staff and the same technical support surgical team that is able to kind of do these procedures. They get really very acclimated to all these different types of tools and what we need to accomplish the procedure and I think that’s really one of the benefits of what we have here. We may not be as large as a city hospital; but we have a large array of services because I think we have a dedicated team and the same team that does everything.
Melanie: In summary doctor, please let men know your best advice about keeping a healthy prostate.
Dr. Vemulapalli: I think in terms of the healthy prostate there are other things that can cause irritative complaints and that could be with regard to lifestyle in terms of caffeine intake, beverage choice, things that have high sugar contents or patients that have a history of diabetes would want to keep an eye on their blood sugars. Alternatively, things like alcohol could also have a diuretic effect on patients causing them to produce a larger quantity of urine as well as caffeinated beverages such as teas or coffee. So, you wouldn’t want to drink any of those beverages before bedtime where you might end up producing more urine because of those agents.
Melanie: Thank you so much for being with us today. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit www.stlukescornwallhospital.org , that’s www.stlukescornwallhospital.org . I’m Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Benign prostatic hyperplasia or BPH is the most common diagnosis made by urologists for men in the age group of around 45-74 and it’s also the most common disorder of the prostate. My guest today, is Dr. Praneeth Vemulapalli. He’s a board-certified urologist and the co-chair of St. Luke’s Cornwall Hospital’s Urology Service. Welcome to the show Dr. Vemulapalli. So, what is BPH and at what age do men start to develop an enlarged prostate?
Dr. Praneeth Vemulapalli, MD (Guest): Well first Melanie, thanks for having me. BPH as you mentioned stands for benign prostatic hyperplasia. It’s a common condition that affects many men, typically more so as they become older in age. Statistics indicate that approximately 10% of men in their 30s have symptoms and it progressively increases to about 20% of men in their 40s to almost around 50% of men in their 50s and up between 60-70% of men as they get into their 60s and 70s and progressively more so and that’s based on autopsy studies that approximately 80% of men in their 80s have signs of this condition. It usually presents with symptoms of difficulty urinating. It could be something as simple as feeling you have to go to the bathroom more frequently, feeling that when you do go, that you don’t empty yourself completely or sometimes you feel yourself getting up more at night to pee. But those are all common symptoms that patients will notice.
Melanie: So, how would you even diagnose, because men don’t necessarily want to come to see a urologist. Their partners have to kind of get them in there to see them and if you are doing your PSA or your digital is that where you are going to find this?
Dr. Vemulapalli: Yeah, and a lot of times it happens just from a conversation. You know as you mentioned, a lot of men might be reticent to come in and get seen by a doctor, it might their spouse that kind of gives them a little push to say heh, honey you know you are getting up more at night or we are stopping on the roadside more often to go to rest areas if we are taking long car trips, maybe you should get this checked out. A lot of times, that conversation might happen with their primary care doctor and through their course of their investigation if they have more urinary difficulties, the primary care doctor might refer them to a urologist such as myself and during our conversation we will have a lot of those talks about what symptoms they are having, what are the bothersome urinary complaints that they are noticing and it’s usually on digital exam. We as urologists really examine many prostates and we have an idea of what is normal growth, what is abnormal growth, what is enlarged, what is normal sized, and it is usually with a combination of the discussion that we have, with regards to symptoms as well as our physical examination, which usually entails a digital rectal exam as well.
Melanie: Does BPH mean cancer? Do they go together? Please clear this up for men.
Dr. Vemulapalli: No, BPH is a common condition. It’s not related to cancer. It’s usually just defined as a benign growth of the gland which can be just hyperplasia which means that the gland typically grows as men get older, whereas cancer, prostate cancer is a totally different ballgame. Patients with prostate cancer may also exhibit urinary symptoms and difficulty due to the growth of the cancer tumor, but they are two separate entities.
Melanie: Doctor, if you determine that a man has an enlarged prostate, what’s the first line of defense?
Dr. Vemulapalli: Typically, we – we have what is called an international prostate symptom score that is a survey that men will typically complete, but when we speak to them and that goes over a whole host of symptoms with regard to urinary frequency, sensation of incomplete bladder emptying, the force of their urinary stream, whether they are getting up many times at night and through just them being able to complete that survey with their own symptomatic profile; we are able to get an idea of where and what degree of obstructive symptoms that they are having with regard to BPH as well. We have a quality of life score which they are able to complete indicating how bothersome those urinary symptoms are to them and that helps us to stratify how bothersome these complaints are. Initially if it is just something where they might feel that they are going to the bathroom more frequently, we might do a little scan to see how much volume is left over in their bladder after they have voided, and it could be something simple as just doing timed voiding to try to make sure that they are able to keep that leftover volume as low as possible. If that’s not really helpful enough, or if they are having more irritative complaints or bothersome complaints, then we might switch to a medicine. There are a lot of medicines that we have available. One of the primary medicines that we use are called alpha blocker medications and they block smooth muscle receptors within the prostate that helps to relax the gland and allow patients to urinate a little bit easier. And that could be of mainstay of therapy and it’s a lot of what patients would use, and they might not need anything more than that. There are alternatively other medicines that men see advertised on TV that are designed to shrink the prostate gland. Those tend to block what are called 5 alpha reductase enzymes and receptors in the prostate and that will over time typically help men to have a decreased size of the prostate gland. And when we are talking about decreased size, we are talking about maybe a 15-20% reduction in the size, but often those medicines take many, many months to have any sign of efficacy, so patients might be on those medicines for anywhere from six to twelve months before they might notice a symptomatic change. But those are the first two-line medications that many urologists would use.
Melanie: Are there any complications if a man decides just to do the watchful waiting or not to have treatment of any kind? Is there something like erectile dysfunction or something that can start to happen as a result of not treating BPH?
Dr. Vemulapalli: Typically, not as a result of BPH, men don’t get any erectile problems or things of that nature. But sometimes these symptoms do progress and we see many men as they get older, they tend to have problems that they were initially just symptomatic, heh doc I was getting gup more times at night and that was reasonable but now, for example, I am getting bleeding and that’s more concerning or they are getting infections or things like that. So, oftentimes if patients aren’t able to void adequately, and save larger residual volumes, they might be set up to form stones in the bladder and such from poor bladder drainage and those can have secondary effects that really have more onerous symptoms for patients that now often they come in to get those symptoms addressed.
Melanie: So, when do you start discussing some sort of surgical intervention with the patient?
Dr. Vemulapalli: Well I think most of us, we would review medical options first with patients, see how they respond to it. Some patients don’t really like the idea of taking daily medications and those patients or if they tried medicines and the medicines really haven’t proved to be very efficacious, in that case, we would consider surgical options and we have a whole host of things that we do that really can deliver a good durable result for patients. Sometimes we do what are called TURP procedures and that stands for – it’s an acronym that stands for transurethral resection of prostate and these are procedures that have been done for many years. Nowadays, we also have more technologically advanced procedures such as laser therapies, myself because I also do a lot of robotic surgery, we are also able to offer patients robotic procedures where if they have really large glands that might not be amenable to transurethral procedures that we can attack those robotically. Sometimes as I mentioned, patients can get stones in the bladder, we might need to open up the bladder to deliver those stones if they are quite large. Really, the surgical intervention really is tailored to what the patient is experiencing and the anatomy of their gland and condition. So, there is a whole host of things that we can do but it really depends on what the patient has and how we can try to alleviate their symptoms.
Melanie: And if you use one of these surgical interventions, such as TURP; do they last then for the life of the man? Do they ever have to be redone?
Dr. Vemulapalli: I think it depends on how much tissue that the patient has. For the large majority of men, I think usually one procedure would really be a durable result. But sometimes, just like no two men are the same; sometimes their genetics can be different and sometimes some patients do get regrowth over time, over many years and that there is a small percentage I would say of patients that might need a repeat intervention. But by and large, I feel if you have been able to give the patient a diligent procedure and are able to give them a durable result, it does tend to last. But there are a few patients that for anatomic reasons or for genetic conditions might have a gland that really grows larger over time. It really depends on when their initial intervention was and over the length of how long a patient might live. I had a patient that had really terrible complaints when they were in their 50s and then 10 or 15 years later, they had another complaint and you look inside and they might have some have some regrowth. It is possible that they might need another intervention. But it’s usually not as common.
Melanie: Dr. Vemulapalli, people assume that this type of technology, they associate it with big city hospitals. Tell us a little bit about your team at St. Luke’s Cornwall and how you use advanced robotic and laser surgery options.
Dr. Vemulapalli: Well our team here at St. Luke’s, we really worked hard to identify one particular team in our urology division that is able to really do a lot of these procedures so you have one dedicated team that really just works in urologic procedures and whether it is for BPH or for cancers or things of that nature and we do a lot of the gamut of procedures from the traditional transurethral resection procedures to cystoscopic removal of stones with lasers to laser therapy for the prostate to doing more advanced robotic procedures. We have done the entire gamut and I think the real benefit with us is that we have one dedicated team so it’s the same nursing staff and the same technical support surgical team that is able to kind of do these procedures. They get really very acclimated to all these different types of tools and what we need to accomplish the procedure and I think that’s really one of the benefits of what we have here. We may not be as large as a city hospital; but we have a large array of services because I think we have a dedicated team and the same team that does everything.
Melanie: In summary doctor, please let men know your best advice about keeping a healthy prostate.
Dr. Vemulapalli: I think in terms of the healthy prostate there are other things that can cause irritative complaints and that could be with regard to lifestyle in terms of caffeine intake, beverage choice, things that have high sugar contents or patients that have a history of diabetes would want to keep an eye on their blood sugars. Alternatively, things like alcohol could also have a diuretic effect on patients causing them to produce a larger quantity of urine as well as caffeinated beverages such as teas or coffee. So, you wouldn’t want to drink any of those beverages before bedtime where you might end up producing more urine because of those agents.
Melanie: Thank you so much for being with us today. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit www.stlukescornwallhospital.org , that’s www.stlukescornwallhospital.org . I’m Melanie Cole. Thanks so much for listening.