Urological Health - Q3 2021 by Mediaplanet UK&IE

Q3 2021 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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How an effective technique is helping resolve prostate problems Over

70%

Surgeons are urging patients with prostate problems to seek diagnosis and treatment at the earliest opportunity to avoid treatable conditions becoming much more serious.

INTERVIEW WITH Rajesh Kavia Consultant Urological Surgeon, London North West University Healthcare NHS Trust

WRITTEN BY Mark Nicholls

Find out more at urolift.co.uk

enign prostatic hyperplasia (BPH), also known as an enlarged prostate, has been described as ‘practically inevitable’ in the older men. The condition is relatively common, affecting more than 40% of men in their 50s and up to 70% of males in their 60s, but if left untreated or undiagnosed it can have an impact on quality of life.1 The enlarged prostate presses on and blocks the urethra, causing bothersome urinary symptoms. Dangers of delays Consultant urological surgeon Rajesh Kavia, who is an expert in the field of prostate conditions, explains that symptoms of BPH, can vary from patients complaining of slow urine flow or incomplete bladder emptying, to wanting to go to the toilet more often or with a degree of urgency.2 Mr Kavia, from the urology department within the London North West University Healthcare NHS Trust, explains: “A lot of men put off asking for referral to secondary care from their GP, because they think that their only options are medications or the traditional surgical options which do carry a risk of sexual dysfunction and incontinence.” “One of the dangers of delaying treatment for this condition is about 4% of patients may not be able to pass any urine at all and their pain and discomfort has to be relieved via a catheter. This becomes more serious with high-pressure chronic retention.”* “This can cause damage to the kidneys,” he says, “but if we catch it reasonably early it can be reversible.” Treatment options Mr Kavia says after diagnosis there are various treatment options available to patients from tablets, minimally invasive procedures through to the more traditional surgical options. For the majority of men, the first course of treatment is still medication. Specifically, alpha blockers, which relax the muscles and make it easier to pass urine. Another group of medications are 5alpha reductase inhibitors, which shrink the prostate. They are effective but are also a lifetime commitment and some men do experience side effects from the medication. Surgery is another option offered to men who experience side effects from the medication or who find that it is no longer effective. Traditional surgery is available to BPH patients but involves cutting away enlarged tissue and can cause sexual dysfunction,

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among other side-effects. It also requires an inpatient stay and a more prolonged recovery time.3 He says: “When I counsel patients for their surgical options, one of the key factors on deciding which option will be most suitable for them is the size of their prostate. If the prostate gland is very large, a patient may be offered more traditional surgery, such as laser or TURP, but if it is smaller, we can look at minimally-invasive techniques.”* For that approach, he opts for the UroLift® System technique which lifts the enlarged prostate, so it no longer blocks the urethra. This is a proven approach to treating BPH and has been extensively studied.4 Faster recovery The UroLift® System does not require heating, cutting, removal, or destruction of prostate tissue.5-10 Available on the NHS, it is generally performed under a local anaesthetic, or with slight sedation as a day-case.11 “A patient having the procedure can usually go home the same day after passing urine often within a few hours of the procedure. The majority of patients do not need a catheter following the procedure, which makes it unique as most procedure options may require this,” he adds. “The procedure is the leading BPH procedure shown to not cause new onset, sustained sexual dysfunction*. “Most patients will experience a quick recovery, though some can experience pain or burning with urination, blood in the urine, and have an urgent need to urinate. Occasionally, a catheter may be required.” One of the major risks that may lead to poor outcomes after treatment, is if patients wait too long before speaking to their GP and subsequent seeking diagnosis and treatment. Therefore, it is important to seek help if you have concerns. *This information reflects the opinion of Mr Kavia References 1. Berry et al, 1984 2. https://www.nhs.uk/conditions/prostate-enlargement/ 3. https://www.nhs.uk/conditions/transurethral-resection-of-the-prostateturp/risks/ 4. https://www.urolift.com/physicians/publications?hsCtaTracking=fd6 38e94-7c4e-4c4d-8249-3ce9b311028f%7Cfc136105-1949-4fa8-abf290e08795a605 5. Roehrborn, J Urol 2013; 6. AUA Guidelines 2003, 2020; 7. Mirakhur, Can Assoc Rad J 2017; 8. McVary, J Urol 2016, 9. Gilling, Can J Urol 2020; 10. Kadner, World J Urol 2020 11. Shore, Can J Urol 2014 12. Roehrborn, Can J Urol 2017 LIFT Study *No instances of new, sustained erectile or ejaculatory dysfunction in the LIFT pivotal study

of men surveyed* said their energy level has been impacted during the day because they get up frequently at night to urinate

About

1 in 5 of men surveyed* report that locating the closest bathroom is the first thing they do when they go somewhere new

Nearly

HALF of men surveyed* have avoided events or activities they enjoy because of their urinary symptoms

3 in 4 About

of men surveyed* have limited the amount they drink in the evening in order to avoid getting up at night to urinate

Content based on surgery of approximately 1,000 US men, aged 45+, who have experienced at least one urinary symptom commonly associated with an enlarged prostate (also known as benign prostatic hyperplasia or BPH) conducted by Neotract | Teleflex in 2021.

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Restoring vital functions through life changing research

Just can’t wait – how OAB is affecting quality of life

We believe science will beat paralysis. Our work funds the research needed to improve movement and restore function, so that paralysis will no longer be considered a life sentence.

Overactive bladder (OAB) is defined as urgency that occurs with or without urge urinary incontinence and usually with frequency and nocturia (NICE 2015).

ommon stories from patients with OAB suggest they “just can’t wait” and are rushing to the toilet, often wet before they get there. Patients often report they go to the toilet prior to outings “just in case”, thus worsening the issue as the bladder learns to empty more frequently. This bladder complaint often goes unreported as patients find the bothersome symptoms embarrassing to discuss.

The embarrassment of accidental bladder leakage caused by OAB can cause patients to feel socially isolated and impacts on ability to work as well as affecting personal relationships. Impact on relationships The embarrassment of accidental bladder leakage caused by OAB can cause patients to feel socially isolated and impacts on ability to work as well as affecting personal relationships. Treatments for OAB can include medication trials and more complex invasive botulinum toxin A injections, commonly known as bladder Botox. The recommendation for first line treatment of OAB is likely to focus on non-invasive lifestyle changes. Therefore, patients who have this symptom can ask their GP for a referral to their local NHS bladder

WRITTEN BY Andy Russell Head of Marketing, Spinal Research

and bowel service where they will be assessed by a suitably trained healthcare professional and given individual advise and support. Lifestyle interventions This will include an examination to confirm diagnosis, followed by some simple lifestyle changes such as BMI and weight management advice and optimal hydration and nutrition advice specific for body size. It may also include constipation avoidance advice and ensuring fluid choices don’t contain stimulants that may irritate the bladder and exacerbate the symptoms, such as switching to decaffeinated and non-carbonated drinks. Next steps, if required, will include pelvic floor muscle examination, teaching pelvic floor muscle exercises and bladder retraining to optimise bladder capacity and support the patient with bladder control. Patients often report that this opportunity to discuss the OAB symptoms with a healthcare professional and be given some simple and achievable advice to promote self-care can build confidence and help improve their quality of life. As well as reducing the need for more invasive procedures.

WRITTEN BY Polly Weston Chair, ACA (Association for Continence Advice)

e have seen the power of scientific research through the development of the COVID-19 vaccination programme. We are using the same urgency to accelerate the development of life changing treatments for those with a spinal cord injury (SCI). Lizzie Tench’s story Lizzie Tench was badly injured nine years ago when she was thrown off her bike after being hit by an overtaking car. She knew something was seriously wrong as she couldn’t feel anything below her waist. She was rushed to a trauma ward where they confirmed her worst fears; she had an incomplete spinal cord injury. She spent five days at the trauma ward and nearly four months in a specialist spinal unit coming to terms with her injury and the reality of not being able to walk again. At this point she didn’t realise the effect of her injury on bladder and bowel control. “I assumed I was wearing a catheter because I was physically unable to get up and go to the toilet.” Problems with these functions are a hidden issue but affect almost everyone with a spinal cord injury (SCI). It can have a devastating impact on health, independence and quality of life. For Lizzie, the lack of control means a loss of freedom and spontaneity. It also results in embarrassing accidents and urinary tract infections. Lizzie also highlights that “Most people with SCIs would say that they would rather have their bladder and bowel control returned to normal than being able to walk again. Research into restoring function is very important.” Creating life changing treatments At Spinal Research, our Below the Belt portfolio of research projects focuses on restoring these functions and brings together teams of scientists to help tackle this urgent need. We currently have five research projects using innovative treatments to help improve function. One is a two-year clinical study led by Dr Sarah Knight at the London Spinal Injuries Unit. Individuals with an SCI will undergo an electrical stimulation and a bladder training programme to improve bladder function.

Spinal Research does not receive support from the UK Government - our research is driven by the generosity of our supporters. Help keep hope alive for thousands living with paralysis. Donate to support our work.

Navigator™ Patient Support Service from Fittleworth offers personal assistance and resources for people living with a spinal cord injury • •

1:1 support from a trained, personal Navigator* Access to an online Navigator content hub

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You are not alone, let’s talk about urology diseases We need to talk about bladders, erectile dysfunction, incontinence and male infertility. Does this make you feel uncomfortable or embarrassed? If so, you are not alone…

Helping provide bladder and bowel care for new mothers

WRITTEN BY Serena Wyman Fundraising Manager, The Urology Foundation

Recent guidance from the Royal College of Nursing suggests that bladder and bowel care in childbirth and beyond should be high on healthcare professionals’ agenda.

esearch shows that one in three women experience urinary incontinence in the first year after having a baby and up to three quarters of these continue to experience this 12 years after giving birth. A further one in 10 women develop bowel incontinence and another one in 12 develops pelvic organ prolapse. Healthcare professionals should be able to open conversations sensitively, enquire about and knowledgably explore bladder and bowel symptoms, enabling women to access the right treatment and management.

We all need to be able to talk more openly about our bladder and bowel and to understand what is normal, how to prevent issues and importantly, what to do if we have concerns. Improving access to care Some areas still lack NHS provision. However, the NHS Long Term Plan is committed to improve prevention, identification and treatment of pelvic floor dysfunction, so pregnant women and new mothers will receive preventative care and treatment for incontinence and pelvic floor issues. New NHS pelvic health clinics will be established at pilot sites with plans, following initial trials, for services to be expanded and made available across the country by March 2024. Additionally, the National Institute for Health and Care Excellence (NICE) are working to produce guidance on the prevention, assessment and READ MORE AT HEALTHAWARENESS.CO.UK

Raising awareness The benefit of these conversations is manyfold. By creating greater awareness of the disease, we can help save lives as more people are aware of the symptoms. It also helps sufferers to be able to talk more easily with friends and family and even employers about what support they will need. Sadly, it is far too common for a urology disease to impact on mental health. In addition to the fear caused by having a urological cancer (although many are now very treatable if caught in time), the non life-threatening conditions such as erectile dysfunction and incontinence cause great distress because of the devastating impact they have on people’s everyday lives. Embarrassment certainly plays a part, but so does isolation, and the stigma that so often surrounds these diseases.

management of pelvic floor dysfunction with publication due in December. The draft guidance encourages women to exercise their pelvic floor muscles throughout life to help prevent pelvic floor dysfunction. Programmes should be supervised by a qualified healthcare professional, who can tailor exercises to the individual and monitor progress. Speak to your healthcare professional Many women who contact Bladder & Bowel UK helpline services have not discussed their continence issue with anyone, often because of embarrassment or not knowing where to seek help. We encourage them to speak to their healthcare professional as most bladder and bowel issues are treatable. We all need to be able to talk more openly about our bladder and bowel and to understand what is normal, how to prevent issues and importantly, what to do if we have concerns. Women should be encouraged, to seek early help for bladder and bowel symptoms. They should not put up with or self-manage any issues that arise.

One in three women are affected by incontinence in their lifetime and at least one in 10 men suffer from erectile dysfunction. Celebrities speaking out We are fortunate in having well known public figures who are willing to share their experiences, such as Stephen Fry and Bill Turnbull talking about prostate cancer, comedian Rhod Gilbert about male infertility and ex England rugby player, Alex Corbisiero, on his testicular cancer. Speaking out makes a very real contribution to breaking down the taboos around these conditions and enabling people to have the conversation. Social media In the last few years there has been a new forum for people to open up these conversations. Everyday people who are suffering from urology conditions have become activists by picking up on the most difficult parts of being a patient and sharing their stories on social media to help educate and inform others.

Bladder & Bowel UK offer support for bladder and bowel health for everyone. They offer confidential advice from specialist nurses and product experts, and information on preventing and dealing with bladder and bowel issues can be found online at https://www.bbuk.org.uk/.

WRITTEN BY Karen Irwin Specialist Nurse and Bladder & Bowel UK Service Manager

t is estimated that one in two people in the UK will be affected by a urology condition at some point. Urology diseases include cancers of the prostate, kidney, bladder, testes and conditions such as erectile dysfunction, incontinence and male infertility. One in three women are affected by incontinence in their lifetime and at least one in 10 men suffer from erectile dysfunction. This unnecessary embarrassment is something we all need to move on from if we are to improve survival and quality of life for sufferers.

For more information visit theurology foundation.org

Talking to your GP The worst outcome of embarrassment is when it causes people to delay seeing their GP or health care professional. Early diagnosis for so many conditions, especially urology cancers, is key and all too sadly there are people that will literally die of embarrassment because they went too late. Please don’t be that person, so let’s talk. MEDIAPLANET

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WRITTEN BY Michelle Terry CEO, Movember

Peer support is vital to managing prostate cancer

Working together is the key to beating prostate cancer faster

Global collaboration can accelerate scientific breakthroughs in prostate cancer diagnosis.

f prostate cancer is caught early enough, it can be cured. However, the tests we currently have that help diagnose the disease, such as the PSA blood test, can be unreliable. It means some men’s cancers are missed, while other men are subjected to repeated unnecessary biopsies. More accurate, less invasive tests are urgently needed so that clinicians can make better-informed decisions about their patient’s treatment. It’s a hugely complex problem and one that can only be solved by bringing together the scientific community’s brightest minds and enabling them to work together.

clinicians whether their patient is likely to need active treatment within the next five years. This breakthrough is the result of years of collaborative effort between scientific teams across the globe. That collaboration drives scientific advances much more quickly and leads to better outcomes for men.

Helping men stay healthy and connected As a charity, we work to raise funds to deliver innovative, breakthrough research and support programmes that enable men to live happier, healthier and longer lives. Committed to disrupting the status quo, millions have joined the movement, helping Sharing global research fund over 1,250 knowledge projects around the Sharing knowledge of what In 2015, Movember world. established a In addition to works and what doesn’t not global network of tackling key health only reduces duplication of researchers from issues faced by men, Canada to Australia to effort but allows scientists to Movember is working build on each other’s learning. to encourage men work on the problem. Sharing knowledge of to stay healthy in what works and what doesn’t not only all areas of their life, with a focus on reduces duplication of effort but allows men staying socially connected and scientists to build on each other’s becoming more open to discussing learning. their health and significant moments There are now some promising in their lives. developments on the horizon. Results from a Canadian study, published earlier this year, built on findings Movember is the leading charity changing the face of men’s health on a global scale, focusing on mental of a European work, which found health and suicide prevention, prostate cancer and compelling evidence in favour of using testicular cancer. MRI-guided biopsies. The charity’s vision is to have an everlasting impact Closer to home, a team from on the face of men’s health. To donate or learn the University of East Anglia have more, please visit Movember.com developed a urine test that tells

It can be challenging at times to talk about incontinence, but support groups can help you to realise that you are not alone.

I WRITTEN BY Steve Allen Patient Representative, Tackle Prostate Cancer

can still vividly remember the time when I first realised that I had become totally incontinent of urine. It was four weeks after my radical prostatectomy and two weeks after my catheter had been removed. I was in the bathroom standing naked and having a shave. I looked down and found I was standing in a small pool of urine – it was literally dripping out of me. I had been warned that there would be a period of incontinence after the catheter was removed. Instead of staying the same or slowly improving, my incontinence had just worsened. I openly wept for the first time. I saw my surgical colleague and the bottom line was: “Time will tell. Surgical options may be available, but probably not until after one year.” I felt desolate. I felt very alone.

I was horrified at how little most men know about how their bodies work – particularly concerning both incontinence and sexual dysfunction. Finding support groups The major breakthrough was when I went, with some trepidation, to my local prostate cancer support group. Would it be full of wet, whingeing old men? Nothing could have been further from the truth. I was greeted with warmth. I felt able to talk frankly about my problem. Yes, of course, as soon as it became apparent I was a doctor I changed from being support-ed to being a support-er. But it changed my attitude to my problem. I took control of my life. Improving patient understanding I was horrified at how little most men know about how their bodies work – particularly concerning both incontinence and sexual dysfunction. It prompted me to become involved with charities such as Tackle Prostate Cancer and Prostate Cancer UK. I now talk freely about my problem. I do my best to improve the knowledge of patients so that they can access the best possible treatment. I hope I have changed lives, because other patients with whom I have talked have changed mine. Other men do the same as I do. I believe peer support is vital to managing this disease. One year after my prostatectomy I had the implant of an artificial urinary sphincter. This has revolutionised my life and, 12 years later, I remain virtually totally continent.

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All these complications can be potentially life threatening and may require emergency hospital admission and treatment. Importantly, the complications may be avoided if men seek help early.

Men must seek help for key urinary symptoms There are a few key terms within benign prostate disease which need to be understood carefully, as the terminology can be potentially confusing.

B WRITTEN BY Professor Iqbal Shergill Consultant Urological Surgeon and Treasurer Elect, BAUS, Wrexham Maelor Hospital, North Wales

enign prostatic enlargement (BPE) refers to the clinical finding of physical enlargement of the prostate, which is benign and not cancerous. Benign prostate obstruction (BPO) is bladder outlet obstruction caused by benign prostatic enlargement. Benign prostate hyperplasia/hypertrophy (BPH) refers to a histological diagnosis – and hence can only be theoretically made after operation. Lower urinary tract symptoms (LUTS) is a non-specific term for symptoms which may be attributable to lower urinary tract dysfunction. In contemporary clinical practice, we use the term LUTS/BPH to refer LUTS caused by BPE resulting in BPO.

objectively quantify the severity of symptoms and its effect on quality of life. The IPSS is very advantageous in that it is valid, reliable and reproducible. Importantly, for clinical follow up, it can also be subsequently used to objectively establish response to surgical treatments.

Studies show that the prevalence of LUTS/ BPH is around 13% in men aged 40-49, rising to a third of men over the age of 70.

Seeking support It is vitally important that men with symptoms seek help. Primarily, a clinical assessment is needed to exclude or diagnose prostate cancer, symptoms of LUTS/BPH can be non-specific and as such, do overlap with some prostate cancer symptoms. Secondly, when a firm diagnosis of LUTS/BPH has been made, there is a significant risk of developing complications, also called “clinical progression” of symptoms. This refers to the future risk of developing acute urinary retention, need for operation, risk of kidney failure and risk of developing urine infections. All these complications can be potentially life threatening and may require emergency hospital admission and treatment. Importantly, the complications may be avoided if men seek help early.

Identifying key symptoms Symptoms from LUTS/BPH may be primarily due to physical blockage to the bladder/urethra, or due to secondary changes resulting in bladder overactivity. Symptoms due to the physical blockage from the prostate are termed obstructive/voiding symptoms. Typically, they would be poor flow, straining, incomplete emptying, hesitancy and intermittency. Overactive bladder symptoms include frequency, urgency (with or without leakage) and nocturia. Urologists will commonly use the International Prostate Symptom Score (IPSS.pdf (baus.org.uk)) to 08

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High risk groups We do not fully understand the exact cause of LUTS/ BPH, but age is the biggest risk factor. Studies show that the prevalence of LUTS/BPH is around 13% in men aged 40-49, rising to a third of men over the age of 70. Furthermore, the prevalence increases to 88% in 80-year-old men. The natural history of LUTS/ BPH is that it is a slowly progressive condition with an inevitable deterioration of symptoms as men get older.

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