Doctors using stents to treat enlarged prostates

Q. Unfortunately, I’m of the age when my prostate is beginning to give me a few problems. No cancer that I know of, but more frequent trips to the bathroom and a “reduced stream,” as they say. Recently, I could have sworn I heard about a new type of treatment but for the life of me I can’t remember where this may have been. Do you know anything about this?

A. I’m betting you may be familiar with a now-common medical procedure in which doctors insert a small metal stent or tube into a blood vessel to enhance blood flow and keep the vessel open. It’s frequently performed on patients who are either having a heart attack or about to have one because of blocked or severely clogged arteries.

Now, St. Louis University Hospital says it has adopted the same idea to alleviate a common problem that vexes more than 50 percent of men over 50. The condition is called benign prostatic hyperplasia (BPH) — in other words, a noncancerous growth of the prostate that occurs as men age. As the size of the gland continues to increase in size, it begins to compress the urethra, the tube through which urine flows out of the bladder. This can lead to all kinds of irksome problems, including weak stream, painful urination and incomplete emptying of the bladder causing frequent nighttime trips to the bathroom. Untreated, these symptoms can lead to incontinence, kidney and bladder damage, stones, urinary tract infections and the inability to urinate at all.

Now, just as stents can open blocked arteries, urologists are using them to open up compromised urethras. It’s called the UroLift system and it involves implanting a small stent into the prostate, relieving pressure on the prostate without cutting into or removing the gland. Instead, the stent lifts and holds the enlarged tissue, easing pressure on the urethra and allowing urine to flow more freely.

“It’s a quick outpatient procedure allowing men to go home the same day with no catheter and no medications,” said urologist Dr. Sameer Siddiqui of the procedure, which has been approved by the Food and Drug Administration. “This is a big advancement in treating BPH.”

In addition to drugs, which can cause side effects, the most common therapy used to treat BPH has been a surgical procedure called transurethral resection of the prostate (TURP). However, this can cause sexual dysfunction, urinary incontinence, and retrograde ejaculation.

“Studies have shown the urethral lift offers no sexual side effects that can come with traditional therapies,” Siddiqui said, citing an April 2014 British Journal of Urology study that found the procedure “allows patients to quickly return to normal activity, provides rapid and durable improvement in symptoms, and preserves sexual function.”

If you want to find out more, call 314-577-8790.

Q. Is it worth getting a shingles vaccination before you’re 60 or 65?

A. It may be worth a shot — but perhaps not by as much as you might think.

While the vaccine is approved for anyone over 50, a new study seems to show it just doesn’t prevent many cases of shingles in people between 50 and 59. At the Cleveland Clinic, Drs. Phuc Le and Michael Rothberg studied the cost-effectiveness of the vaccine by looking at the number of cases of shingles and postherpetic neuralgia prevented in terms of something they called the incremental cost per quality-adjusted life year (QALY) saved.

Usually, a cost-effective treatment is one that costs $100,000 or less per QALY. The Cleveland Clinic researchers determined that the Zostavax vaccine would prevent only 25 cases of shingles and one case of postherpetic neuralgia per 1,000 doses given in people 50 to 59. As a result the cost per QALY for this vaccine in this age group is $300,000 — or three times the cost-effective maximum. Moreover, the vaccine is only good for 10 or 12 years, so you’d have to get revaccinated in your 60s. And many insurance companies may not cover the shot for younger patients.

Of course, if you’re one of those cases it prevents or reduces the severity, you’ll be glad you asked for it.

Q. Can you tell me who does the voice of Finger, the taxi dispatcher in “The Fifth Element,” as well as the woman who voices his mother?

A. As far as I can tell, those are secrets that may go to the grave of the people who gave their vocal chords a small workout for this 1997 sci-fi favorite that stars Bruce Willis. They received no direct mention in the movie credits, so it has continued to be a subject of hot debate on numerous websites from the Internet Movie Database to The Straight Dope.

The most popular candidate for the taxi dispatcher seems to be Mark Sinclair — alias Vin Diesel — just before his first major role as Private Adrian Caparzo in “Saving Private Ryan” in 1998. Diesel has never confirmed this, but he has had at least two other voice-over roles as Richard Riddick in “The Chronicles of Riddick” and as Groot in last year’s smash “Guardians of the Galaxy.” However, I also found at least one vote for Bill Nunn, best known for his roles of Radio Raheem in Spike Lee’s “Do the Right Thing” and Robbie Robertson in Sam Raimi’s Spider-Man trilogy.

As for Korben Dallas’ dear ol’ mom, the most movie fans say it’s Jill Mullan, who gets a special thanks in the final credits for no given reason, although some have a feeling it’s Bruce Willis’ wife at the time, Demi Moore. And I’ve found no speculation for the voice of a Mr. Shadow. As always, I would love to hear from any filmophile who knows otherwise.

Today’s trivia

How did the English rock band Duran Duran come to choose its odd name?

Answer to Saturday’s trivia: Dame Edith Mary Evans played dozens of the most famous stage roles in literary history, from the classics of Richard Sheridan and Oscar Wilde to the contemporary works of George Bernard Shaw and Noel Coward. But she always adamently refused to play one of the greatest tragic roles of all time, Shakespeare’s Lady Macbeth. Why? This is how she explained it once to English actor-director John Gieldgud: “I could never impersonate a woman who had such a peculiar notion of hospitality.” You might remember that the wife of the Scottish nobleman first invites King Duncan as an overnight guest and then goads her husband into killing him. Later while her newly crowned hubby starts plotting other murders, she sends away more guests from a banquet when he starts hallucinating.

This story was originally published September 12, 2015 at 10:52 AM with the headline "Doctors using stents to treat enlarged prostates."