Bladder & Bowel - Q2 - Jun 2019

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DR ALEX GEORGE The fear of admitting urinary symptoms and issues. » p2

BOWEL CANCER UK Early diagnosis is crucial to bowel cancer survival rates. » p4

THE UROLOGY FOUNDATION Overactive bladder?

Help is at hand. » p6

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Prostate issues and fear of admitting urinary symptoms and issues WRITTEN BY: DR ALEX GEORGE Doctor and TV Personality

From my experience as a doctor, there is an undeniable stigma surrounding certain health issues when it comes to the male population.

Even the mere mention of a prostate examination sends most men into a silent panic, and for many, it is that fear that prevents them coming to see us doctors in the first place.

I

have had conversations with countless men who have admitted they would rather risk having an undiagnosed serious illness than go to see the doctor, a thought I find quite terrifying. This stigma becomes amplified when it comes to prostate concerns.

Let's be frank; men are embarrassed when it comes to anything to do with the private parts, but to us doctors, this is baffling. A prostate examination is quick and painless and, for medical professionals, this is a procedure we will do day in, day out. I hate to trivialise the issue, but a prostate exam really isn’t a big deal.

So why the stigma? Personally, I believe that television, films and social media have all contributed to this fear, as well as myths passed down from the generations. In other countries, such as France, for example, there is no such stigma. Much of the medications we take orally, they will use in rectal form. They are very relaxed about the issue, and so they should be.

I have seen men in the A&E department who have presented with urinary retention, i.e. being unable to pass urine – sometimes for many hours, or even a day or so in some instances. Often, it turns out they have had symptoms for several months and only sought medical attention when it got to an extreme point.

Time and time again I hear the phrase, “I didn’t want to trouble the doctor,” but often, on further questioning, it comes out that they were embarrassed to talk about sensitive subjects for fear of judgement. Not only is this really sad but also potentially very dangerous.

I have personally seen the consequences of patients leaving it late to visit the doctor, and that delay has caused damage to the kidneys as a result of urinary retention. This is even more frustrating when it turns out that the underlying diagnosis – such as a benign prostate enlargement – is the cause, which is very much a treatable condition.

As a general rule, if we are able to pick up problems early, often, we are able to diagnose and provide treatment much more effectively than if we find problems later down the line.

It is so important that we tackle these stigmas head on, so that men feel more open and able to come forward and ask for help, rather than suffer in silence.

Read more at healthawareness.co.uk

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Don’t suffer in silence, ‘help is at hand’ WRITTEN BY: KAREN IRWIN Service Manager and Specialist Nurse, Bladder and Bowel UK

Bladder and bowel problems are not uncommon, but many individuals prefer not to openly discuss what, in essence, is private to us all. That is, being in control of our bladder, or not having difficulties with our toileting habits and routines.

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eople are often reluctant to come forward and present to health professionals, to seek the help and advice they need. This is commonly due to embarrassment, fear, or not realising that there are solutions to treating and managing bladder symptoms.

Common problems may include increased urinary frequency and/or urgency, frequently getting up at night to pass urine (nocturia), passing large amounts of urine at night, urinary incontinence or difficulty voiding or passing urine. It is also important not to ignore other symptoms, such as blood in your urine.

Firstly, speak to your GP We would suggest speaking to your GP or other health professional in the fi rst instance. They will be able to suggest the best way forward, undertake initial screening and advise if further investigation of symptoms is required.

It is important to be aware that bladder and bowel health is an important component in a person’s health and wellbeing, at any stage of life. There are an estimated 14 million men, women, young people and children of all ages, living with bladder problems in the UK. Bladder and bowel problems are more common than you may think It is estimated that 61% of men in the general population experience lower urinary tract symptoms and around 34% of women are living with urinary incontinence. In addition, 900,000 children and young people suffer from bladder and bowel dysfunction. We are also aware that an estimated 6.5 million adults in the UK suffer with

some form of bowel problem.

These figures relate to those individuals who are known and have presented themselves to health ser vices. There are, however, a great many others who simply put up with urological and continence symptoms; who self manage and suffer in silence. It is well known that for many people, these symptoms impact hugely on their quality of life.

A specialist, communitybased team for continence issues People should be encouraged to know that much can be done to cure, treat and improve continence symptoms. Where this is not achievable, an individualised management plan can help improve the quality of life for most individuals. The initial assessment, treatment and management for continence issues is best undertaken by staff trained in continence care.

These services, often referred to as ‘bladder and bowel services’ or ‘continence services’, are usually based in the community, consisting of a team of specialist of nurses and other continence healthcare professionals. These professionals assess and advise on conservative treatment options, such as dietary advice, lifestyle adjustments, bladder retraining, medication advice and pelvic floor muscle exercises, to name but a few.

Those individuals experiencing more complex problems, or who have not responded to initial treatment, can be referred to specialist services, such as urology, urogynaecology, geriatrics, or specialist physiotherapy.

Where to go to find information to help The internet provides people with lots of information on continence and urological issues, from trusted sites like the NHS, which enable patients to educate themselves with credible, reliable information. Other credible sites, such as charities and organisations, dedicated to this specialist area, offer helpline advice, support and signposting to services. These services are not only there for those experiencing continence problems, but for those caring for people with these issues, too.

In addition to medical intervention, sometimes people need practical solutions to manage what seems like an unmanageable problem. These may include products to enable them to remain in work, take part in sporting activities or simply to socialise and lead as normal and independent a lifestyle as possible.

There are many thousands of individual product brands available to help manage bladder and bowel problems. Organisations such as Bladder & Bowel UK or Continence Products Advisor offer unbiased information and advice on products that are available.

Their advice is written by continence healthcare professionals and formulated from evidence-based research. So, be encouraged to seek help and advice. By talking openly about your condition, help and support is available. Don’t suffer in silence.

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Breaking down the barriers of living with a stoma With over 102,0001 people believed to be living in the UK with a stoma, why do people continue to feel a sense of isolation or a need to keep it a secret?

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stoma is an ar tificia l opening in the abdomen used to divert the flow of faeces or urine from the body. A stoma bag is worn over the stoma, into which bodily waste is collected.

In the case of an ileostomy, it is the end of the small bowel (known as the ileum) that is brought out to the surface of the abdomen. An ileostomy bag is typically emptied several times during the day and for many, overnight.

Providing the right support Feelings of embarrassment, fear, anger and fr ust rat ion are not uncommon when a stoma is formed.

Thankfully, however, a stoma can also be a welcome relief and an opportunity to move forward, resulting in an improved quality of life for many.

Gaining confidence post-surgery is key when living with an ileostomy, or any type of stoma. A lack of confidence can affect what many consider to be the simplest of tasks, such as socialising with others or leaving the house. While there is a physical change to the body after surgery, it is important to recognise that, for many, there can also be an impact on how they feel about themselves, or concern for how others may see them.

C a mpa ig n s on so c ia l me d ia such as #BeSelfieConfident and #Glad R agsA ndOstomyBags are helping people to grow their confidence and are normalising living with a stoma. Talking through feelings with their Stoma Care Nurse, friend or family member can often alleviate apprehension too.

In our experience of connecting people living with an ileostomy, we have found that some prefer to share their concerns with someone unknown to them; someone who understands, having been through a sim i lar ex per ience, offer ing guidance and practical lifestyle tips.

How can society help?

Talking about stomas and bags can help to normalise conversation while increasing acceptance. As a nation that typically reaches for the broom when bowels are mentioned, we must continue to encourage dialogue to break the ‘poo taboo’. When it comes to stoma formation, age doesn’t discriminate and neither should society.

While public awareness is increasing, there is still much more to be done.

For those who have lived with

WRITTEN BY: SCOTT CLIFFORD Communications Manager, Ileostomy and Internal Pouch Association

chronic illness, alleviated or overcome by stoma formation, it can mean they are no longer controlled by disease.

The constant need to search for the nearest toilet reduces. It is important to remember, however, that there are many reasons for stoma formation.

While many are formed following chronic illness or disease, stomas are also performed under emergency conditions, leaving the person little or no time to research or understand what having a stoma means for them.

It’s time for society to accept that a stoma is part of life for so many. It’s likely someone you know has a stoma and only through normalisation can we encourage more people to feel comfortable living with their stoma.

For guidance and support on living with an ileostomy or an internal pouch please contact IA on 0800 0184 724 or email info@iasupport.org Our volunteers are themselves living with an ileostomy or an internal pouch.

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1: Black P (2009a) Managing physical postoperative stoma complications. British Journal of Nursing; 18: 17, S4-S10.

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Bowel cancer: what you need to know WRITTEN BY: KARIS BETTS Health Expert, Cancer Research UK

Bowel cancer is the fourth most common cancer in the UK, but over half of cases are preventable – and thanks to research, more people are surviving the disease than ever before.

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ut, isn’t getting cancer just a lottery? Though you might think cancer is all down to genes or just bad luck, there are plenty of things we can do to reduce our chances of developing the disease. Some things are beyond our control – cancer risk rises with age as there’s been more time for genetic mistakes to develop in our cells.

Although there are no guarantees, you can reduce your risk by maintaining a healthy weight, not smoking, cutting down on red or processed meat, and eating a balanced diet with lots of high-fibre food like whole grains and vegetables.

What should I look out for?

You don’t need to check your body in a certain way or learn a list of symptoms, just get to know what’s normal for you, and tell your doctor about anything that’s unusual or doesn’t go away. This includes your poo: what it looks like and how often you go. You may feel embarrassed, but if something’s not right, it’s worth getting it checked out.

Should I go for screening if I feel fine?

Screening is for people without symptoms, because it aims to spot the signs of potential cancer before you can. Nine in ten people survive bowel cancer when it’s caught at an early stage, so screening can save lives by finding cancer when treatment is more likely to work. But no test is perfect - screening can miss cancers, or find cancers that wouldn't cause a person any harm - so whether you accept the invitation or not is up to you, and make sure you read the information included to help you decide.

How do they screen for bowel cancer?

Bowel cancer screening involves checking for tiny traces of blood in a sample of poo, which can be a warning sign. Tests are sent in the post for you to complete privately at home. There are a few ways to collect your poo sample: put a plastic tub in the toilet bowl, or use a plastic bag or glove over your hand. Then just wipe the sample on a card, put that in the hygienic envelope and post it back.

Do I really have to put my poo in the post?

It might sound a bit unpleasant, but it doesn’t take long. A new test is being introduced, which is easier because it only needs one sample. This has the potential to detect more cancers, but with the health system in crisis, there aren’t enough cancer specialists to meet demand - so we’re urging the Government to invest in more NHS staff to carry out these tests and give patients the best chance of survival.

Read more at healthawareness.co.uk

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Early diagnosis saves lives WRITTEN BY: DEBORAH ALSINA MBE Chief Executive, Bowel Cancer UK

Bowel cancer is the fourth most common cancer in the UK, with almost 42,000 people are diagnosed with bowel cancer annually. Sadly, around 16,000 people die from the disease each year, making it the second biggest cancer killer. But this shouldn’t be the case. Bowel cancer is treatable and curable, especially if diagnosed early.

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arly d iag nosis is cr ucia l to survival rates as nearly ever yone w i l l su r v ive i f diagnosed at the earliest stage.

S c re en i n g i s t he b e s t w ay to diagnose bowel cancer early when treatment has the best chance of working. It can also prevent bowel cancer through the removal of polyps (non-cancerous growths) that may develop into cancer.

The Bowel Cancer Screening Programme in England, Wales and Northern Ireland currently sends all men and women aged 60 to 74 (50 – 74 in Scotland) a home test kit every two years. However, both Welsh and English governments have since committed to lower the age at which people become eligible for bowel cancer screening to 50, in line with Scotland and international best practice.

With around 4,500 people aged 50-59 in the UK diagnosed with bowel cancer each year and a further 1,200 dying from it, this commitment will save many lives.

A new, simple and potentially more acc urate test, k now n as the faecal immunochemical test (FIT), has recently been introduced into the Bowel Cancer Screening Programme in England. This test

detects hidden traces of blood in poo that could indicate bowel cancer or polyps. It has the potential to detect twice as many cancers than the previous test and has been proven to increase participation in screening.

If blood is detected, people will be referred for a colonoscopy to either confirm a diagnosis of bowel cancer or receive the all clear.

End the workforce capacity crisis Improvements to the screening programme, an ageing population and changes to GP referral guidelines have meant more people are being referred for a colonoscopy – a key diagnostic test for bowel cancer – and this is putting NHS hospitals under unprecedented pressure.

At the very least, nearly a million more tests are needed, year-on-year in England, with demand for colonoscopies doubling in the last decade.

But this has not been matched with additional trained workforce by the Government, and is having a significant impact on both colonoscopy and pathology services.

In fact, staff shortages in bowel cancer diagnostic services are the single biggest barrier to meeting commitments to improve survival

rates for t he disease. A lready, thousands of patients are waiting longer for life-saving tests that diagnose bowel cancer.

Catherine, who was diagnosed with stage 3 bowel cancer, shares her experience of waiting longer than she should for life-saving tests.

She explains: “In 2014, I spotted bleeding and visited my GP. They dismissed it as nothing serious. In late 2016, the bleeding became more frequent so I returned to the doctor.

I was finally referred for a non-urgent appointment and asked to wait three months.”

B owel C a ncer U K’s C apac it y Crisis campaign is urgently calling for t he s e work forc e c ap ac it y issues to be addressed in the NHS Improvement’s upcoming People Plan. It’s vital that clear commitments are made to increase capacity in bowel cancer diagnostic services so that more lives can be saved from the UK’s second biggest cancer killer.

This is particularly important as the NHS Interim People Plan, published in June, failed to outline measures to address these capacity issues. © HEADSHOT CREDIT: LEO HAYMARKET

Read more at healthawareness.co.uk MEDIAPLANET

Fibre: the key to a healthy you

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NHS guidelines say our dietary fibre intake should be 30g a day, as part of a healthy, balanced diet. Despite this advice, though, many people in the UK are only eating an average of 15-18g per day – it’s alarming!

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ot everyone realises the full impact of not getting enough fibre in their diets; others struggle with knowing exactly which foods are fibre-rich, and how much of these foods they need to consume to meet the recommended intake.

What is fibre and why is it so important?

Fibre is basically the must-have of the nutrient world. There are two types of fibre: soluble and insoluble. With soluble fibre, natural bacteria in the bowels breaks down the fibre. It slows down the emptying of your stomach, making you feel fuller and helps lower your cholesterol. Insoluble fibre passes through the digestive system virtually unchanged, binds to waste in the bowel and helps to prevent constipation.

Studies have found that dietary

fibre can feed friendly gut bacteria and lower blood sugar levels. In addition, there is strong evidence that fibre contributes to healthy bowel function. The NHS advises that eating enough fibre could reduce your risk of developing bowel cancer, diabetes and heart disease.

Studies have found that dietary fibre can feed friendly gut bacteria and lower blood sugar levels.

In addition, there is strong evidence that fibre contributes to healthy bowel function.”

How easy is it to get fibre in our diets?

Including things like high-fibre breakfast cereals, wholemeal breads, wholewheat pasta and fresh fruit and vegetables in your diet is a step in the right direction.

Finding the right combination of foods to make the full 30g recommendation can sometimes prove tricky, which is why supplements, hand in hand with a fibre-rich diet, might be a good idea. To put this into perspective, three teaspoons of Inulin

powder provides 15g of fibre, which is the same as eating approximately four apples, five bananas, 750g of strawberries or four cups of beetroot.

Supplementation therefore provides an easy solution to boost your daily fibre intake.

According to Bowel Cancer UK, both having enough fibre and maintaining a healthy weight can help reduce your risk of bowel cancer. It is therefore vital to our health and wellbeing that we get enough fibre in our diets.

Sources referenced: www.nhs.uk/live-well/eat-well/how-to-get-more-fibre-into-your-diet/

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WRITTEN BY: ANDREW PETROU M.OST, MA (PSYCH), DC Practising Osteopath, Registered Dietary Counsellor, Pharmacare

What is Inulin and what’s all the hype?

Inulin is a fibre-rich substance, which is naturally found in high amounts in the root of the chicory plant, along with an estimated 36,000 other plants. Inulin’s solubility is considered to be higher than many other types of fibres, meaning it absorbs water more easily and therefore helps form soft stools that can easily be passed through the bowels, promoting regularity.

Inulin is also a non-digestible prebiotic, which allows it to pass through the intestines unabsorbed.

During this process, Inulin naturally ferments and feeds the healthy microflora that populates the gut, thereby promoting digestive health.

Inulin came into the spotlight in the UK, when Angela Rippon in her BBC documentary ‘How to Stay

Young’, highlighted the benefits of Inulin in helping to reduce visceral fat – the fat that gathers around the heart and other organs as we age.

Other celebrities, such as Michelinstar TV chef, Tom Kerridge, spoke of how he lost 11 stone. Through his diet he often used Inulin as a sugar replacement.

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Urinary tract infection – are antibiotics always necessary?

WRITTEN BY: CHRIS HARDING Chairman, British Association of Urological Surgeons subsection of Female, Neurological and Urodynamic Urology Consultant Urological Surgeon

Urinary tract infection (UTI) is very common, especially among females, and around half of all women will experience a UTI in their lifetime. Typical symptoms would include pain on passing urine, frequent urination and dark, cloudy or strong-smelling urine.

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raditionally, UTI has almost always been treated with a course of antibiotics, but recent publicity surrounding the potential disadvantages of antibiotics has encouraged UTI sufferers to look for alternative treatment strategies.

The major concern surrounding the overuse of antibiotics is the emergence of bacteria which are resistant to antibiotics. The UK antimicrobial resistance strategy and action plan states that resistant bacteria are becoming more common and causing international concern. This plan suggests that the emergence of resistance is an inevitable result of the use of antibiotics and stresses the urgent need for prudent prescribing by clinicians as part of the strategy to control resistant bacteria.

There have already been a number of cases of bacterial infections that are resistant to all known antibiotics and the publicity surrounding these has rapidly increased awareness of this global threat.

Alternatives to antibiotics For urinary tract infections there are several strategies that patients can use before recourse to antibiotics. Most patients will increase their fluid intake at the time of UTI in an attempt to ‘flush out’ the infection and indeed this is one of the body’s natural in-built defences against UTI. Bacteria that have attached to the lining of the bladder can be expelled in the urine via increased urination. Furthermore, making the urine less acidic with a urinary alkalinising agent, such as sodium bicarbonate, may also help alleviate symptoms, specifically pain.

Simple pain killers, such as paracetamol or anti-inflammatory drugs such as ibuprofen, can also be effective for symptom relief.

Painkillers may be adequate for acute, one-off episodes There is a growing body of evidence to suggest antibiotics may not be necessary for mild infections such as acute cystitis in patients without pre-existing urinary tract abnormalities. A 2015 study published in the British Medical Journal looked at over 200 women with mild UTI treated with ibuprofen and found that two in three made a full recovery from their UTI episode without the need for antibiotics.

Studies such as this have led to clinicians and patients alike questioning the need for antibiotics for all cases of UTI. Mild symptoms may respond to these strategies but patients with severe symptoms or systemic effects, such as high fever or feeling very unwell, should not rely on these options as they are likely to require antibiotic treatment to prevent a significant infection developing.

Read more at healthawareness.co.uk

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The most common disease you’ve never heard of WRITTEN BY: LOUISE DE WINTER CEO, The Urology Foundation

Overactive bladder can completely ruin a life and it is more common than both diabetes and asthma, yet it’s almost never spoken about. It’s time we brought a stop to that. Here’s our guide.

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or the roughly eight million people in the UK who struggle with overactive bladder (OAB), it means that they find it very difficult to hold their bladders. If you are suffering from OAB you may find yourself suddenly desperate for the loo and you will have to find a toilet in time or risk wetting yourself.

This can have an enormous impact on a life. You find yourself going to bed at night knowing that you'll have to get up multiple times to rush to the loo. If you have an important meeting at work, you'll find it difficult to be there for long without having to rush out. Going out anywhere is risky because you always need to know you can access a toilet.

A ny t h ing from going to t he cinema or theatre to a sports match or country walk can become fraught.

For some people with OAB, the fear

of not being able to find a toilet can leave them housebound.

Overactive bladder (OAB) can ruin a life, but help is at hand We don't talk about OAB enough.

In fact, we more or less don't talk about it at all. There is a shame aspect associated with toilet troubles and it's time we tackled it. No one should be too ashamed to come forward for help because treatments for OAB are readily available.

For World Continence Week this year, The Urology Foundation (TUF) celebrated 15 years of the use of Botox as a treatment for OAB. Th i s i s, i n p a r t , t h a n k s to resea rch 1 t hat M r A r u n S a ha i conducted with a grant from The Urology Foundation. With TUF's funding, Mr Arun was able to run

the world’s first, level one, double blind placebo controlled trial of Botox as a treatment for idiopathic OAB. Botox, as well as drug treatments, is easy to access and so no one should be worried about seeing their GP if they have an issue with holding their bladder.

Get your Need To Pee card If you struggle with holding your bladder and finding yourself needing the toilet often, then you might benefit from having one of TUF's Need to Pee cards.

These cards are designed to get you access to a toilet in a local business with a minimum amount of fuss and time.

Read more at healthawareness.co.uk

1: nhs.uk/news/medication/botox-and-weak-bladders/

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BPH patients don’t have to suffer in silence Minimally-invasive procedures could end the sub-optimal treatment being endured by men with benign prostatic hyperplasia (BPH).

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enign prostatic hyperplasia (BPH) has been described as ‘practically inevitable’ in older men. According to the NHS, 40% of men over 50, and 75% of men in their 70s have urinary symptoms caused by an enlarged prostate, which forces the urine tube to narrow.

There was a time when many men just accepted BPH and its associated symptoms as being part of older age – but not anymore. “In the past, there was a perception that this was an old man’s lot, but people are much more proactive about seeing their doctor now,” says Dr Jonathan Rees, a GP with a special interest in urology.

By and large, the first course of treatment for most men is still medMEDIAPLANET

ication. Alpha blockers, which relax the muscles and make it easier to pass urine, they are effective but are also a lifetime commitment. Surgery is another a proven option for those with more severe symptoms, but with that comes the risk of sexual dysfunction and incontinence.

Simpler, quicker, cheaper minimally-invasive procedures Minimally-invasive procedures could offer more viable solutions to more men, whereby tiny implants are inserted into the urethra to hold open the obstructed pathway.

“We’re seeing new, minimally-invasive treatments, like this, that are simpler, quicker, cheaper and more

tolerable for patients and have a better side-effect profi le,” continues Dr Rees. “These could be a consideration for people who might have less severe symptoms, but don’t want to take medication for the next 25 years.”

Better access and results Alternative treatments could also encourage the estimated 69% of men with BPH who choose not to take medication or undergo traditional surgery, to get the support they need. Dr Rees also believes that the procedures, many of which can be conducted in outpatient or day case units under local anaesthetic, could help to improve the quality of life of many patients.

INTERVIEW WITH: DR JONATHAN REES GP Tyntesfield Medical Group and Chair, Primary Care Urology Society

“We realise many men are being sub-optimally controlled on medication but, subjectively, we know they would have better outcomes with minimally-invasive therapy,” he says.

Availability is not consistent While the new treatments have been approved for use within the NHS, the threshold criteria for referrals differs across the country. This is something that Dr Rees would like to see change.

“What we’re after is a fair and level playing field, so all men get equal access to the therapies,” says Dr Rees.

“There is cost, the impact on patients, and there are the side-effects of medication and surgery… We need to look

at all these things together.”

With an ageing population, the number of men with BPH is only going to increase and alternative therapies, if universally available, could help ensure these men get the treatment they need.

Written by: Kate Sharma

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