New prostate procedure could bring relief to rural millions

A potential breakthrough in the treatment of benign enlargement of the gland may benefit men in China's countryside and across the globe. Zhao Xu reports.

Although it has been more than a decade, Jiang Hansheng can still remember the look on the face of "an expert in Beijing" when he eagerly explained a method he had experimented with for years to treat benign prostatic hyperplasia, or enlarged prostate gland, a condition that occurs frequently among men aged 60 and older.

"The expert simply smiled and shook his head slightly. And my heart sank," recalled Jiang, a retired urologist from Shandong province in East China. The open dismissal represented nothing new or surprising for the rural doctor, though. From the early 1990s, Jiang spent 10 years researching and performing a procedure called "balloon dilation of the prostrate"; he also expended a lot of time and effort attempting to convince his peers and superiors that the method was an effective treatment for BPH.

The condition is non-life threatening and rarely painful, but it can cause a range of problems, including the need to urinate frequently, involuntary urination and leakage, that can be frustrating and embarrassing for the patient.

"The urethra is partially surrounded by the prostate grand, which in turn is encased within a hard capsule of membrane," said Tian Long, an urologist at Chaoyang Hospital in Beijing. "With the total volume inside the capsule remaining unchanged, an enlarged prostate means a narrower space for the urethra, which in turn gives rise to many urinary symptoms concerning both storage and voiding."

Tian is one of six patent-holders of a surgical procedure called "Transurethral Columnar Balloon Dilation of the Prostate", known to doctors as TDUP. The procedure, which usually takes about five minutes, involves inserting a long, column-shaped balloon into the section of the urethra enveloped by the prostate and then inflating it. Ideally, the dilated urethra exerts pressure on the capsule around the prostate, causing it to break within minutes. "Once broken, the capsule can never grow back together and therefore all the inner pressure is released once and for all. This means that the urethra will feel no pressure however large the prostate becomes in the future," Tian said.

"The short procedure time has sharply reduced the risk of cardio-cerebrovascular diseases, such as thrombosis, and fatal pulmonary embolism (blood clots in the lungs) that has a high rate of occurrence among senior patients," he said, comparing the procedure with electrotomy, the use of high-frequency electric current to cut or destroy tissue, and laser surgery, the predominant methods of treating BPH. Both methods take about an hour to complete and involve the removal of all or some of the prostate.

"Last year, a 94-year-old man underwent the balloon-dilation procedure, followed by a 92-year-old veteran soldier. Both were too weak and physically unstable to seriously consider other options."