Expert: Stephen W. Leslie, MD - 1/16/2006

Question
Hi Dr. Leslie,

I'm 51, and my urologist has diagnosed me with an enlarged prostate. I'm prone to agree with his assessment, since I have dribbling, reduced flow and frequent delayed start, all of which has been disruptive in my life. (After surgery last year to repair my rotator cuff, it was almost impossible for me to urinate, even several hours after general anesthesia.)

My urologist is recommending Cooled ThermoTherapy to reduce the size of the prostate. Are you familiar with this procedure? If so, do you have any thoughts on it?

Follow-up question: He informed me that the procedure carries a small risk of infertility. Since I would still like to have children (I'm single), he suggested I investigate a sperm bank, but he could not advise me further on that. Would you reckon that one sperm bank is as good as another? Can you suggest any resources in this regard?

Thank you very much,
Jona

Answer
I've not been that happy with the cooled thermotherapy.  Some patients have very significant pain and symptom relief is not as good as with other procedures.  However, I have a relatively limited experience with it.  You should ask your urologist how many he's done and what his results are like.

If you are that concerned about fertility, why not try medications first?  Uroxatral in particular is highly unlikely to interfere with fertility issues and still provide reasonable urinary relief.

Once fertility issues are resolved, a clear discussion about the pros and cons of the thermotherapy, ILC laser, TUNA, TURP and Green Light Laser procedures can all be compared and review.  Many of my patients select the ILC laser (I'm designated as an instructor and have extensive experience with this particular laser) but even so it has a failure rate of about 15%.  Those that fail, will need to pursue other options.

A sperm bank may be a good idea before any surgical procedure that has the remotest chance of infertility.  As far as choosing a sperm bank, those associated with a university medical center are more likely to have higher standards.