Wrapping Your Prostate in a Bow

I remain baffled why so few women choose to grab the yoke and bust into the ether, and while I celebrate the difference between the sexes, there is one aspect of being a man that sucks: the prostate. 
While serving a very useful function as one of the sexual and reproductive organs, with age it often chooses to hypertrophy, a hundred-dollar word for enlarge, and this really messes with whoever’s prostate it happens to be.

Sitting at the junction of bladder and urethra, the tube through which urine exits the body, an enlarged prostate sends premature messages to the brain suggesting the bladder is full and needs emptying causing an urge to pee frequently. By constricting the urethra, urinary stream diminishes and other aspects of what should be a satisfying relief deteriorate with age. Not to be confused with cancer, this errant growth, benign prostatic hyperplasia (BPH) is very common and afflicts millions of American men to some degree.

Eating lots of tomatoes and red fruits might help, but knowing the location of bathrooms becomes critical, and not drinking any fluids prior to bedtime might diminish disturbed sleep for nocturnal bathroom breaks. Medications have some role to play, but be careful not to fall afoul of the FAA—for example, although Cialis (tadalafil) is allowable for the treatment of erectile dysfunction “as needed,” it is not OK if used daily at a low dosage for BPH.

When I was training, we would often operate to “shell out” the prostate, rather like Little Jack Horner pulling out a plum in the old nursery rhyme. This operation was uncomfortable for patients and a better mousetrap was required. So along came TURP (trans urethral resection of the prostate), where an endoscope was inserted into the urethra and the impinging prostate shaved off in slices using a hot wire loop. Less invasive for sure, and widely accepted, this operation helped countless men lead a better quality of life.

Recently a new, minimally invasive operation covered by Medicare and insurance, “UroLift,” has been developed that can be carried out in the doctor’s office under local anesthesia. Rather than remove the prostate tissue, four small devices are placed that “cinch” the prostate tissue out of the way, rather like tightly tying a parcel with a bow. The devices use materials that surgeons have been implanting in the body for years—a common suture, stainless steel, and “nitinol,” a metal that has memory and conforms to a given shape. The results are very encouraging and seem to work for some men. After the operation, if at any time an MRI is required, the patient must tell the doctor as the powerful magnet used in the machine can affect the implants. You can watch a video of the procedure here

Enter George “Jud” Schandel, naval veteran and Phoenix-based Mooney pilot who underwent the procedure and discusses the positive impact it had on his life. Schandel also plays in a three-man cowboy band and his comment about needing to “hit the head” before going on stage summarizes the impact BPH can have on quality of life.

If one has a procedure like this, a pilot must self-ground as necessary under 14 CFR 61.53, which can mean not flying until fully recovered and released by the doctor for normal activities. The condition, procedure, and associated visits to health care providers are reportable on the next application for a medical certificate issued under Part 67 and, of course, all relevant medical records, operative reports, and laboratory or radiology tests should be available.  

An airplane engine needs good fuel flow for satisfactory performance, and a man needs good urine flow for a satisfactory life. So keep an eye on both!
Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification

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