Dear Dr. Roach: It was less than five years ago that I had a TURP (transurethral resection of the prostate) surgery for slow urination. It is not at a critical point yet, but it feels like my urine flow is slowing down again. How often do men who’ve had a TURP surgery require a second operation?
A normal prostate is the size of a walnut. As men age, it enlarges. Does it ever stop growing at a certain point? How large can it actually get? Can it get to the size of an orange or larger?
Anon.
You are right that in young men, the prostate is typically the size of a walnut. In many men, the prostate enlarges, but there are different anatomical areas within the prostate, called zones. The urethra, which carries the urine from the bladder out through the penis, goes right through the transitional zone of the prostate, and it’s this zone that most often causes symptoms in older men.
Surgery is done less often now for enlarged prostates than 20 years ago, because medication is much more effective. Most men don’t need surgery, but surgery is certainly still done. In addition, there are other options, such as photoselective vaporization, microwave treatment, cold and laser treatments, and prostate artery embolization. The decision of which to offer is in the hands of the urologist, but I can give some guidance on how often a repeat surgery is necessary.
After five years, about 7% of men who had the surgery you had required a second operation. Most other treatments were similar, but some weren’t as long-lasting. Prostatic artery embolization required retreatment 24% of the time at five years, while microwave treatment required retreatment 31% of the time.
Unfortunately, the prostate tends to keep growing. You really don’t want to beat the “world record” of 4 liters, which is about the size of a small watermelon. (The person who had it didn’t have any symptoms, so treatments weren’t done.)
Dear Dr. Roach: I received a COVID vaccine seven weeks ago. It’s the one that has been given since 2023, so it was not an updated vaccine. But the Food and Drug Administration just approved and released the updated vaccine for 2024. Can I get the most recent and updated vaccine, or must I wait?
V.C.
A new vaccine was approved by the FDA in August, and it’s available now, specifically for the new omicron variant, KP.2. This new vaccine closely targets the circulating viruses. You can get the vaccine if you have not had (any) COVID vaccines in the past two months, so you just need to wait another week.
There is a lot of COVID circulating right now in many areas of the country, and getting a vaccine right away may be a good choice for people, especially if they haven’t been vaccinated in a long time or if they are at a high risk due to age or medical conditions. Some people might consider waiting a couple of months for the expected winter surge. I am advising most of my patients to get the new vaccine now, but your particular situation may be different. So, talk to your doctor about the optimal timing.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
