Nick is a 79-year-old retired engineer living the good life in Cupertino, California. He and his wife are empty nesters. They enjoy monthly visits to their nearby Cambria getaway and spending time with their daughters, one in California and one in Florida.
When prostate problems occurred — a common concern among men over 50 — Nick's logical engineering mindset led him toward innovative answers and successful surgery at El Camino Health's hospital in Los Gatos. Now, he's symptom-free and enjoying retirement.
"I was in the semiconductor capital equipment business for years," says Nick. "During retirement, you can do things you couldn’t do when you were working so feverishly."
Nick's healthy lifestyle includes home workouts, regular gym visits and hiking with friends on trails above Saratoga’s golf and country club.
"We hike about 4.5 miles, with a 900-foot climb,” says Nick. "I enjoy my workouts and my life. It's very pleasant."
In addition to providing energizing challenges and camaraderie, Nick's active lifestyle likely contributed to his long-term good health. Other than seeing an endocrinologist for diabetes, he's never needed specialized care. Eventually, however, prostate issues presented some detours.
Urinary Tract Symptoms Men Shouldn't Ignore
The prostate — a small reproductive gland just below the bladder — tends to grow larger with age. An enlarged or inflamed prostate can press on the urethra, the tube draining urine from the bladder. This can block flow, making it difficult to urinate or fully empty the bladder. Symptoms can range from incontinence to frequent late-night trips to the bathroom.
Over 90% of men over 80 have an enlarged prostate. At any age, it's important to see a doctor about unusual urinary symptoms to rule out infection, benign growths or cancer.
Nick first visited a urologist 19 years ago. Urologists specialize in urinary tract and male reproductive system disorders. In 2005, Nick was treated for a urinary tract infection (UTI) — a potential prostate-disorder complication.
About 10 years later, testing confirmed an enlarged prostate — benign prostatic hyperplasia (BPH) — with urinary tract blockages. Nick's urologist prescribed medication to relax prostate and bladder muscles so urine could flow more freely.
"The medication worked for about eight years," says Nick.
Prostate Complications and the Search for Solutions
Nick began researching other treatments. By late 2023, ultrasound indicated a very large prostate — initially estimated to be 110 grams. After surgery, it was confirmed to be 90 grams or 3.2 ounces.
Diagnosis varies with age and symptoms. Prostates over 40 grams are generally considered enlarged, while those over 80 grams are defined as very large. In January 2024, Nick learned that he also had an enlarged bladder with abnormal bladder pressure and function.
He started self-catheterization twice a day to help reduce bladder size and infection risks. Nick began researching surgical procedures. He learned that if surgery is delayed, the bladder can thicken and muscles squeezing the bladder become ineffective.
After Considerable Research, Nick's Choices Were Clear
After investigating several options, Nick determined that many common prostate treatments didn't do the job. He also knew friends who had surgery but needed to return repeatedly for follow-up care to treat infections and other complications.
"They had poor results," says Nick, "so as I learned more about laser enucleation surgery, that seemed like the thing for me."
The prostate consists of the adenoma — the inner tissues that surround the urethra — and an outer capsule that encloses these tissues. During laser enucleation surgery, the doctor uses precisely focused laser beams to remove all the enlarged adenoma tissue growing inside the prostate gland. Laser enucleation is the only minimally invasive treatment that allows for complete removal of the adenoma tissue. Surgeons also use laser pulses to seal blood vessels, which limits blood loss and eases recovery.
In February 2024, Nick met with El Camino Health urologist Edward Karpman, MD. They discussed treatments, including the newer thulium laser enucleation procedure (ThuLEP).
Learning About ThuLEP
Dr. Karpman explained the procedure to Nick. During ThuLEP surgery, the doctor separates the growing adenoma tissue from the surrounding capsule of the prostate and pushes it into the bladder. Using another specialized instrument, the surgeon then breaks the adenoma tissue into smaller pieces and removes it from the bladder.
The surgeon removes the three separate lobes of the prostate along their clear borders with the outer capsule, which remains intact.
"This approach ensures that the tissue will never grow back," says Dr. Karpman, "and no further procedures will be needed."
Since thulium laser enucleation is relatively new, it's not widely available. Few surgeons in the U.S. are well trained and experienced in the procedure, which requires high-level skills and expertise.
When expertly performed, ThuLEP procedures involve less time, advanced precision and less interaction with sphincter muscles, which helps to minimize risks. Potential complications of laser prostate procedures can range from temporary incontinence to the chance of injury to the urethra and sphincter muscles controlling urine flow. Nick wanted the maximum amount of offending tissue removed without risking injury or infection.
"ThuLEP can remove offending tissues while leaving the urethra and other organs in good shape," Nick explains. "I was happy to learn that Dr. Karpman was highly capable for this job and teaches ThuLEP to others. He was extremely clear about what it would and might not do for me."
ThuLEP Prostate Surgery on the Schedule
Nick had ThuLEP surgery in April 2024, under general anesthesia. The procedure took almost two hours. Nick checked into the hospital at 11 and was discharged by 10 the next morning.
"Dr. Karpman took out 66 grams of tissue — that's 2.3 ounces from a 3.2 ounce enlarged prostate, which is wonderful," says Nick. "Dr. Karpman and his team met and exceeded my expectations. Everyone was focused on care and seemed to really want to be there. I was impressed with their skills, and the hospital seemed well managed with all the right technologies and equipment."
Back to Hefty Workouts and Lofty Hikes
After surgery, Nick had almost no bleeding or discomfort. He used a catheter for 36 to 48 hours and, after its removal, reported no sign of any incontinence or other symptoms.
"Everything healed quickly," Nick says. "The hardest part was waiting four weeks before doing heavy exercise."
Nick rates his experience as "excellent." He encourages other men to seek early, expert evaluation to resolve prostate problems.
"It doesn't get better by waiting," says Nick.