“The human brain is built to compare. It’s Darwinian to consider an alternative when one presents itself” This is the conclusion from Helen Fisher, an anthropologist and human behavior researcher at the Kinsey Institute.

I recently came across Fisher’s TED talks in 2006 and 2008.

She is a leading expert on the biology of “love and attraction”. In fact, her work is so applicable in today’s society that she is the most referred scholar in love research community (I did not even know there was such a community!). She was even hired by match.com to utilize her research to formulate hormone and personality based matching systems for couples.

It is not just for love and sexual partnerships that we compare the choices presented to us, and consider alternatives. Indeed, it is the intrinsic Darwinian behavioural instinct for us to exhaust all the alternatives, before we commit to the final decision.

In her documentary film about breaking hearts and loneliness, entitled “Sleepless in New York”, the big questions asked were “What if there is no alternative?” or even worse – “what is the alternative is the wrong choice?”

To help hundreds of men to consider their alternatives when it comes to prostate operations. We will address the dilemmas one of our reader faces.

Dear Dr. G,

My name is Aziz and I am 48. I have a problem.

I have been having issues with an enlarged prostate for the last three years.

Initially, I have been treated successfully with medications. Sadly the medicine became less and less effective as I grew older.

I was rather shocked when I could not urinate three months ago when I travelled back from Seoul for work. I was admitted to the hospital and a catheter was inserted into my penis to drain the urine.

The doctor said to me my prostate is so large that it has occluded the out flow. This has also caused backpressure to the kidneys and resulted in damaged kidneys.

My urologist had advised me to have the scrapping operation (TURP) in order to open up the obstruction. He explained to me the consequence of the operation would affect my sex life. Apparently, even lasers will have the same problems

Come on! I am 48 and at the peak of my career. I feel sad and helpless that I cannot solve this problem. Seriously, is this the end of my sex life?

On that note, can you clarify what are the sexual compromises I must endure?

I have looked online for alternatives, and understand there are new technologies that can help men like me. I even found out the possibilities of using microwave and TUNA to get ride of the prostate. Microwaves? Are they the same ones in the kitchens?

Can you please tell me where I can find these alternatives?

Truthfully, I am not ready to say goodbye to my sexual ability at the age of 48.

Help me, please!!

Aziz.

The prostate is a strange organ. It is responsible for the production of semen, which enhances the function of sperm. With age, one would imagine the diminishing sexual and reproductive roles in men, would result in the shrinkage of the gland. On the contrary, it apparently is the only organ in men’s body that will continue to grow relentless, resulting troubling symptoms. The onset of the urinary problems generally occurs in a man’s 60s, but some men may be unlucky to face the issues in their 40s.

When the size of the prostate reaches certain threshold, obstruction of the urinary flow can cause severe problems such as infections, bladder stones, kidney failure and retention of urine. Under such circumstances, patients are treated with catheterization and awaiting the imminent operation.

The principle of prostate operation is simply coring out of the occluding tissues allowing optimal urine flow. Sadly, the destruction of prostate tissues may have the negative consequences of backward ejaculation (retrograde ejaculation) or ED (erectile dysfunction) in two-third and one-third of men, respectively. Many sufferers mistaken the mighty lasers will have a different outcome. Sadly, the sexual compromises are comparable.

Technological advancements had been studied to quest for improvement of urinary flow without the sexual side effects. Indeed, therapeutic alternatives such as microwaves and TUNA have been extensively examined. Both technologies have the aims to “cook” the prostate to a smaller size allowing urine passage. If you start getting worried about urologist resort to using “TUNA” fish to cook your prostate with microwave. Rest assured, TUNA stands for Trans Urethral Needle Ablations and there is nothing fishy about it.

Although the “cooking” method was used, the outcome has not been a recipe for success. One can imagine the cooked prostate tissues in the pelvis often resulted in pelvic pain and urgency in urination. In many men, the urinary efficacy of the operations and the protective sexual health effects were also short-lived.

Michael Caine, with his renowned distinctive Cockney accent once said: “To me, growing old is great. It’s the very best thing – considering the alternative.”

Of course, Aziz can consider the “alternatives”. If he chooses to do nothing, he will either ended up with wearing the catheter long term. If he opted for removal of the catheter, he would be doomed with the horror of life long dialysis. Lastly, the alternatives of TUNA microwave prostate will leave you with pelvic pain and short-lived benefits. On the other hand, the decision to elect for the scraping or laser operations has a long-term gain.

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