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Get Your Life Back For men with BPH, a new technique called Aquablation removes enlarged tissue more precisely, with fewer complications. I zik Marko, now 58, an investor living in Tarzana, started experiencing symptoms of benign prostatic hyperplasia (BPH) about three and a half years ago. BPH is the overgrowth of prostate gland tissue. While it is called benign because it is not cancerous, it can cause complications such as frequent urination and an inability to empty the bladder. At first Marko took an oral medication that can shrink the prostate. But after a couple of years the drug stopped working, and he experienced urinary retention during a business trip to Colombia. "I travel a lot for my business, and long flights were a problem because of my BPH," Marko says. At the emergency room there, doctors placed a catheter to allow urine to drain, a temporary remedy. When he returned home, Marko contacted Richard Shapiro, MD, a urologist at Providence Cedars-Sinai Tarzana Medical Center and a pioneer in a recently developed, Medicare-approved procedure called Aquablation therapy. Dr. Shapiro recommended Marko undergo this state-of-the-art technique to remedy his BPH. This innovative technology can help mitigate the problems caused by BPH, which becomes more common as men age. Half of men in their 50s experience it to some degree, and the rate rises to 80% in men over 70. When the prostate, which lies below the bladder and surrounds the urethra, becomes enlarged, a man's urine stream may become weak, or it may stop and start so that the bladder fails to empty. These effects can cause inconvenience, depression and decreased quality of life. If left untreated, it can lead to infection, incontinence, bladder stones and even impaired kidney function. A CUSTOMIZED SURGERY Aquablation therapy is an exciting new treatment for BPH and has enhanced our patients' lives in so many ways. It is minimally invasive, precise and consistent. It uses a robotically controlled water jet— the AquaBeam Robotic System—to remove excess prostate tissue. No two prostate glands are the same size and shape, and this robot customizes the surgery to the individual anatomy. "The robot's movements are controlled by the surgeon, who observes the prostate using ultrasound and a camera inserted through the urethra," Dr. Shapiro says. (Other procedures use only a camera, which restricts the doctor's ability to visualize the prostate in 3D.) The prostate is "mapped" so the surgeon knows precisely where to remove the tissue, sparing important areas of the gland. "This technique is faster and safer than traditional surgery, especially for men with a larger prostate who previously may have required a surgical incision or prolonged laser treatment," Dr. Shapiro says. "There is less bleeding and a lower potential for tissue damage or other serious complications such as urinary incontinence or erectile dysfunction." Aquablation therapy is performed under general or spinal anesthesia, and patients spend one night in the hospital. Recovery is quick. Since undergoing the procedure, Marko has experienced no problems with his prostate. "Unlike when I was taking medication, my bladder empties completely now," he says. "There is no more obstruction. I pee like I did when I was 17 years old." In fact, he wishes he could have undergone Aquablation therapy years ago. "Don't be afraid or embarrassed to ask for help," Marko says. "My life has changed completely for the better. I no longer have trouble when I travel. I feel like having the procedure with Dr. Shapiro saved my life." HALF OF MEN IN THEIR 50s EXPERIENCE IT TO SOME DEGREE, AND THE RATE RISES TO 80% IN MEN OVER AGE 70. HEALTH CARE IS PERSONAL Selecting the right health plan during open enrollment is important, but it can be overwhelming. You want affordable, high‐quality care for yourself and your loved ones. You want to feel confident that when you need care, you'll get the best there is. When you select a health plan that includes Providence, you'll have access to the best physicians from the largest, most comprehensive health care network in SoCal. Before you choose a plan, make sure Providence is in the network. At Providence, you'll get all this: convenient care close to work and home extensive network of specialists to meet all your health care needs in-person and virtual visits after‐hours care through our nurse advice line, urgent care or ExpressCare Providence app for connected care Call 855-967-6026 to learn more or visit us online at providence.org/ open-enrollment. Health Matters: Providence Cedars-Sinai Tarzana Medical Center | 7

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