When Mel Bruemmer pitches a horseshoe right, you’ll hear about it.
Not because he says so, but because of the unmistakable clang of a ringer, the point-scoring pitch and measure of a good horseshoe player.
Mel throws a lot of them. Whether at his indoor practice shed in Jefferson City, one of the four public horseshoe pits in town, or at tournaments across the Midwest, he can score ringers on 70% or more of his pitches.
“I was born and raised a horseshoe pitcher,” Mel, now 75, said. “My dad was a horseshoe pitcher, and I've just loved the game my whole life.”
The game has long been Mel’s way to unwind — a mix of competition, stress relief and social time when he needed a break from the world.
He stopped playing other sports like basketball and softball as his kids grew up, coaching their teams instead of playing himself. But Mel always had time for horseshoes, even if it was just a half hour of practice.
“My primary love for horseshoes stems from the camaraderie and the organizing of the sport,” Mel said. “The people in horseshoes are great people, they love to be together, so getting to know everyone is enjoyable.”
But just as distinctive as the metal-on-metal clash of a scoring throw is the disappointing — and quieter — thwap when a shoe lands harmlessly in the clay or runs to the back of the pitching box.
As Mel entered his 70s, he started hearing that sound more often. Something had thrown off his form.
“I couldn’t find the rhythm that my body needed to play well,” Mel said. “I was having health problems with my prostate, and I was in denial for quite a long time, but it finally just came up and really hit me.”
Mel had annual checkups with a urologist in Jefferson City because of symptoms, including urinary pain, that seemed to get slightly worse each year.
His family members — including his wife and daughter-in-law, both nurses — noticed his ankles and legs were swelling due to urinary retention. Mel brushed it off, saying he was wearing tight socks, and hoped the medications he was taking would make the problem disappear.
But in March of 2024, after talking to his urologist, Mel was referred to MU Health Care and urologic surgeon Daniel Au, MD.
“My urologist told me I was at the point where I needed to have my prostate removed,” Mel said. “He had heard about some newer procedures in Columbia and gave me the choice.”
Mel had benign prostate hyperplasia, or BPH, a noncancerous condition common in men. The prostate gland grows as men age, putting pressure on the bladder and urethra. About half of men 50 and older have an enlarged prostate — increasing with age to 70 percent of men 70 and older — though not everyone has symptoms they notice or feel.
“I think a lot of men are uncomfortable talking about urinary issues, and when it comes to male urinary problems, it only gets worse with time,” Dr. Au said. “Because of those factors, I see a lot of men who are needlessly suffering with urinary issues for 20 or 30 years who could have been treated.”
Mel and Dr. Au talked about Mel’s goals: He wanted to be around his family and play horseshoes without discomfort.
They also talked about Mel’s medical history, which included an episode where he couldn’t go to the bathroom, also called complete urinary retention. That episode, a medical emergency, meant Mel needed a catheter for a few days. It was also a sign that his medications, which worked at first, had become less effective.
“A lot of guys are slowly getting worse without realizing it,” Dr. Au said. “It might not be noticeable day-to-day, but some men are at a point where they don’t leave the house to go grocery shopping without knowing where the nearest bathroom is. They don’t go to Cardinals games anymore because it’s embarrassing and disruptive to go to the bathroom every inning.”
Mel’s BPH caused swelling, discomfort and difficulty sleeping. His retention episode put his kidneys at risk of damage, and being catheterized made him realize he wanted to treat the issue directly.
“I put myself through a lot of junk that I didn't need to put myself through,” Mel said. “A lot of being sick, a lot of just not being able to do what I love to do because I was in denial.”
Difficulty, discomfort or pain urinating, urinary frequency or temporary inability to urinate are all symptoms of BPH and should not be considered a normal part of aging for men.
An episode of complete retention — having a full bladder that you can’t empty — is a medical emergency because it causes kidney and bladder damage. But for urologists like Dr. Au, it’s also a clear sign to try a different line of treatment.
“We know that retention episodes put people at really, really high risk for having the same thing happen again in the future,” Dr. Au said. “For a lot of men, surgery to remove excess prostate tissue is the best option.”
MU Health Care offers a full range of treatment options for BPH. Because Mel takes blood thinners, and because of the size and shape of his prostate, Dr. Au recommended a new, minimally invasive treatment called holmium laser prostate enucleation, or HoLEP.
The procedure uses a precisely focused laser to remove prostate tissue that blocks urine flow and puts pressure on the bladder. The approach lowered Mel’s risk of bleeding after surgery.
“Dr. Au made sure the procedure fit what I needed, and I needed to have this done,” Mel said. “This did not have an incision with it, and Dr. Au has a way about him that made me comfortable, so I was confident.”
For most men, HoLEP is an outpatient procedure that takes less than three hours.
Mel expected to go home with a catheter and on pain medication. But after using the bathroom in his recovery room, he was discharged without either and told to avoid heavy lifting for 30 days.
“It was unbelievable,” Mel said. “I’ve had more pain from a tooth cleaning. I just did not experience any pain at all and felt pretty darn good from the moment I went home. It’s a miracle.”
For Dr. Au, who has performed more than 150 HoLEP procedures at MU Health Care in the past 12 months, it’s a reward to be the last urologic specialist most of his patients need.
“This is a life-changing intervention for a lot of men, and one thing I keep hearing is, ‘I wish I’d done this sooner, why didn’t I do this sooner?’” Dr. Au said. “If there's a plumbing problem and I can fix it, and you don't need my help anymore, that's the ultimate outcome.”
Back home in Jefferson City, Mel returned to practicing and found his old form. He, too, wished he’d done something about BPH sooner. But he's grateful that his symptoms are gone, and he’s back to family gatherings and horseshoes tournaments.
“If you can call having any procedure done a good experience, this was as good as it gets,” Mel said. “I'm going to get back to where I was competing for a championship. I don't have anything standing in my way right now.”