What are the results of TURP for BPH?
The TURP is a common surgical procedure that urologists have performed for decades. It is the gold standard to which other minimally invasive surgical treatments are compared. Subjective and objective success rates with TURP are reported to be 85-90%. The long-term results of a TURP are well established, with durable objective improvements demonstrated 10 years post-procedure.
What is minimally invasive surgical treatment of BPH?
Even though open prostatectomy and TURP, TUIP, and TUVP are commonly performed, reliable operations, urologists have sought procedures that are less invasive and easier on the patients. These procedures have become known as minimally invasive surgical treatment (MIST) of BPH. These MIST techniques include VaporTrode procedure, laser procedures, hyperthermia and thermotherapy, radiofrequency ablation, balloon dilation of the prostate, urethral stents, and high-intensity focused ultrasound.
The VaporTrode (CIRCON/ACMI) uses high electrical energy transmitted through a grooved rollerball that is run over the area of prostate to be treated. VaporTrode prostectomy uses the same instrumentation as a TURP, but instead of a resecting loop, the VaporTrode device is used. This vaporizes the prostate tissue. The advantage of VaporTrode is that there is less bleeding. A long-term study comparing subjective and objective outcomes of TURP and VaporTrode demonstrated similar subjective outcomes for both with an average of 10 years of follow-up, with slightly better objective outcomes with TURP.
What is laser therapy of the prostate?
Since the 1980s, several generations of lasers have been used to treat obstructive prostate symptoms. LASER is an acronym for light-amplification stimulated emission resonance. In practical terms, this means that the light energy is very focused and allows powerful and precise application of the light energy to tissue.
The potential advantages of laser therapy include minimal bleeding, avoidance of TUR syndrome, less retrograde ejaculation, the ability to treat patients on blood thinners (such as Warfarin [Coumadin] and aspirin), and the potential to treat patients on an outpatient basis.
What types of laser therapy are available?
A variety of laser therapies are available. Not every urologist or every hospital has access to every laser available on the market. The following are some of the laser therapies used to treat BPH:
Interstitial laser coagulation: This procedure is performed under local anesthesia on an outpatient basis. The Indigo Laser Optic Treatment system is used with a cystoscope through which a fiberoptic probe is inserted into the prostate. The prostate is heated via the probe for about 3 minutes and this coagulates the obstructing prostatic tissue. The procedure can be repeated in different areas of the prostate. The procedure takes about 30 to 60 minutes to perform. After the procedure is performed an indwelling foley catheter is placed which is usually removed in a few days. It is not uncommon to see some blood in the urine after the procedure, which usually clears in a week. Rarely, erectile dysfunction, retrograde ejaculation, and incontinence can occur.
Photoselective vaporization of the prostate (PVP):
This procedure uses a special high-energy laser (e.g., GreenLight PVP™ Laser) to vaporize excess prostate tissue and seal the treated area (Figures 25a and b). The procedure is performed on an outpatient basis in a hospital or surgical center and may be performed under local, spinal, or general anesthesia. The procedure takes about 30 minutes to perform, depending on the size of the prostate, and patients are usually discharged within a few hours. As with interstitial laser coagulation, the procedure is performed via a cystoscope. Many patients do not require a catheter after PVP, and those who do typically are catheterized for less than 24 hours.
HoLAP (holmium laser ablation of the prostate):
This procedure involves using a laser to vaporize obstructive prostatic tissue. The decision whether to use HoLAP or HoLEP (holmium enucleation of the prostate) is based primarily on the size of the prostate. Ablation usually is performed when the prostate is smaller than 60 cc (cubic centimeters).
HoLAP offers many of the same advantages as HoLEP when compared to traditional surgery (e.g., TURP). These potential benefits include a shorter hospital stay, less bleeding, and shorter catheterization and recovery times. Patients who undergo HoLAP usually do not
Figure 25 (a) Formation of lesions in the prostate. (b) Multiple lesions formed in the prostate.
Courtesy of Medtronic, Inc. © Copyright 2003.
require overnight hospitalization and in most cases, the catheter is removed the same day or the morning following the procedure.