What are the advantages of a laser prostatectomy? What are the alternatives to GreenLight PVP laser prostatectomy

Why have a laser prostatectomy?

The reasons are the same as for a TURP, which are:

• urinary symptoms due to an enlarged prostate (BPH) that are bothersome and are not adequately improved by medicines, changing one's lifestyle
• urinary symptoms due to BPH that are bothersome and cannot be treated by drugs or other minimally invasive techniques
• urinary symptoms due to BPH proven to be due to bladder outlet obstruction on urodynamics with a desire to remove obstruction in order to avoid long term problems of bladder outlet obstruction
• The inability to pass urine without a catheter ('urinary retention')
• kidneys that are not functioning properly because the prostate is blocking the bladder
• recurrent urine infections due to obstruction caused by the prostate
• bleeding from the prostate due its enlargement (BPH), which may not have improved with a 5-alpha reductase inhibitor like finasteride or dutasteride
• prostate cancer ('channel TURP'): this is to allow urine to flow and is not intended to be curative

In addition, the treatment can be performed in patients who have abnormal clotting or are on drug thinners (e.g. aspirin, warfarin etc) in certain cases.

What are the advantages of a laser prostatectomy?

Urinary symptoms are reduced as much as for traditional surgery and significantly more than with the use of medication. In addition, there is shorter stay in hospital, shorter period or no catheterisation and less blood loss. There is much less bleeding, which is why the procedure can be performed on men taking aspirin.

The instrumentation for a laser prostatectomy is smaller than that used for a TURP, so, in theory, there should be a reduced chance of a urethral stricture.

Saline is used during the procedure to irrigate the area, and this is safer than the irrigation used to a TURP that can cause a rare but dangerous problem known as TUR syndrome.

How well does a laser prostatectomy work?

The GreenLight PVP works as well as TURP for small or moderate sized prostates. Providing men have bladder outlet obstruction, 9 in 10 men should experience a significant improvement in urinary symptoms after laser prostatectomy. Patients who had a catheter in should be able to pass urine with little problem.

What are the alternatives to GreenLight PVP laser prostatectomy

There are several procedures of which the most common are listed below.

• Transurethral Needle Ablation (TUNA) of the prostate: this is a less invasive procedure than laser prostatectomy, can be performed in day surgery or as an outpatient, with fewer problems and maintains normal ejaculation. Symptoms are improved after TUNA, but not quite as much as after laser prostatectomy.
• TURP: This is the gold standard treatment for BPH by which other treatments are judged. Compared to laser prostatectomy, There is more blood loss and a greater chance of needing a blood transfusion, a longer hospital stay and more post operative complication. There is less discomfort felt in the bladder and penis after this compared to laser prostatectomy and usually there is no slough to pass.
• Open prostatectomy: For this, an incision is made in the lower abdomen under general anaesthetic or when the skin is made numb from the waist down, and the prostate removed. Urinary symptoms are improved possibly slightly better than laser prostatectomy. A prolonged hospital stay is required and bleeding can occur sometimes requiring a blood transfusion. This option is reserved for very large prostates that are usually too large to be treated by one of the other options.
• Prostate stent: This is usually reserved for patients who are unsuitable for any other form of therapy. It is performed in day surgery, involves local anaesthesia, but is less effective than the other options.
• Transurethral Microwave Thermotherapy (TUMT): this is another minimally invasive option that works well in selected patients but still results in retrograde ejaculation.