Holmium Laser Treatment and Greenlight Laser PVP

A) Holmium Laser Therapy

Holmium Laser Treatment is a minimally invasive treatment for BPH.  It is an alternative to transurethral resection of the prostate, or TURP, which surgically removes some or all of  the prostate.  In this procedure, laser energy is targeted toward the prostate, with the goal of tissue destruction or ablation.  There are fewer side effects,  little or no bleeding and a shortened hospital stay.  Patients who undergo the laser treatment are often fully recovered within a week. Unlike TURP, there are generally few or no sexual side effects, making it a popular choice for many men suffering from BPH.  In addition, patients who take certain blood-thinning medications and thus may be unable to undergo TURP are good candidates for the laser treatment.

The Holmium laser is very powerful pulsed KTP-YAG laser which is absorbed by water.  When it is brought in contact with tissue, it causes v hitting of intracellular or extracellular water which then results in an immediate tissue vaporization or destruction (ablation). The physician who performs the procedure uses a very small, flexible fiber to deliver the laser energy.  The laser is rotated side to side in a sweeping motion, and the tissue responsible for the symptoms is removed.  This immediately cauterizes the tissue, resulting in little to no bleeding, in contrast to some of the other surgical procedures.  Many patients are sent home within 2 to 24 hours after the procedure free of any catheter, but the treatment effects remain for as many as seven years.  A holmium laser can also used to blast urinary or bladder stones.  This is especially helpful when a patient has both BPH and bladder stones.  Therefore, this patient can be treated for both conditions simultaneously.

B) GreenLight Laser PVP

The GreenLight Laser PVP is the newest and least invasive of the surgical techniques for BPH.  Using a green-light laser and a fiber optics delivery system, this technique offers a solution that works with minimal side effects and a short hospital stay.  Unlike other techniques, 30% of patients do not need a postoperative catheter and more than 90% of patients are discharged home within one to two hours after the procedure.  During this minimally invasive procedure, a fiber optic device is inserted through a cystoscope, and very powerful laser light is pointed at the prostatic tissue that is causing the blockage.  The treated tissue is immediately coagulated and vaporized without bleeding.   The entire process is completed in under an hour, and many men report immediate relief of symptoms.  This procedure has been shown to be both immediately effective as well as durable, with results lasting an average of five years.  The procedure is not shown to cause any post operative  impotence, and there is less chance of retrograde ejaculation with this procedure than with TURP.  However, it is common for patients to have some burning sensation during urination immediately after the procedure which usually resolves within a month. Because of its immediate results and lack of dangerous side effects, the GreenLight Laser is a popular choice for men suffering from BPH.  

Men with exceptionally enlarged prostates are not ideal candidates for GreenLight Laser, as the prostate must be removed surgically in most cases.  Your doctor is the best person to evaluate and recommend candidates for laser treatment.  It should be noted that  patients with neurogenic bladder disorders are not suited for laser treatments.
It is best for patients who are on aspirin or other blood thinning medications to stop those medications one week before their scheduled procedure.  However, in special circumstances, some patients may be allowed to remain on these drugs if deemed medically necessary.  Patients should have a complete medical evaluation one week before the procedure.  They should not eat or drink anything after midnight the day of the procedure but can take their essential medications with a small sip of water early in the morning of the procedure.  Once the procedure is completed, the majority of patients are discharged home the same day with or without a catheter.  If a catheter is left in, it is usually removed in the doctor’s office the next day.  A mild burning sensation is common and occasionally blood in the urine may appear.

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