TURP Treatment and Laser Treatment
About TURP Treatment and Its Advantages
Transurethral resection of the prostate, or TURP, is a procedure in which a section of prostate tissue is removed. While the procedure has many side effects, it does alleviate more symptoms than any of the other treatments available for BPH. Up to 90% of patients who undergo TURP see a dramatic improvement in their symptoms with little or no complication from the surgery.
During this procedure, the prostate is visualized through the urethra using a special cystoscope called a resectoscope. With this instrument, the prostate section to be removed is shaved into manageable pieces, which are then removed as the tissue is cauterized (heat is applied so that bleeding is minimized). The patient is under general anesthesia during this time. After the surgery, a Foley catheter is used to drain the bladder. Urine will initially be bloody, but will soon become clear. As with all surgeries, there are some risks, but these are generally low, especially if the patient fully discloses all current medication they regularly take which might interfere with the surgery (such as blood thinners). Generally, patients who undergo TURP will remain in the hospital from one to three days.
Patients with prostates estimated to be in between 30 and 90 grams are best suited for TURP surgery, whereas in patients with a prostate measuring 90 grams and above, an open prostatectomy is recommended since it can be very difficult for a surgeon to remove a large prostate using TURP. Once prostate size reaches 90 grams or higher, bleeding may become more difficult to control during the TURP surgery. Additionally, patients may also absorb excessive fluids during this extensive surgery which can cause brain swelling and other complications.
Generally, patients with larger prostates may choose to undergo an open prostatectomy, in which an incision is made through the lower abdomen. This procedure is more involved than the TURP treatment and the patient will have longer post-operative recovery time in the hospital. In addition, they will remain on the Foley catheter for several days.
If the patient is having less severe symptoms and opts for a less invasive surgery, their physician may recommend a laser prostatectomy, in which highly powered light is used to destroy prostate tissue. This procedure removes only the tissue immediately blocking the urethra, and the patient generally does not remain in the hospital. A catheter is used to drain urine for several days following this procedure.
TURP is generally quite successful at removal of symptom-causing enlarged prostates. Bleeding, fluid absorption and infection are the most common risks associated with the procedure. Other less common risks of the surgery may include problems with urine control, infertility, the flow of semen into the bladder instead of through the urethra (retrograde ejaculation), and trouble obtaining and maintaining an erection.
For most patients, the benefits of the procedure outweigh the risks. Patients should remain off of their feet for several days following the procedure, and should allow up to 3 weeks for a complete recovery. In addition, they should avoid alcoholic beverages, spicy foods, and caffeine, as these may slow down the healing process. Patients should avoid strenuous activity for 3 to 4 weeks to allow for complete healing of the tissue, and may wish to take dietary supplements to avoid constipation, which can impede the healing process. Those patients who are on blood thinning medication should stop their medication after consulting with their physician at least one week prior to their surgery and should not resume taking them until they have been cleared by their urologist. With the proper precautions, the patient’s post-operative time will be pain-free, and the patient will see a reduction in symptoms.
Holmium Laser Therapy and GreenLight Laser PVP
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.
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.