New Green Light PVP: a procedure for the treatment of benign prostate enlargement.
The recent acquisition of this new laser system offers the large number of men with symptoms due to benign prostate enlargement (BPH) an alternative to standard surgical treatment for this common non-cancerous condition.
The advantages of this new technique are that it is ‘minimally-invasive’ and can be performed as a day-case procedure with very few complications. Using ‘cutting edge’ technology, high power laser energy is delivered to the obstructing prostate tissue causing the tissue to vapourise without significant bleeding. This laser is one of the first of its kind in the south of England and given the excellent early results it is likely it will soon become the treatment of choice for men with troublesome urinary symptoms.
Men with benign enlargement of the prostate may suffer from obstruction to the flow of urine through the water pipe (urethra). This is due to swelling or enlargement of the prostate such that the bladder has to work under pressure to expel the urine. This gives rise to problems with urination and in some cases this may result in a complete stoppage with a painful inability to pass urine.
Most commonly, however, men present to their practitioners with varied lower urinary tract symptoms; urgency, frequency of urination, difficulty starting, poor flow and dribbling. If mild, these symptoms can be treated by medication, but if this fails or if symptoms are severe or if a complete stoppage occurs, then surgery is usually necessary.
The traditional surgical procedure involved coring out of the passage through the prostate by passing equipment up the urethra. This operation is called trans-urethral resection of the prostate (TURP) and it has been the preferred operation for the last 25 years with over 50,000 such operations carried out every year in the UK.
The long term results of this operation are very good but men are usually in hospital for 3 days and a catheter is kept in place for 1-2 days following surgery and the risk of bleeding requiring a blood transfusion is in the order of 5%.
Lasers have been used for a number of years but the results have never been sufficiently good to displace TURP as it has not been easy to get the procedure down to a daycase episode, furthermore some patients complained of pain passing water for a few weeks following the operation.
With recent technological advances the new generation high power KTP laser ‘Greenlight PVP’ represents a very significant challenge to the ‘gold standard’ status of TURP.
Why is this new treatment so good?
This laser system is able to deliver a very powerful modulated KTP-YAG laser beam which is absorbed by the haemoglobin pigment in tissue. This causes massive localised heating of the prostate tissue resulting in instantaneous vaporisation with virtually no bleeding. The laser is also passed up the urethra and so there are no ‘cuts’.
The advantages of photoselective vaporisation (PVP) of the prostate are outlined below:
- No cases of impotence have been reported following this operation (for TURP this is the case for as many as 1 in 7 men)
- It is less likely to cause any change to the amount of ejaculatory fluid produced during sex
- Bleeding is rare and so patients do not need to stop tablets such as aspirin before surgery
- The majority of patients are home within 24 hours and so this is truly a day-case procedure
- If a catheter is sited after the procedure, it may be removed later the same day or the following day
- There is no limit to the size of prostate that can be treated this way
- Men otherwise deemed unfit for traditional surgery such as TURP are likely to be able to have this new alternative treatment
This operation is usually performed under a general anaesthetic and takes about 1 hour with at least three of these operations currently being performed each week at the North Hampshire Hospital and the Hampshire Clinic.