Laser Treatments

PVP

Photoselective vaporization of the prostate (PVP) is a minimally invasive procedure that uses a special high-energy laser (e.g., GreenLight PVP™ Laser) to vaporize excess prostate tissue and seal the treated area. The procedure is performed on an outpatient basis in a hospital or surgical center and may be performed under local, spinal, or general anesthesia. PVP takes between 10 and 30 minutes to perform, depending on the size of the prostate and patients are usually discharged within a few hours.

The type of laser used in PVP is delivered to the prostate through an endoscope (device that consists of a tube and an optical system) that is inserted into the urethra. The procedure prevents damage to surrounding tissue and minimizes side effects such as pain, blood in the urine (hematuria), and swelling.

Many patients do not require a catheter after PVP, and those who do typically are catheterized for less than 24 hours. Patients are advised to avoid strenuous exercise for 2 weeks following the procedure and can usually resume regular activities the next day. PVP provides immediate and long-lasting results comparable with other minimally invasive procedures.

HoLAP

HoLAP (holmium laser ablation of the prostate) 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 require overnight hospitalization and in most cases, the catheter is removed the same day or the morning following the procedure.

Microwave Treatments

Cooled ThermoTherapy™TUMT™

Cooled ThermoTherapy™/TUMT™ reduces BPH symptoms, preserves sexual function, and provides durable results using the Targis® system or the Prostatron® system. Treatment can be completed within 30 minutes, usually does not require anesthesia, and is performed in a physician's office or an outpatient setting.

In this treatment, a specially designed antenna inside a catheter is inserted into the prostate through the urethra. This antenna is used to direct microwave energy into the prostate to heat and destroy enlarged tissue. During the procedure, cool water is circulated through the catheter to minimize patient discomfort, protect adjacent urethral tissues from excessive temperatures, and reduce the risk for serious side effects.

Medication is often administered to reduce discomfort and help patients relax during the procedure. Many patients are able to read, watch television, or listen to music during treatment and some may experience the following:

  • Bladder spasms
  • Pressure in the rectum
  • Sensation of needing to empty the bladder or have a bowel movement
  • Warm or burning sensation in the abdomen or penis

Following treatment, anti-inflammatory medication and antibiotics may be prescribed. Most patients can resume normal activity immediately after treatment. Destroyed prostatic tissue is reabsorbed by the body or discharged in the urine over the course of 6 to 12 weeks and BPH symptoms gradually improve during this time.

Side effects usually resolve without intervention within a few weeks of treatment and include the following:

  • Frequent urination
  • Pink discharge in the urine or around the catheter
  • Soreness in the lower abdomen
  • Urethral inflammation and swelling (most patients require catheterization for 2–5 days)
  • Urgency (even after removal of the catheter)

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Prolieve™

Prolieve™ Thermodilatation System is a transurethral microwave thermotherapy (TUMT) device that also uses a special balloon catheter to open up (dilate) the urethra, as well as microwave energy to heat and destroy enlarged prostatic tissue. In this procedure, the balloon catheter is filled with warm water. After the temperature of the tissue returns to normal, the urethra remains open. Prolieve™, which takes about 45 minutes, is performed in a physician's office under local anesthesia. In a recent study, about 5% of patients required catheterization following the procedure.

Other Minimally Invasive Treatments

AquaTherm™

The AquaTherm™ System uses water-induced thermotherapy (WIT) to destroy obstructive prostatic tissue and reopen the urethra. WIT can be performed in ambulatory surgery, outpatient surgery, or a physician's office. It takes only 45 minutes and does not require general anesthesia.

A catheter made up of four contiguous sections - the urinary drainage lumen, the positioning balloon, the treatment balloon, and the insulated shaft - is attached to a computer console that heats water to 60° C (140° F). Throughout the procedure, the computer console precisely maintains the water temperature at 60° C, and urine is allowed to pass by means of the urinary drainage lumen.

The urologist inserts the catheter through the urethra and into the bladder. Once the urinary drainage lumen and the positioning balloon reach the bladder, the positioning balloon inflates and secures the catheter. The treatment balloon, resting in the prostatic urethra (located directly below the bladder), inflates and fills with water. Temperature-controlled water circulates through the insulated shaft into the treatment balloon. The catheter conducts heat through the insulated shaft to the prostate gland, raises the temperature of the gland, and destroys the obstructive tissue. Destroyed tissue is either sloughed off or absorbed by the body over time. After 45 minutes of treatment, the catheter is removed.

Following the procedure, a urethral catheter remains in place for approximately 4 to 17 days, or until normal urinary flow is restored. Temporary hematuria, or blood in the urine, is usually present after the procedure, and treatable urinary tract infection or urinary urgency also may occur.

TUVP

Transurethral vaporization of the prostate (TUVP), also called vaportrode, involves direct application of heat (under 100° F) to the prostate tissue with a grooved roller-bar that vaporizes tissue. The immediate tissue loss leads to quick improvement of symptoms. The procedure takes from 20 to 65 minutes. The catheter is usually removed within 24 hours and most patients go home within 2 days.

 

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