There is good news for sufferers of BHP (Benign Hypertrophy
of the Prostate) and other prostate conditions - new laser
treatments are available that have significantly less side
effects than the previous treatments (TURP/TUNA), and much
shorter recovery durations. In addition, the new laser
techniques are ideal for patient who are on blood thinning
medications - a not uncommon coincidence, as both
conditions tend to crop up in men over fifty.
You should, however, know that there are two laser
technologies currently in use for prostate reduction or
enucleation: the Holmium (YAG) laser, and PVP (KPT) laser
(otherwise known as "Green Light".) The differences between
the two are in the wavelength of the lasers used, and the
nature of the energy transmitted to the tissues.
PVP LASER (Green Light)
The PVP (KPT) laser has a somewhat long wavelength that
penetrates the tissue more deeply - in fact, the energy
penetrates more deeply than it ablates (removes). What this
means is that tissue that is left behind has been affected
by the laser. The result can be a phenomenon known as
necrosis of the affected tissue: the remaining tissue dies
and may require further treatment of other means to remove,
down the line.
This can be a serious side effect. PVP laser treatment is
considered viable for smaller prostate conditions, but not
for larger, as the possibility of necrosis is higher.
HOLMIUM LASER
The Holmium (YAG) laser has a shorter wavelength and
penetrates less deeply than the PVP. Energy from the laser
is imparted only to the the tissue that is ablated
(removed). As a result, there is no necrosis concern.
In a panel discussion of noted urologists comparing the two
technologies for HoLAP procedures[1], the experiences of
all came down positively for the Holmium vs. the PVP laser.
HoLEP - ENUCLEATION OF THE PROSTATE
With the Holmium laser, it is now possible to completely
remove the prostate with minimal side effects. This is
called enucleation. The procedure entails making a pair of
incisions in the bladder, going in with the flexible laser
instruments, and detaching the prostate completely from the
surrounding tissues. It is then sectioned, and the sections
are brought into the bladder through the incisions, where
they are broken up into passable bits (the bits are passed
through the catheter.)
This is becoming the new "gold standared" treatment,
replacing the TURP procedure in many advanced urological
centers. Side effects are minimal, and, according to one
study[2], sexual function (ability to gain and maintain an
erection) may actually increase, depending on the nature of
prior dysfunction, if any.
WHERE TO GO?
One consideration is going overseas for treatment. HoLEP
is available in at least one group of urolotical hospitals
located in India, using exactly the same procedures and
equipment as in major US facilities. The procedure can be
done for as little as a fifth to a tenth of that in the US.
[1]Urological Times [2]Journal of Andrology
----------------------------------------------------
Garrick Berger is the managing director of Overseas Medical
Connection (http://www.overseasmc.com), a company dedicated
to assisting prospective patients evaluate their overseas
treatment/medical tourism options. The company also
maintains a forum (http://forum.overseasmc.com ) for those
wishing to exchange research and experiences on medical
treatment overseas.
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