Laser Prostate - Indications for Surgery and Alternatives

Tim Larner explains about laser prostate pvp greenlight laser

Indications for Surgery and Alternatives

What symptoms can the prostate cause?

An obstructing prostate may cause the urinary flow to become weak and in extreme cases to cease altogether leading to retention of urine requiring a catheter (a tube through the penis to drain urine into a bag). Other symptoms may be having to wait at a urinal before being able to start to pass water and finding at the end of urination the the stream may stop and start. Other associated problems may be getting up at night frequently to pass urine and passing frequently during the day sometimes without much warning.

The IPSS (International Prostate Symptom Score) attempts to quantify these symptoms:

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Please answer the following questions about your symptoms. Write your score for each question at the end of each row.
Over the past month, how often have you		Not at all	Less than 1 time in 5	Less than half the time	About half the time	More than half the time	Almost always	Your Score
1. Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?		0	1	2	3	4	5
2. Over the past month, how often have you had to urinate again less than two hours after you finished urinating?		0	1	2	3	4	5
3. Over the past month, how often have you stopped and started again several times when you urinated?		0	1	2	3	4	5
4. Over the past month, how often have you found it difficult to postpone urination?		0	1	2	3	4	5
5. Over the past month, how often have you had a weak urinary stream?		0	1	2	3	4	5
6. Over the past month, how often have you had to push or strain to begin urination?		0	1	2	3	4	5
7. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?		0	1	2	3	4	5
								Total
	Delighted	Pleased	Mostly Satisfied	Mixed	Mostly Dis-satisfied	Unhappy	Terrible	Your Score
Quality of Life due to Urinary Symptoms If you were to spend the rest of your life with your urinary condition just the way it is now, would would you feel about that?	0	1	2	3	4	5	6

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Men with a score of 0-7 can be considered to have relatively mild symptoms whilst those scoring 8-19 have moderate symptoms and those scoring over 19 having severe symptoms. Obviously a simple scoring system does not take personal situation into account and a final QOL (quality of life ) score tries to address this by asking how you as an individual feel about your symptoms.

What are the alternative treatments?

Many men with symptoms can be treated with medication and gain a satisfactory response. The two commonly used families of drugs are the alpha –blockers (which cause the muscle in the prostate to relax) and the 5 alpha reductase inhibitors which stop testosterone being converted into a more active form and hence slowly shrink the prostate.

Most men seeking surgery will have tried 1 or both of these families of drugs.

Men seeking surgery often fall into one of several groups:

1) Failure or only partial response to medication.
2) Those unwilling to take lifelong drugs.
3) Men with catheters.
4) Men wanting relief from their symptoms by a single operative intervention.

What are the alternative operations?

The commonest operation for urinary symptoms due to an obstructing prostate is Trans – Urethral Resection of the Prostate (TURP). This is an effective procedure and has been considered the “gold-standard” operation for many years. It is a major procedure, however, and results in bleeding from the prostate gland, which may be severe. In order to stop this bleeding from clotting in the bladder, a catheter is placed (a tube through the penis into the bladder) and fluid is run through this to wash the bladder out until the bleeding stops. This results in an average in-patient stay of about 5 days. After a TURP return to normal activities is usually delayed for about 4 weeks. Due to this and other complications there has been much interest in less invasive procedures that cause less blood loss, shorter in-patient stay and faster return to normal life.

Any patient who has been offered a TURP is suitable for PVP. Due to the minimal bleeding PVP may also be suitable for patients who have been declined TURP due to prostate size.

There are other procedures available in specialist units including thermotherapy, interstitial lasers and cryotherapy. None of these less invasive procedures have been shown to have as good an outcome as TURP or PVP and so I do not offer them.

This is not designed as an exhaustive list of other modalities of treatment and should you have any questions about other techniques I would be happy to discuss them.

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