For several decades now TURP (also known as the “re-bore operations”) has been the standard treatment for men with lower urinary tract symptoms or water work trouble secondary to BPH (an enlarged prostate). TURP surgery produces durable and reliable improvements in flow rates and subjective symptom scores. As a result, it has been one of the most common urological operations performed.
Despite its efficacy, however, TURP is associated with a significant side-effect profile, including bleeding and the need for blood transfusions, infections, strictures, sexual problems and incontinence. In fact the rate of erectile dysfunction (ie erections not being as good as they were prior to surgery) has been reported as high as 18% in some series. In addition to the complications from TURP men who undergo a TURP require on average two to three days of catheterisation after the surgery and hospitalisation before undergoing a trial of void (catheter removal) and discharge.
GreenLight Laser prostatectomy was introduced in 2003 to with a view to providing excellent results comparable with a standard TURP procedure but with significantly fewer side effects. This technique was pioneered by a Dr. Malek from the Mayo Clinic, in the United States, initially using first generation, low powered machines. The initial models have now been used with excellent results for several years. These initial results demonstrate excellent functional outcomes with improvements in flow rates and symptoms that are as good and as durable as those achieved with a TURP procedure. The advantages to GreenLight Laser prostatectomy, however, include a significant reduction in the likelihood of bleeding, significant reduction in catheterisation times, hospital stay and complication rates.
In Dr Chabert’s clinic younger men have a catheter placed for only 2 hours after surgery and 95% of these men are able to return home on the same day as their surgery. Older men have a catheter for an average of 14 hours, spending one night in hospital before returning home.
Until recently, there was no randomised controlled trial (scientific study) comparing TURP with laser prostatectomy. However, a recent publication from Melbourne demonstrates that GreenLight Laser Prostatectomy and TURP, are equivalent in terms of improvement in symptoms but there were significant improvements in side-effect profile in favour of GreenLight Laser Prostatectomy. These improvements included: reduced the length of hospital stay, a reduction in catheter time and a 22% reduction in cost. Indeed the mean duration of catheterisation amongst the GreenLight Laser Prostatectomy group was in the order of 12 hours and the length of stay one day.
There has been a recent upgrade of the technology allowing higher energy to be delivered in a more focused fashion. This has resulted in more precise surgery and reduced treatment times. In contrast to TURP GreenLight Laser Prostatectomy allows vaporization of tissue and simultaneously seals the tissue resulting in an almost bloodless field. The net result is that patients who are on blood thinners such as warfarin, Plavix and aspirin can be treated whilst remaining on this medication.
This technology has only been available in Australia, in major metropolitan areas. This technology is now available to men in Northern NSW and Southern Queensland through the provision of this service at St. Vincent’s Private Hospital, Lismore and John Flynn Private Hospital, Tugun, Queensland.
Through LUA Dr Charles Chabert has established the first GreenLight Laser Prostatectomy program in Queensland. Dr Chabert was one of the first surgeons globally to use the 180W XPS GreenLight Laser in combination with Moxy fibre technology.
- In the majority there is very little blood loss and little pain afterwards. The time in hospital is less than the average length of stay with a TURP operation. There is significantly less bleeding, lower risk of a transfusion and a quicker recovery. The likelihood of erectile difficulties is also substantially less than has been reported with a TURP.
- Men required a night in hospital and need to refrain from normal activity for around 2 weeks. Whilst erectile function is maintained in almost all men, retrograde ejaculation occurs in most.
Details of the Procedure
In the majority of cases men will be treated with a single overnight stay in hospital or be allowed to return home on the same day as their operation. A general anaesthetic most commonly is used for the operation. A telescopic camera is then inserted into the penis and the internal surface of the prostate visualized. The GreenLight laser beam is then directed onto the prostate surface and tissue vaporized in an almost bloodless fashion. GreenLight Laser vaporization is continued until all obstructing prostate tissue has been removed.
A small urethral catheter (small plastic tube into the bladder) is inserted at the end of the procedure. This is left in place overnight only. After removal of the catheter, men go home once they have successfully passed urine and emptied their bladder.
Follow-up takes place 12 weeks after the surgery to confirm symptomatic improvement.