Less Invasive Procedure Offers Hope for High Risk BPH Patients
Ann B. DeBellis
The transurethral resection of prostate (TURP) is the current gold standard for treating benign prostatic hyperplasia (BPH), but the less invasive prostate laser vaporization technology is proving to be beneficial for patients as well and has similar outcomes to the traditional procedures.
Mell Duggan, MD, of Urology Centers of Alabama started using Greenlight PVP™ Prostate Laser Vaporization about five years ago. “I started using the technology when some of the new anticoagulant medicines, like Plavix, came out at the same time cardiologists were using medicated stents,” he says. “Many patients wearing catheters were still candidates for TURP surgery but taking them off of the anticoagulants was risky. In those cases, we used the laser vaporization which is as effective and safer for this group of patients.”
The green light procedure typically is performed on an outpatient basis under general anesthesia and removes excess prostate tissue using a patented high-power, narrow-spectrum laser. The laser energy vaporizes and precisely removes the enlarged prostate tissue in a usually bloodless procedure, allowing the patient to remain on blood thinning medication. The laser also makes it easier to treat very large prostate glands which typically require an open surgical procedure. Objective measures such as flow rate and patient satisfaction rates are equal to the results of TURP and can be done on some patients who are not candidates for TURP, Duggan says.
Following a TURP, the patient spends one to two days in the hospital with a large catheter and constant bladder irrigation. The TURP can result in the absorption of irrigation fluids during surgery which can be a significant problem in patients with congestive heart failure. As a result, many elderly men may not be good candidates for the surgery but may tolerate the laser vaporization, because absorption of irrigation fluids during the laser procedure has not been significant.
Duggan says that while laser vaporization is now the leading procedure in some parts of the country, not a lot of physicians have embraced the technology. “The Greenlight PVP™ has expanded indications for treatment compared to the traditional TURP because it is less invasive,” Duggan says, “but not everyone is performing the procedure. TURP is a good operation and because it takes a while to become proficient in the laser procedure, many physicians don’t see the need to learn it.”
A possible deterrent to learning to use the Greenlight PVP™ technology is the need to wear protective goggles to protect the eyes from the laser. “When learning the laser procedure, many doctors don’t like wearing goggles so they prefer to stay with the TURP,” Duggan says. “In addition, use of a videoscope is required during the laser procedure. Like the goggles, some urologists don’t like to use the scope, so that can be another deterrent to learning the procedure.”
Another reason a lot of physicians aren’t performing the procedure is because they are not being trained on the laser vaporization technology during their residency. “The Board of Urology requires residents to perform a certain number of TURPs, so there aren’t a lot of cases left over for performing the laser procedure. As a result, they have to learn the procedure after their residence which is often difficult to do,” Duggan says.
Duggan has taught the Greenlight PVP™ procedure to physicians in Alabama, Tennessee, Mississippi and Arkansas. He often consults with this network of physicians and they sometimes send their most difficult-to-treat patients to Duggan. “Being in a urology group of 30 physicians, requires some sub-specialization. I am fortunate to have had the opportunity to learn to perform the Greenlight PVP™ procedure and to be able to use my expertise to help patients,” he says.