Easing the Symptoms of BPH
Benign prostatic hyperplasia (BPH) affects approximately 10 percent of men per decade of life. As the population continues to age, more men experience lower urinary tract symptoms (LUTS) due to BPH. Despite advances in the medical management of LUTS/BPH, some men ultimately require surgical interventions to alleviate their urinary symptoms.
The UW Department of Urology has seen significant advances in the treatment of LUTS secondary to BPH with its experience with the GreenLight laser photoselective vaporization of the prostate (PVP). Members of the Department who perform PVP include David R. Paolone, MD, Andrew Graf, MD and Daniel Williams, MD. They have been performing the procedure since 2006 and have a combined experience of over 250 cases.
The GreenLight PVP procedure utilizes laser energy at a wavelength of 532 nm to vaporize obstructing prostate tissue in a nearly bloodless fashion. Unlike a transurethral resection of the prostate (TURP) which typically requires a two- to three-day hospital stay, the PVP allows patients to go home the same day or the next morning. Most patients require a urethral catheter for no more than 24 hours, and some patients are even able to be discharged the same day without a catheter. Another advantage of the GreenLight PVP over the traditional TURP is that the procedure has been safely completed on patients taking anticoagulants and other blood thinners.
The recent advent of a 120 Watt High Power System (HPS) has greatly enhanced the ability of the GreenLight PVP to treat large prostate glands, including those greater than 80 ml in volume. Many patients who present with catheterdependent urinary retention have been treated with the GreenLight PVP HPS, and the success in allowing these patients to urinate on their own has been substantial.
Numerous recent publications have demonstrated improvements in LUTS, urine flow rates and post-void residual urine volumes following treatment of BPH with the GreenLight laser. Additionally, these improvements are comparable to those seen with TURP and are equally as durable with results now up to 10 years. The UW Department of Urology’s experience with the GreenLight PVP has been consistent with these findings and has been presented at local and regional urological society meetings.
Resident education has been favorable with regards to GreenLight PVP. The procedure has a fairly short learning curve, and most resident physicians have achieved competence in the procedure after participating in as few as 10 cases. Key factors in training include beginning with glands less than 50 ml in volume and avoiding those with prominent median lobes.