Green Light Photovaporization Of The Prostate

Green Light Laser Prostate Surgery Is A Big Boon

Prostate enlargement is a deadly infection experienced by most of the men that brings discomfort in their life. It is caused due to growth of prostate gland due to which urethra is compressed.

As such the follow passage for urine is obstructed and this results in increased bothersome urinary symptoms like irritation, strained, slow, discontinuous and frequent urine. Among many treatments to cure this infection, green light laser therapy is one of the best treatments for this infection as it involves the use of modern technology of lasers.

Since long this treatment has set of new standard care for treating enlarged prostate symbols. You might have heard about the surgery with the name PVP, which stands for photoselective vaporization of the prostate. Green light laser therapy has received FDA clearance in May 2001.

Basically laser surgery uses high energy lasers to destroy prostate tissue. Following procedure is followed in green light laser surgery. The patient is first given general or spinal anesthesia. The doctor then passes the thin laser fiber through the passage called urethra into the prostate using cytoscope, cytoscope is a camera that allows doctor to examine bladder and prostate, and delivers bursts of energy. Each burst lasts for 30 to 60 seconds. The high energy of lasers destroys prostate tissue by vaporizing them and prostates are thus removed.

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What Will Happen During Prostate Pvp

You may need to urinate before your procedure. You may be given medicine to keep you asleep during the procedure. Or, you may be given medicine to keep you calm and relaxed. With this medicine, you will be awake during the procedure but you will not feel pain. Your healthcare provider will insert a scope into your penis through your urethra. He will insert the laser through the scope and move it to the prostate. He will use the laser to vaporize the enlarged prostate tissue until the blockage is removed. You may need a catheter after the procedure to drain urine from your bladder.

Recovery After Vaporization Therapy

Vaporization is an outpatient procedure, that allows patients to leave the hospital / surgical center within a few hours after recovery. After the procedure, a urinary catheter will be placed in the bladder to drain urine. This is generally removed after 24 hours. However, some patients may require a catheter for a longer period of time. In general, patients are able to return to normal activities within a short time as directed by their physician.

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Strengths And Limitations Of This Study

• This updated meta-analysis included a larger number of studies involving more participants which adds precision to previous findings.

• This study analysed both safety and efficacy, focusing on sexual functioning and quality of life measures because lower urinary tract symptoms treatment related adverse events have a hugely detrimental impact on ones psychological well-being.

• Quality assessment methods used did not highlight substantial differences between studies because blinding is not possible given the characteristics of the two interventions under investigation.

• Due to the limited number of studies in this field, we were unable to conduct subgroup analysis around laser power which is necessary to identify the most effective/efficient standard.

• Surgical experience with laser technology, drop outs and withdrawals as well as other important factors were seldom reported in any detail which inhibits further analysis.

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Outcome Measures And Statistical Analysis

Surgeon experience was analyzed as a continuous variable . The following data were included in the database: patient age, body mass index , anticoagulant and antiplatelet therapy at surgery, American Society of Anesthesiologists score, Charlson comorbidity index , anticoagulant/antiplatelet medication, previous BPH medical history, history of retention, preoperative prostate volume and PRV . Preoperative symptoms index score including international index of erectile function , Quality of life , overactive bladder short form , international consultation on incontinence questionnaire-urinary Incontinence short form preoperative International Prostate Symptom Score , prostate volume , prostate-specific antigen level, maximum flow average flow , and postoperative PVR were also recorded. Patients with preoperative prostate volumes > 100 mL were excluded. In addition, the operative time and energy delivered on the prostatic tissue were assessed for each surgical step of the procedure. Intraoperative and early and 6-months post-operative complications as well as functional outcomes were collected prospectively.

Descriptive statistics were obtained reporting medians and inter-quartile ranges for continuous variables and number and percentages for categorical variables, as appropriate, were obtained.

The same analyses were used to evaluate the association between surgeon experience and overall operative time for aPVP.

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Post Greenlight Laser Surgery Recovery

jim0601

I had GL surgery four days ago and would appreciate feedback regarding the recovery process from those that have also undergone this procedure. I currently void every 30 to 60 minutes at night and every 30 to 60 minutes during the day. My flow is a stream for a few seconds then dribbles for maybe 30 seconds. Is this pretty typical? After the surgery I was drinking 1 1/2 liters of water per day but I may reduce this because I am not convinced my bladder is emptying fully. What do you think about this? When I void, it really burns at first and often I will get bladder spasms as well. Do you think the pain is radiated pain from where the prostate was vaporized? Do you think I will see improvement with these symptoms on a daily basis or weekly basis over the next month or so?

3 likes, 163 replies

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Harvard Experts Discuss Surgical Options For Benign Prostatic Hyperplasia

• By Harvard Prostate Knowledge

Benign prostatic hyperplasia is one of the most common disorders affecting men as they grow older. Yet there is much confusion about the best way to treat this disorder surgically, in part because it seems that every year, a new surgical option is introduced.

Harvard editors invited three experts to participate in a roundtable discussion to share their thoughts about the relative benefits and risks of current surgical treatments for BPH.

The panel consisted of these experts:

Transurethral resection of the prostate . Still the most common form of surgery, TURP is often inelegantly referred to as the Roto-Rooter technique. This procedure takes place in an operating room under general or spinal anesthesia. During the procedure, the surgeon uses an instrument called a resectoscope to view the prostate . The surgeon threads the resectoscope through the penis to the prostate, then uses the electrical loop to cut away the overgrown tissue thats pressing against the urethra.

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What Are The Benefits Of Laser Surgery

• Immediate symptom relief.
• Urine flow improves dramatically after virtually bloodless procedure.
• Patients are typically catheter free within 24 hours many immediately after the procedure.
• Patients are able to return to their ordinary daily activities in 2-3 days.

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Massachusetts General Hospital

Transurethral Vaporization Of The Prostate / Greenlight

Laser prostatectomy is a minimally invasive procedure to treat BPH. You may also see it referred to as Greenlight PVP, Transurethral Vaporization of Prostate , or laser prostatectomy. A telescope is placed into the urethra up to the prostate, and your urologist then uses a laser to vaporize prostate tissue that is obstructing flow of urine from the bladder.

This procedure has fewer side effects than the traditional Transurethral Resection of Prostate and is much more effective than microwave prostate treatments. Laser Prostatectomy is done under general or spinal anesthesia as an outpatient procedure. Most patients keep a foley catheter for less than 24 hours. Other benefits include long-lasting relief of BPH symptoms, the ability to stop BPH medications, and faster return to normal activities.

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Green Light Laser Prostate Surgery Side Effects

Benign prostatic hyperplasia or BPH is affecting countless male patients all over the world. It is a good thing that there are now innovative treatments available.

• Green light laser surgery uses the wavelength for green light.
• This high powered green laser beam can destroy the surplus prostate tissues without causing damage to the surrounding tissues. Still, if damage does occur, it would be very minimal.
• What makes the surgery very effective is that the light vaporizes the surplus tissues so that there is no need to open up the patient. This vaporization is done using safe pulses so that there is only minimal bleeding.
• When the surplus tissues are removed, the enlarged prostate can be opened up to allow better urine passage from the bladder.
• The treatment is also safe for use for most patients, even those using blood thinners.
• This type of treatment is preferred by many doctors and patients because recovery time is faster and side effects are minimal.

How Is Bph Diagnosed And Whos A Candidate

We typically diagnose BPH after hearing of a patients symptoms, most commonly the frequent or urgent need to urinate. We often ask patients to complete questionnaires to measure the extent to which their symptoms bother them, as well as the strength of their urine stream. Ultimately, if a man has problems urinating, we determine if its BPH by measuring the size of their prostate via an ultrasound and evaluate the appearance of their prostate with a cystoscopy, a procedure that uses a small camera to identify signs of BPH, such as the narrowing of the urethra where it passes through the prostate gland.

The best candidates for GreenLight laser surgery are men who want a treatment option that is going to last long-term. While most men are candidates for the surgery, its not the right option for everyone . Following a GreenLight laser surgery, patients can experience retrograde ejaculation, where semen travels backward into the bladder during sex rather than exiting through the penis. Men who cant or dont want to go under anesthesia also are not good candidates for this procedure.

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Data Synthesis And Statistical Analysis

We aimed to perform a meta-analysis comparing the medium-term outcomes after Green-Light PVP for clinical BPH compared to TURP. Meta-analyses were performed when studies were reporting the same outcomes. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios , 95% Confidence Intervals, and p-values. Risk ratios of more than one indicate an increased risk of complications after TURP. Functional outcomes were pooled using the inverse variance of the mean difference with a fixed effect, 95% Confidence Intervals, and p-values. Analyses were two-tailed, with a significance set at p 0.05 and a 95% confidence interval. Study heterogeneity was assessed utilizing the I2 value. Substantial heterogeneity was defined as an I2 value > 50% or a Chi2 p-value < 0.10. Meta-analysis and risk of bias assessment were performed using Review Manager 5.4 software by Cochrane Collaboration. The quality assessment of the included studies was performed using the Cochrane Risk of Bias tool.11 RoB 2 was applied for randomized studies and ROBINS-I for retrospective and prospective non-randomized ones.

Read Real Stories Of Men Who Underwent Treatment Of Enlarged Prostate At New York Urology Specialists

We offer treatment for prostate problems, including slow urine stream, frequent urination at night, difficulty emptying the bladder, and other problems to patients within driving distance to our offices as well as from other states and countries. Our patients come from New York, New Jersey, Pennsylvania, Connecticut, and over 70 countries worldwide.

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Recovery After Greenlight Laser Surgery

Please note that these recommendations apply to patients who undergo Greenlight Laser prostatectomy at New York Urology Specialists. Other surgeons may have different recommendations. Please contact your surgeon for instructions.

Patients can have a regular diet after the Greenlight laser of the prostate. For patients who undergo Greenlight laser prostatectomy at New York Urology Specialists, you may drink alcohol socially within reason once youre not taking medications.

You also may engage in regular nonstrenuous activities such as walking. Men should avoid sexual activity for 3-4 weeks after the Greenlight laser procedure to allow the prostate to heal. Similarly, biking and strenuous running should be avoided for 3-4 weeks after the procedure as it may provoke bleeding.

Who Can Have This Treatment

All patients with an enlarged prostate, known as Benign Prostatic Hyperplasia are suitable, including those on anticoagulants. Because we use powerful, third generation laser technology and proven techniques, we can treat men with large prostates, including those who have gone into retention and are dependent upon a catheter.

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Perioperative And Postoperative Features

Generally, no intraoperative complications were recorded. Two patients experienced early postoperative complications . Median catheterization and hospitalization time was 2 days .

Functional outcomes 6 months after surgery are shown in Supplementary Table 2.

Median Hb, PSA, Qmax was 0,60 g/dl, 1.56 ng/mL, 18.5 mL/s, respectively.

Comprehensively, we recorded a meaningful post-operative improvement in both storage and functional symptoms as well as in global quality of life scores at validated questionnaries .

A significant inverse correlation between the amount of energy delivered on the prostatic tissue and the degree of improvement of LUTS was detected considering the entire surgical procedure. The same analysis applied to the individual steps of the aPVP procedure confirmed a significant inverse correlation for all steps regarding the general improvement in IPSS, while only for steps 1-3 regarding the imporvement in storage LUTS .

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What Can You Expect The Day Of Your Procedure

On the day of your procedure, you will come to the treatment center. You should have someone drive you home since this is an outpatient procedure. Keep in mind that different patients may require a different treatment regimen.

Before treatment, your physician may give you medication to help you relax during the procedure. You may also receive medication to help you avoid infections.You may be asked to empty your bladder.

You will be brought into the procedure room and moved into the treatment bed where you will lie on your back. You will be provided anesthesia that will allow you to sleep through the entire procedure. Depending on the treatment center, other types of anesthesia may be used, including spinal block or a nerve block.

Once you are asleep or the anesthesia block takes effect, your physician will insert a cystoscope through your urethra. The laser fiber is introduced through the cystoscope and advanced into the urethra at the location of the prostate. The physician systematically vaporizes the enlarged prostate tissue until the obstruction is removed.

Following the GreenLight procedure, you will likely experience immediate improvement in flow and symptoms, but will possibly have mild short-term urgency and frequency or mild pain during urination. Blood in the urine occurs less frequently however, retrograde or diminished ejaculate volume is common. You may require a catheter for a short time, which is dependent on the physicians discretion.

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What Can I Expect From The Procedure

The procedure takes an average of 60 to 90 minutes under general anaesthetic. A thin laser fibre is positioned within the laserscope and is passed up through the urethra to deliver the treatment.

At BPC, we recognise that for some men, a trim TURP can be a useful procedure at the end of GreenLight laser surgery if residual prostate tissue is still present. We call this a trim TURP. By completing the procedure in this way, the normal flow of urine out of the body is restored and the likelihood of needing further surgery in the future is reduced. Having a trim TURP in additional to laser surgery does not have a significant impact upon your post-operative recovery, our experience shows. After your procedure, you will spend one night in hospital.

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Data Extraction And Statistical Analysis

Preoperative parameters were extracted together with intraoperative data including operation times, changes in haemoglobin and transfusion rates. Postoperative data including length of hospitalisation, duration of catheterisation and treatment-related complications were also analysed. Functional results including IPSS, Qmax, PVR, QoL and IIEF were assessed at 3, 6, 12, 24, 36 and 60 months after surgery.

Mean difference was used to assess continuous parameters. Authors were contacted when data were expressed as medians with corresponding range values. Otherwise, the statistical formula elaborated by Hozo et al was implemented to back-calculate means and SD in accordance with the recommended methods described in the Cochrane Handbook for Systematic Reviews.

Results were expressed as risk ratios with corresponding 95% CI for dichotomous variables. I2 was utilised to assess heterogeneity across studies. An I2< 50% is generally considered an acceptable level of heterogeneity therefore a fixed effect model was applied. In instances where the I2> 50%a random-effects model was applied as is the standard procedure for higher levels of heterogeneity. Pooled effects were synthesised using Z test and a p value < 0.05 was set at the threshold for statistical significance.

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