Research And Quality Assurance
The GreenLightTM laser surgical method has been scientifically studied in our clinic since 2006. The results of these investigations have been published in a number of high-ranking international journals and presented at the most important urological congresses worldwide . The research work was awarded poster prizes by the German and European Society of Urology at several congresses and the prestigious Mauermayer Prize of the German Society of Urology in 2009.
The results of this research work have contributed, among other things, to the fact that this surgical method has become established worldwide. For quality assurance purposes, three-dimensional ultrasound examinations of the prostate are performed in our clinic as part of the GreenLightTM laser surgery. These are used to determine the extent of the prostate tissue removal and to ensure that the excess tissue is removed as completely as possible.
The Need For Further Treatments
There is a chance of the sudden swelling of the prostate gland right after surgery. Some men may need a follow-up treatment after laser ablative surgery because all the tissues are not removed or these tissues may grow back over time, resulting in the prostate gland to become enlarged again. If laser surgery fails to provide lasting results, then it may be necessary to undergo more invasive treatments such as an open prostatectomy surgery.
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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Greenlight Laser Therapy For Benign Prostatic Hyperplasia
GreenLight Laser Therapy combines the effectiveness of the gold standard transurethral resection of the prostate surgical procedure with fewer side effects. Several studies have shown comparable outcomes between the two procedures. During the GreenLight procedures, the physician uses a laser to remove the excess prostate tissue. The result is a larger channel for urine flow to pass through. Removing the excess tissue eliminates most lower urinary tract symptoms.
The criteria for selection of patients for GreenLight Laser Therapy are the same as those for TURP, so any patient who would benefit from TURP may also be a candidate for GreenLight.
GreenLight Laser Therapy can be performed in a hospital outpatient center, surgical center, or specially equipped physicians office. The patient is usually put under general or spinal anesthesia for the duration of the treatment. Typically, no overnight stay is needed. However, in some cases when a patient travels a long distance, has other medical conditions to consider, or is in frail condition, an overnight stay may be recommended.
Immediately Relieve Bph Symptoms With Greenlight Laser Surgery
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Benign prostatic hyperplasia , or an enlarged prostate, affects many men as they age. In fact, about 50 percent of men ages 50 to 60 and 90 percent of men over 80 have BPH. Because BPH is so common, its vital that people receive quality treatment such as GreenLight laser surgery that can help alleviate their symptoms.
GreenLight laser surgery relieves BPH symptoms that often interfere with mens everyday lives, such as:
- Difficulty beginning urination
- Frequent or urgent need to urinate
- Urinary retention, or the inability to completely empty the bladder
- Waking up throughout the night to urinate
- Weak urine stream or a stream that stops and starts
The procedure is also less invasive than other BPH treatment options, so patients typically recover quicker.
LISTEN: Dr. Marchalik discusses GreenLight laser surgery for BPH in the Medical Intel podcast.
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Who Is Eligible For The Procedure
The Greenlight Laser procedure is intended to be performed on those men who have persistent symptoms of an enlarged prostate in spite of treatment with medications, or for those who do not tolerate the medications well, or those who donât want to use the medications.
It is Dr. Lotenfoeâs experience that men tend to live with symptoms for a long time in an effort to avoid surgery and possible complications such as loss of urinary control and erectile dysfunction. In recent studies the Greenlight Laser procedure has similar improvements and longevity of improvement as the Golden Standard TURP , but with less side effects, less blood loss and shorter hospital stay. There was no discernible worsening in erectile function, and loss of urinary control was less than 2 percent.
Understanding Greenlight Laser Therapy
Benign Prostatic Hyperplasia
BPH or benign prostatic hyperplasia or hypertrophy is a benign enlargementof the prostate. The prostate is located below the bladder and surroundsthe urethra . Its main function is to produce fluid thattransports sperm during ejaculation. In many middle-aged men the prostatebegins to grow for reasons not fully understood. This benign growth cancause many urinary symptoms in men.As the prostate enlarges it impinges upon the urethra. This pressure canobstruct urinary flow and elicit urinary problems such as:
- Frequency
- Urgency, sudden urge to urinate
- Straining
- Retention, inability to urinate
Medical Management
In many instances these symptoms can diminish or resolve with the use ofmedications. Typically, an alpha blocker such as Flomax or Doxasozin isused in combination with an alpha reductase inhibitor such as Proscar orAvodart for maximal medical management. These are safe medications thatmany men stay on for years without difficulty. But often these medicationslose their efficacy or don’t relieve the symptoms well and furthertreatment is necessary. Surgical intervention is the next step.
GreenLight Laser Therapy
Procedure
Recovery
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Greenlight Laser Pvp Vs Turp
Historically, successful treatment for BPH required an open prostatectomy a major abdominal surgery requiring a lengthy hospital stay and months of recovery. When instrumentation made it possible to reach the prostate gland by entering the urethra rather than abdominally, a procedure called transurethral resection of the prostate became the preferred treatment. It is considered safe, effective, and efficient. However, doctors and patients wanted even shorter recovery times, quicker results, and fewer long-term side-effects, leading to alternative treatment methods being developed. Over the past two decades, procedures to treat BPH have taken advantage of advanced energy sources, such as lasers, microwaves, radio waves, and ultrasound. These new technologies have achieved the goal of being less invasive and provide shorter recovery periods and more immediate results for patients.
Medium And Longer Term Outcomes
You can expect to return to all your normal activities within about two to four weeks after GreenLight laser surgery. Most patients are able to return to driving 48 hours after their operation. The procedure has very good long term durability performed by experienced surgeons. It is very rare for men to need further surgery. The most common side effect of the procedure is a dry orgasm. Men continue to have the same sensation of orgasm but semen goes back into the bladder and you pass it when you next empty your bladder. This is very significant if you wish to have more children and you must discuss this prior to making any decision about prostate surgery.
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What To Know About Bph
BPH describes theenlargement of the prostate gland that sits beneath your bladder. This enlargement is common in men as they get older.
The urethra, the tube that channels urine from your bladder and out of your body, passes through the center of the prostate. When the prostate becomes swollen or enlarged, it can press on the urethra and block the flow of urine.
This pressure can lead to persistent discomfort and symptoms like:
- Difficulty urinating
- Sudden or frequent urge to urinate
- Frequent urinary tract infections
You might also notice you have to urinate more often during the night.
In addition to aging, BPH can be the result of diabetes, heart disease, or obesity. If you have a family history of BPH, you might be at increased risk for having the condition, too.
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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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Types Of Radical Prostatectomy
The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.
Open prostatectomy
In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus.
Laparoscopic prostatectomy
In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.
Robot-assisted laparoscopic prostatectomy
Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.
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Where To Get Greenlight Pvp Prostate Laser Surgery In Nyc
At New York Urology Specialists, we offer specialized treatment for enlarged prostate for men. Same-day virtual video appointments and in-person appointments are available.
or make an appointment online.
We perform a cystoscopy, urodynamic testing, prostate and bladder ultrasound in our office. We offer Urolift procedure, Rezum water-vapor procedure in our office, and laser enucleation of the prostate in a hospital setting. We treat urinary and erection problems. We offer confidential appointments.
Our appointment costs are affordable with or without insurance. We offer free insurance verification.
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My Greenlight Laser Surgery: I Almost Look Forward To Going To The Toilet Now Sixty
Looking back, I never had would be considered a good flow. During the time it took for me to pass urine, three other blokes would come and go. It got to a point where I felt increasingly self-conscious about it and it put me off going out.
My Dad had the same problem. He ended up having the traditional operation, the TURP and was told after surgery that the main problem was that his bladder neck was much smaller than normal. I remember thinking at the time, I wonder if I have the same thing.
It is one of those problems that you do tend to put up with because it isnt life-threatening and you get used to it. For me, it was a conversation with a customer that made the difference. He had been for GreenLight laser surgery with Mr Alan Doherty and said it was the best money he had ever spent and that the procedure itself was a breeze.
I went to see my GP and explained I was considering the procedure. The GP said he thought my prostate was slightly enlarged and referred me to Mr Doherty. I was convinced by the GreenLight laser approach: medication didnt appeal to me at all and from conversations Ive had with other men, didnt seem to be very effective.
Equally, from the experience of men I know who have had the TURP, that seemed a very tough operation with a long period of recovery. Even after surgery, some of them had problems like incontinence, so I didnt want to have the TURP.
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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
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Cost Of Treatment And Insurances
At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.
We accept many health insurance plans. We would be happy to verify your eligibility and benefits and provide you with detailed information on your health plans coverage. and credit options are available to help you pay for medical care.
Greenlight Laser Treatment Of Bph
The GreenLight Laser is used in the treatment of Benign Prostatic Hyperplasia , commonly known as enlargement of the Prostate. GreenLight laser treatment is a therapy that evaporates prostatic tissue which is blocking the outlet of the bladder. It is performed under anesthesia by placing a telescope into the urethra up to the level of the prostate. The laser fiber is guided through the scope and the prostate tissue is then quickly and gently vaporized. Other names for the procedure include photovaporization of the prostate or photoselective vaporization of the prostate or laser ablation of the prostate. You may also see the GreenLight laser referred to as a KTP laser.
Several other laser therapies exist. Interstitial laser therapy is a type of thermotherapy that heats the prostate tissue, but does not vaporize or remove it. Holmium laser therapy is another high power laser that evaporates tissue in a procedure similar to the GreenLight. At the University of Virginia, we use the new GreenLight HPS system, which is a higher powered version of the original GreenLight laser made by LaserScope/AMS. The higher powered GreenLight HPS allows the surgeon to remove more of the obstructing prostate tissue in a shorter time than the older GreenLight system.
In most cases patients undergoing GreenLight Laser treatment will have either general anesthetic or spinal anesthetic with sedation. The choice should be made by you in consultation with your surgeon and the anesthesia provider.
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Laser Technology Has Lowered Complications For This Very Common Procedure Allowing Patients To Heal At Home
This article was originally published June 5, 2020 on PSQH by Amy E. Krambeck, MD.
Benign prostatic hyperplasia , or enlarged prostate, is exceedingly common, affecting half of men in their 50s and about 90% of men aged 80-plus . As a result, although most patients are treated with medication, surgical procedures to treat BPH are very common as well, making up a significant portion of urological surgeries in any hospital.
With any BPH procedure, tissue is removed to open the urethra. Patients typically stay at least one night in the hospital. There has been a successful ongoing effort to reduce inpatient time for BPH surgery by limiting complications, especially postoperative bleeding.
At my Level I trauma hospital, which runs near capacity at all times, sometimes beds were not available for my patients, and they had to spend the night in the recovery room. We postulated that we could free up beds and offer better treatment for our patients by performing BPH surgery on an outpatient basis. Because we were performing very safe surgery with the latest laser technology, it seemed we had finally reached the point where it was safe to send patients home.
Transitioning to outpatient surgery
Patients go home with a catheter, the home care for which is explained by medical assistants using an educational template. The catheter is removed the next day in our office or, if the patient has traveled for surgery, at a physicians office closer to home.
Who Needs To Have Holmium Laser Enucleation Of The Prostate
BPH occurs in more than 40 percent of men over the age of 60 and is a leading cause of urination symptoms, including difficulty in passing urine. As men age, the symptoms of this condition can worsen. Although many cases of urinary obstruction from BPH can be treated without surgery, patients who do not benefit from such medical treatments may eventually need surgery to avoid or deal with long-term problems such as retention of urine, urinary tract infections, and bladder stones. Patients who are appropriate for HoLEP are typically symptomatic due to very large prostates.
Patients may not be candidates for HoLEP if:
- They have bleeding problems.
- They have had certain types of prior prostate treatments.
- They cannot lie on their back with their legs raised. This position is necessary for the procedure.
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