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Photoselective Vaporization Of The Prostate

What Are The Alternatives To Photoselective Vaporization Of The Prostate

Holmium Laser Enucleation and Photoselective Vaporization of the Prostate

There are medical treatments that are available to treat this condition. Other surgical alternatives are Transuretheral Resection of the Prostate or TURP. In rare cases of an exceptionally large prostate gland, patients may benefit from a major surgical procedure to remove larger volumes of prostate tissue. There are on-going clinical trials at the University of Colorado for other minimally invasive treatment alternatives. Should you have any questions about these please consult your physician.

Comparing Pvp With Turp:

  • Similar IPSS scores, maximal flow rates, and postvoid residual
  • Length of catheterization and length of stay were shorter, and transfusion rate was lower in the PVP group
  • PVP improved the IPSS score and other parameters to similar extents, as did TURP at six months and one year
  • At two years, the improvements were sustained
  • The overall complication-free rate and reintervention rate of PVP were comparable to those of TURP

A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update.AUCornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S SOEur Urol. 2015 67:1066.

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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What Are The Risks

All surgical treatments have inherent and associated risks. The PVP System is intended for the removal of soft tissue, including vaporisation of the prostate for benign prostatic hyperplasia . Potential risks include irritative symptoms, bleeding, retrograde ejaculation and urinary tract infection. You should talk with your doctor or urologist about benefits and risks before moving forward with any treatment option.

Data Extraction And Statistical Analysis

Photoselective Vaporization of the Prostate (GreenLight PV)

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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Incidence Of Treatment Failure

The primary outcome, treatment failure, was defined as any subsequent surgical reintervention or any emergency acute urinary retention event after the initial procedure. The median follow-up time was 2.8 years.

At seven years, the unadjusted cumulative failure rates were 15% for TURP, 14% for PVP, 7% for EEP and 18% for other procedures .

What Is The Expected Postoperative Course

The surgery typically last between one and three hours. The patient will wake up with a rubber tube called a catheter that drains the bladder. These catheters typically remain in overnight and can be safely removed at home in most circumstances. The patient are typically able to leave the hospital within three to four hours after the surgery. Once at home I encourage light activity for a three week period of time. Pain is relatively minimal and short-lived, however patients are sent home with pain medications. There is some discomfort or burning in the penis that can last on and off for up to several weeks. This is believed to be related to the prostate gland healing from the surgery. Some patients do report discomfort at the tip of the penis that is mild and short lived. Patient can see blood in the urine on and off for several weeks following the procedure. This is somewhat related to physical activity, which is one of the main reasons why we encourage only gentle exercises such as walking for the first three weeks following the procedure.

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Safety And Efficacy In Anticoagulated Men With Medical Comorbidities

The hemostatic nature of 80-W KTP laser prostatectomy has made it a natural choice for anticoagulated patients at high risk for clinically significant bleeding. Sandhu and colleagues reported the results of the 80-W KTP laser in 24 men receiving various forms of anticoagulation.7 Of the 24 men, 8 were taking warfarin, 2 clopidogrel, and 14 aspirin. These patients displayed an increased prevalence of cardiovascular disease: 8 had a history of myocardial infarction, 7 had a history of cerebrovascular disease, and 7 had a history of peripheral vascular disease. After laser prostatectomy, no patient developed clinically significant hematuria postoperatively. There were no episodes of clot retention. No transfusions were required. Overall, all patients underwent PVP safely without any adverse thromboembolic or bleeding events. One patient had transient postoperative urinary retention requiring catheterization, 2 patients developed retrograde ejaculation, and 2 patients had urinary tract infections postoperatively.

What Are The Complications Of This Procedure

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Uretheral discomfort as mentioned above. Bleeding as mentioned above. An infection of the bladder or kidney is a possibility but is unlikely, urinary leakage is a rare but potentially disabling complication. There is a about a five percent chance that this could effect the ability to obtain normal penile erection after the surgery. A very common complication after the surgery is a lack of ejection due to the change in the opening between the bladder and the prostate caused by the procedure. A narrowing in the urethra called a stricture is a complication that can result in other minor procedures. Additionally, areas of the prostate may continue to grow and cause future obstruction after the procedure.

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Bph/enlarged Prostate Program At Chesapeake Urology

From more conservative, non-surgical measures to innovative minimally invasive procedures, our urologists provide the most advanced care for men living with BPH.

Laser Vaporization of the Prostate

Laser Vaporization of the prostate is a technique that uses a special laser to heat and vaporize the prostate tissue that is obstructing part of the urethra.

In studies comparing the laser technique with the more traditional surgical procedure called Transurethral Resection of the Prostate , GreenLight Laser Therapy improves BPH symptoms and quality of life as effectively, but with fewer side effects.

Most men are good candidates for laser vaporization therapy, which is an outpatient procedure performed in one of Chesapeake Urologys Summit Ambulatory Surgery Centers. In this procedure, a small fiber is inserted into the urethra through a cystoscope. Laser energy is delivered through the fiber to remove the enlarged prostate tissue, restoring natural urine flow and relieving symptoms of BPH quickly.

Advantages of Laser Vaporization Therapy:

  • The procedure is minimally invasive and performed on an outpatient basis
  • Most men return home only a few hours after the procedure
  • Quick recovery and return to normal activities
  • Normal urine flow is restored quickly
  • Very few long-term side effects
  • Long-lasting relief from bothersome urinary symptoms

Risks:

Some patients may experience minimal side effects from laser vaporization including:

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What Is The Procedure For Laser Vaporization Of The Prostate

To start, you are given general anesthesia to make you asleep and pain-free during the procedure. You are positioned carefully.

An instrument with a light and camera, called a scope, is then gently inserted into the urethra. A numbing gel is used to help the scope glide easily.

The surgeon is able to reach the prostate and see the tissue causing the blockage.Your doctor uses a laser thru the scope to vaporize and destroy excess tissue from the prostate, clearing the blockage.

When the surgery is complete, the scope is removed. Your surgeon may place a Foley catheter to help drain your urine for a few days.

A Foley catheter is a thin tube inserted through your urethra and into your bladder. The tube will keep your bladder empty to allow you to heal and feel more comfortable. The foley is easily removed a few days after the procedure. The balloon is deflated, and the tube simply slides out.

The advantages of laser vaporization:

  • it can be faster with less bleeding and
  • can be safer for patients who are at high risk for bleeding.
  • And many patients have a faster recovery.

The major disadvantage of laser vaporization is no tissue is taken out for testing. Because the extra, enlarged prostate tissue, is destroyed not removed.

Be sure to discuss with your surgeon why this method has been recommended for you.

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Enlarged Prostate Treatment Options

When symptoms begin to interfere with your lifestyle, its time to consider treatment choices. Understanding your options will help you make the right choice for your desired outcome and lifestyle needs. Discuss this information with your urologist.

GreenLight is suitable for most patients with an enlarged prostate. With over 200,000 procedures performed worldwide, the GreenLight procedure is creating a new standard of care a standard that offers freedom from enlarged prostate symptoms.

What Is Photoselective Vaporization Of The Prostate

Green Light Laser Photovaporization Of The Prostate Cpt Code ...

This is a procedure that attempts to alleviate urinary symptoms caused by benign enlargement of the prostate gland. The enlarged prostate can compress the urethra and cause bothersome urinary symptoms. The procedure removes prostate tissue by using a laser to turn the tissues into gas. This allows easier urinary flow. Similar techniques such as Transuretheral Resection of the Prostate have been successfully used to treat symptomatic benign prostate enlargement for several decades. The TURP procedure does result in patients having to stay in the hospital for a day or two as it is associated with more bleeding and other complications. The use of the laser has allowed us to operate with less concern for bleeding allowing for outpatient surgery in most cases.

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What Are The Disadvantages Of Photoselective Vaporization Of The Prostate

The main disadvantage is that as the tissue is turned into gas, no tissue is available for analysis. In rare cases this could potentially miss a prostate cancer that may exist in the prostate gland. In order to help ensure that prostate cancer is not present at the time of the procedure, blood test are usually checked to screen for patents that may potentially have cancer and a prostate biopsy would be performed if there is a suspicion.

Creating A New Standard Of Care

The GreenLight Laser Therapy is a procedure that combines the effectiveness of the traditional surgical procedure known as Trans Urethral Resection of the Prostate with fewer side effects.1

GreenLight uses laser energy to remove enlarged prostate tissue. This results in an open channel for urine flow through, but with less risks of sexual and other side-effects common with TURP. Most patients return home a few short hours after the PVP procedure and can return to normal, non-strenuous activities within days. The GreenLight laser system delivers the ultimate BPH solution free from urinary symptoms, free from compromise, free to go!

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Why Jacksonville Prostate Center

The GreenLight laser is a revolutionary treatment for BPH. Many physicians are now offering GreenLight therapy to their patients. However, it is clear that all GreenLight operations are not the same. Many studies are now showing that low volume GreenLight centers have a higher complication rate with regards to bleeding, incontinence and reoperation. In addition, if enough tissue is not removed, recurrent symptoms can develop in a short period of time. At McIver, you can be assured that you are in excellent hands.

Previous Trial Findings Seem Generalizable

Photoselective Vaporization of the Prostate (PVP) Laser Therapy for BPH

These real-world findings are consistent with outcomes from randomized controlled trials, notably GOLIATH, which demonstrated equivalent surgical reintervention rates after PVP and TURP over two years of follow-up.

This study also supports the need to investigate real-world outcomes for EEP procedures, such as holmium laser enucleation, in a larger number of patients. 85% of patients who underwent EEP were discharged the same day, suggesting these procedures are feasible in the ambulatory setting.

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Psa And Prostate Configuration

PSA has been considered as a predictor of success of PVP. Te et al. suggested that there is a significant difference in efficacy in patients with a PSA of 6.0 or 6.1 ng/mL before PVP . Although those with PSA of 6.0 ng/mL had significantly superior postoperative urinary flow rate and post void residual, those with total Prostate Specific Antigen 6.1 ng/mL still had acceptable outcomes. It is probable that these results reflect larger prostate volumes in the group with the higher tPSA value. Te et al. used the 80 W laser and it is possible that greater de-bulking of the larger prostates would be possible with the higher powered 180 W laser now available.

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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What Does Photoselective Vaporisation Of The Prostate Cost

PVP Therapy is covered by Medicare and most private insurance. Its still a good idea to discuss any deductibles or out-of-pocket costs with your doctor or urologists office upfront. There is no guarantee of insurance coverage for any procedure or product. It is the responsibility of the patient to contact their insurance provider for specific coverage information.

Adequate Training And Learning Curve

BPH Greenlight PVP

The introduction of PVP was accompanied by the requirement of surgeons to develop new skills sets. Accordingly, a significant learning curve has been associated with PVP. Several groups have reported the use of a GreenLight simulator as a training tool to optimise the quality of utilising PVP equipment . The training simulation included a 30-minute tutorial by an experienced operator and was subsequently followed by ten sessions of five training modules. The use of a training simulator resulted in improvements in operating times, error rates and instrument costs. Clinically, Misrai et al. performed a single surgeon series and reported that 120 consecutive cases were required to optimize operating time . In this series, following the learning curve, total energy to prostate tissue efficiency increased over time.

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Is Greenlight Laser Pvp Treatment Right For Me

GreenLight Laser PVP is a recent addition to the minimally invasive techniques in the treatment of BPH. The procedure uses the technology of high-powered laser light combined with fiber optics to vaporize the overgrowth of prostate cells quickly and accurately. As the surgeon directs the laser at the prostate, the intense pulses of light emitted from the fiber are absorbed by the blood. Within moments, the temperature of the blood becomes so great it causes the nearby cells to vaporize. GreenLight is being used as an alternative to transurethral resection of the prostate and has been shown to be its equal in terms of effectiveness in an improvement of symptoms. There is growing interest in this technique by patients and practitioners because of its simplicity and efficiency. GreenLight stands alone in its ability to give patients quick symptom relief, ease and comfort of urinary flow, and minimal short-term side effects. This technique is too new for long-term studies to have been completed, but after five years it has been shown to maintain its level of improvement in urinary flow and comfort, and for giving men the quality of life they deserve.

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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Is Greenlight Laser Pvp Safe

GreenLight Laser PVP has been enthusiastically acclaimed as a significant breakthrough in laser techniques in precisely vaporizing the overgrowth of prostate cells without damage to surrounding tissues and vessels. It is safe, effective, simple, offers a quick recovery, and a recognized improvement over other minimally invasive treatment procedures currently available for BPH.

The Green Light laser technique uses high powered energy beams delivered through a thin laser fiber which safely and precisely vaporizes surface tissue at the enlarged prostate which had blocked the normal flow of urine.

The high pulsed laser removes the tissue causing the blockage and coagulates blood vessels, minimising bleeding. So in a lot of ways, the green light laser technique is a lot safer, faster and more precise compared to the other options you will have on the table, but most importantly, patients will recover faster from such an intervention.

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