Technological advances such as the laser have redefined the surgical treatment of enlarged prostate. Laser is actually an acronym for **L**ight **A**mplification by **S**timulated **E**mission of **R**adiation. Light that is emited is converted to heat energy that has various effects on the tissue that the light is directed at.
The Green Light PVP (photoselective vaporization of the prostate, American Medical Systems) is a very precise laser that vaporizes and removes the enlarged prostate tissue. The significance of the color of the laser light (green) is that this results in absorption by hemoglobin which is contained within red blood cells and not absorbed by water. The procedure may also be known as laser prostatectomy or laser TURP. The technique involves painting the enlarged prostate with the laser until the capsule of the prostate is reached. By relieving this portion of the prostate, patients are able to void much easier through a wide-open channel in the prostate. If one thinks of the prostate like an orange, the laser removes the pulp and leaves the rind (prostate capsule) behind. The procedure needs to be performed under general or spinal anesthesia.
Patients who undergo this form of therapy have a dramatic increase in the flow of their urine post-procedurally, and this is usually seen within 24 hours. Studies demonstrate a 170%-252% improvement at 3 years after the procedure. The procedure is also much less risky than transurethral resection of the prostate (TURP), the gold standard for prostatic surgery. Minimal blood loss is associated with this procedure. The results that are obtained with the laser are long-lasting and few patients require additionally surgery later on after the procedure is completed.
Post-operatively, patients are able to return to their normal routine within 24 hours after the procedure. Post-operative analgesics are rarely used. A small percentage of patients experience transient burning with urination. Erectile dysfunction is not associated with this procedure. Many patients do not require a catheter post-operatively and those that do usually have it in place for less than 48 hours.
The procedure is done as an outpatient and has a very minimal morbidity associated with it. Due to the laser’s properties, patients who are on blood thinners may even undergo this form of therapy. Unique to this procedure compared to other minimally invasive alternatives such as TUNA (transurethral needle ablation of the prostate) or microwave therapy, is the fact that results are immediately seen.
Given the outcomes that are being obtained with this technique, it wil not be long until this replaces TURP as the gold standard for the treatment of prostate obstruction.