Indications
PVP is an alternative to drug therapy or more invasive surgery for BPH treatment. This treatment might be right for you if any of the following apply:
- You do not want to take another daily pill
- You have tried BPH medication but are unhappy with the side effects
- You do not want to undergo major surgery with a higher risk of side effects and complications
- You want to regain your quality of life with minimal downtime
Testing
You made need the following tests prior to PVP:
- Cystoscopy
- Uroflow
- Prostate Ultrasound
- Urodynamics (Less common)
- Urinalysis
Procedure
During this procedure your urologist uses a scope that can have a laser fiber passed through it. The GreenLight™ Laser is one option. There are several other laser types available made by different companies. All of these products have the same goal which is to vaporize the obstructing prostate tissue. Blood vessels are coagulated and sealed. The end result is a visibly opened channel.
At the completion of the surgical procedure a catheter is generally placed and procedure is done under general or spinal anesthesia.
After the Procedure
Plan on needing a urethral catheter for one night. You will typically have burning with urination after the catheter is removed. This lasts typically for 2-3 weeks. Irritative symptoms such as frequency and urgency can take up to 3 months to improve. You should notice an improvement in stream within a week. You will likely have retrograde ejaculation.
Benefits
- Typically shorter catheterization times compared to TURP
- The risk of bleeding is very low. May be preferred in very active patients anxious to get back to exercise
- Improvement in symptoms is rapid
- Outpatient procedure
- Durable results
Results
GreenLight Laser Therapy has equivalent clinical outcomes to TURP, fewer serious adverse events, shorter recovery and lower overall hospital costs.
I-PSS scores decrease by 60-70%, Maximal flow rate improves by approximately 15 ml/second and quality of life improves significantly. Results are durable and very comparable to TURP.
Summary of GreenLight Laser Therapy Randomized Controlled
| Number of GreenLight Patients | IPSS | Qmax (flow rate) | PVR (ml) |
|---|---|---|---|
| 59 | 25→9 | 8.8→18.6 | 129→22 |
| 60 | 20→6 | 7.4→20.1 | 146→24 |
| 10 | 27→10 | 6.9→17 | 53→11 |
| 10 | 22→7 | 10→20.5 | 150→4 |
| 50 | 24→8 | 8.0→23 | NA |
| 50 | 20→7 | 6.7→19.6 | 143→31 |
| 69 | 22→6 | 90→0 | 90→0 |
| 136 | 21→7 | 9.5→23.3 | 110→38 |
IPSS -international prostate symptom score, Qmax -max flow rate, PVR -post-void residual
- Rieken M, Bachmann A. Update on Greenlight laser vaporization (PVP) 2014. World J Urol. 2014 Nov 5.
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(6):1066.
Complications
The most common procedure related complications are bleeding and urinary tract infections. Short term irritative voiding symptoms are quite common with frequency, urgency and some dysuria (burning). These typically begin after surgery and resolve over a week or two. Long term urinary issues may include urethral stricture resulting in obstruction and prostatic regrowth. Urinary incontinence is very uncommon.
Retrograde ejaculation is common. Men are still able to experience a sensation of orgasm following the surgery. However, because the bladder neck is opened, the ejaculate fluid (semen) will usually travel back into the bladder rather than out the end of the urethra. It is still possible to have children following this procedure, even if there is retrograde ejaculation; however, this will require specialized fertility procedures. There is a small incidence (<5%) of decreased erectile function.
Contraindications
The laser system is contraindicated for patients who:
- Cannot undergo anesthesia
- Have uncontrolled bleeding disorders
- Have acute urinary tract infection (UTI) or severe urethral stricture