Laser Prostate Procedures: A Review and Comparison

There are new laser treatments available for sufferers of BHP (Benign Hypertrophic Prostate) and other prostate conditions. They are replacing the “gold standard” TURP and TUNA procedures, and are characterized by much shorter recovery periods and are ideal for patients who might also be on blood thinner medication (Coumadin/Warfarin).

You should, however, know that there are two laser technologies currently in use for prostate reduction or enucleation: the Holmium (YAG) laser, and PVP (KPT) laser (otherwise known as “Green Light”.) The differences between the two are in the wavelength of the lasers used, and the nature of the energy transmitted to the tissues.

PVP LASER (Green Light)

The PVP (KPT) laser has a somewhat long wavelength that penetrates the tissue more deeply – in fact, the energy penetrates more deeply than it ablates (removes). The consequence is that unablated remaining tissue has been affected by the laser. The result can be a phenomenon known as necrosis of the affected tissue: the remaining tissue dies and may require further treatment of other means to remove, down the line.

This is a potential detrimental side effect. PVP laser treatment is considered viable for smaller prostate conditions, but not for larger, as the possibility of necrosis is higher.

HOLMIUM LASER

The Holmium (YAG) laser has a shorter wavelength and penetrates less deeply than the PVP. Energy from the laser is imparted only to the the tissue that is ablated (removed). As a result, there is no necrosis concern.

In a discussion comparing the two technologies (for HoLAP application)[1], a panel of noted urlogists universally concluded the Holmium laser to be preferable to. the PVP laser.

HoLEP – ENUCLEATION OF THE PROSTATE

With the Holmium laser, it is now possible to completely remove the prostate with minimal side effects. This is called enucleation. The prostate is completely detached with fine (2-3mm) laser instruments, and passed through a pair of incisions in the bladder. It is then sectioned, and the sections are brought into the bladder through the incisions, where they are broken up into passable bits (the bits are passed through the catheter.)

This is becoming the new “gold standared” treatment, replacing the TURP procedure in many advanced urological centers. Side effects are minimal, and, according to one study[2], sexual function (ability to gain and maintain an erection) may actually increase, depending on the nature of prior dysfunction, if any.

WHERE TO GO?

One consideration is going overseas for treatment. HoLEP is available in at least one group of urolotical hospitals located in India, using exactly the same procedures and equipment as in major US facilities. The procedure can be done for as little as a fifth to a tenth of that in the US.

[1]Urological Times [2]Journal of Andrology