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Enlarged Prostate Special Report

PVP or TURP for BPH?

If you've tried medication for benign prostatic hyperplasia (BPH) and it hasn't controlled your symptoms, it's time to consider a different approach. That used to mean surgery to remove excess prostate tissue. But today you have a number of less invasive options, including a new laser procedure called photoselective vaporization of the prostate (PVP) or GreenLight laser therapy.

PVP is an effective and increasingly popular treatment for benign prostatic hyperplasia (BPH). Studies show that PVP offers advantages over transurethral resection of the prostate (TURP) -- the gold standard treatment for BPH -- and older laser therapies. But a few unknowns remain -- namely, how effective is it in the long term and which men are the best candidates?

Vaporizing Excess Tissue -- In PVP, a high-energy laser destroys the prostate tissue that is squeezing the urethra and causing bothersome urinary symptoms. The doctor uses a cystoscope (an instrument to view the bladder) to insert a thin fiber into the urethra. This fiber emits laser energy that heats excess prostate tissue until it turns to vapor, creating an open channel for urine flow.

One big advantage of PVP over older laser therapies is that PVP instantly removes excess prostate tissue. As a result, symptom relief is immediate or occurs in the next several days just as it does after TURP. With other laser therapies, the excess prostate tissue is destroyed but takes several months to shed from the prostate, which delays improvement of symptoms.

Another plus for PVP: The laser energy immediately seals blood vessels, making it a virtually bloodless procedure -- unlike TURP, which can result in excessive bleeding and a transfusion.

Because PVP carries minimal risk of severe bleeding, one recent study in the European Journal of Urology suggests that men on oral anticoagulants -- aspirin, coumadin (Warfarin), or clopidogrel (Plavix) -- to prevent heart attacks or strokes or who are otherwise at risk for bleeding consider it as a first-choice therapy for symptomatic BPH.

Additional Advantages -- PVP offers additional advantages over other BPH treatments.

  • Shorter hospital stays. As with TURP and other laser procedures, PVP is performed under general or spinal anesthesia. However, in most men PVP is performed on an outpatient basis and takes about 30 minutes, depending on prostate size. Compared with a hospital stay of one or two days for TURP, most men go home the day of the PVP procedure.
  • Earlier catheter removal. TURP, PVP, and other laser treatments require a catheter placed in the bladder at the end of the procedure. But after PVP, the catheter can be removed within 24 hours. In contrast, catheterization is necessary for as long as three days after TURP.
  • Better symptom improvement. In a study in the Journal of Urology, researchers compared treatment outcomes for PVP, TURP, transurethral microwave thermotherapy (TUMT), and transurethral needle ablation (TUNA). Assessment of treatment outcome was based on the degree of symptom improvement in each man's American Urological Association/ International Prostate Symptom Score (AUA/IPSS), maximum urinary flow rate, and quality of life. PVP produced the most improvement in all three measurements.
  • Lower cost. The same study compared the costs of these procedures. After taking into account the cost of initial treatment, follow-up care, adverse events, and need for retreatment, PVP was also less costly than the other treatments.

The Take-Home Message -- Explore all your options for benign prostatic hyperplasia (BPH) treatment. TURP is the gold standard for now, but for many men, PVP is an appropriate and attractive alternative. This is especially true if you can't stop taking anticoagulants before the procedure or your age or other health conditions make it too risky to undergo the rigors of surgery. PVP is also a good option if TUMT, TUNA or other minimally invasive procedures do not offer symptom relief.

Posted in Enlarged Prostate on December 29, 2009

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