Lasers have a wide range of applications in urology varying from treatment of prostate enlargement, kidney stones, strictures (narrowing of urinary pipe) and urinary cancers. With availability of 100 Watts holmium lasers stones of any size, any composition and any location within kidney can be pulverized into dust.
WHAT IS THE PROSTATE?
The prostate, a part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis.
WHAT IS BPH/BEP?
BPH is non-cancerous enlargement of the prostate and is a common cause of bladder outlet obstruction and lower urinary tract symptoms in men over 40 years of age. It is prevalent in men over 50 years of age to the extent that two out of ten males will eventually require an operation to relieve the symptoms of BPH.
WHAT ARE THE COMMON SYMPTOMS OF ENLARGEMENT OF PROSTATE (BEP/BPH)?
Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, especially at night. Other symptoms include difficulty in starting the urine flow or dribbling after urination ends. Also, size and strength of the urine stream may decrease.
IS BPH A RARE CONDITION?
No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.
DOES BPH LEAD TO PROSTATE CANCER?
No, BPH is not cancer and cannot lead to cancer. Still, both problems can happen at the same time. There may not be any symptoms during the early stages of prostate cancer. So whether their prostate is enlarged or not, you should talk to urologist about whether prostate cancer screening is right for them.
WHAT ARE THE TREATMENT OPTIONS FOR PROSTATE ENLARGMENT?
BPH can be managed medically or surgically. The standard surgical treatment of BPH is transurethral resection of the prostate (TURP). However, relatively high morbidity associated with TURP has led to the development of minimally invasive techniques as HOLEP with the use of holmium laser.
WHAT IS HOLEP?
Holmium laser enucleation of the prostate (HoLEP) is a treatment for an enlarged prostate (benign prostatic hyperplasia). During HoLEP, a laser is used to precisely remove the obstructive portion of the prostate, similar to open surgery without the need for incisions. With HoLEP, surgeons remove the entire portion of the prostate gland that can block urine flow, which improves urinary symptoms and provides a lasting solution as there is nothing to grow back following this procedure. HoLEP is an effective and less invasive alternative to older, more traditional methods of removing prostate obstructions. In addition, HoLEP preserves removed tissue for microscopic examination.
WHAT IF I DENY THE SURGERY INDICATED FOR ME?
A syndrome of bladder decompensation will eventually develop if the symptoms persist for long. This can manifest as an accumulation of residual urine, which can lead to recurrent urinary tract infections and the formation of bladder calculi. In severe cases, acute urinary retention can occur and obstructive nephropathy can develop if high voiding pressures are transmitted back to the kidneys.
WHAT ARE THE ADVANTAGES OF HOLEP OVER CONVENTIONAL TURP?
- Significantly less bleeding compared to TURP
- Discharge is often quicker than after TURP at 1-2 days
- No upper size limit of prostate that can be removed
- The chance of recurrence requiring further surgery is very low
- The PSA generally drops to very low levels after HoLEP operations
WHAT IS THE EFFECT OF REMOVAL OF THE PROSTATE TISSUE?
Since the obstructing tissue has been removed there will be an immediate improvement in your urine flow and as the prostate cavity heals, urinary symptoms will improve further.