LASER AND PROSTATE

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LASER AND PROSTATE

LASER AND PROSTATE

Benign prostatic hyperplasia or Hypertrophy (BPH) is one of the most common diseases in men. It occurs in 30% of patients over the age of 60 with the onset of urinary disorders (weak urine stream, difficulty starting it, frequent, urgent and nighttime urination, frequent infections); in severe cases, it is even necessary to adopt a bladder catheter in order to help the patient who cannot urinate.

In the early stages, BPH is treated with medication (tamsulosin, alfuzosin, silodosin, dutasteride, etc.); however, when the drug therapy fails, surgery is recommended.

The indicated techniques for BPH are traditionally two:

  • TURP (trans-urethral resection of the prostate) is an endoscopic technique: it does not require incision, and it is performed by visualizing the prostate through the urethra and removing tissue by electro cautery or sharp dissection. 
  • Prostatic adenomectomy is an open surgery technique: a cut is performed on the patient's skin in order to remove the enlarged portion of the prostate.

Today many alternative techniques are available: one of them, probably the most safe and convenient, is the thulium laser transurethral prostatectomy (THULEP).

It is effective and non-invasive like the TURP, but it brings important benefits such as reduction of bleeding, catheterization time and therefore of hospital days.
The thulium laser is suitable for the treatment of soft tissue, such as the prostate; it interacts effectively with water and therefore it perfectly adapts to endoscopic surgery; it is strongly absorbed by all tissues, and does not spread in those areas that must not be treated. 
The thulium laser can be successfully employed also for the treatment of tumours, stenosis, bladder neck incision and for lithotripsy (i.e. a technique for treating stones in the kidney and ureter).

 

THULIUM LASER ENUCLEATION OF THE PROSTATE (THULEP)

Definition: Thulium laser enucleation of the prostate (THULEP) is an endoscopic technique: this means that it does not require incisions, because the surgical instrument is inserted through the penis. The aim of this procedure is to reduce the urinary and obstructive symptoms due to the enlargement of the prostate, which causes problems to the emptying of the bladder. It is an innovative technique and a valid alternative to the classic resection of the prostate (TURP).

Indications: BPH that causes urinary difficulties

Description of the technique: an instrument called a resectoscope, through which is inserted a laser probe, is introduced into the abdomen of the patient through the urethra.
The laser removes the obstructing portion of the prostate gland, which is then reduced into smaller fragments, finally aspirated from the resectoscope.
At the end of surgery the surgeon will put a catheter into the patient’s bladder to drain urine.
The duration of the procedure varies from 40 to 120 minutes, depending mainly on the size of the prostate.
The surgery is performed under regional (spinal) or general anaesthesia.

Postoperative course: The day after surgery the catheter is usually removed and, in absence of complications, the patient can be discharged. In the case of hematuria, (blood in the urine) medical staff may decide to maintain the catheter a few more days.

Results: Like the TURP, the laser technique allows obtaining an increase in strength of urinary flow and a reduction of residual urine related to the volumetric reduction of the prostate. The patient feels much better. He will urinate less often and his urine flow will be more powerful; nighttime urination will reduce or cancel, such as urinary infections.

Compared to TURP the laser technique has remarkable advantages, such as:

  • bleeding reduction: this allows performing this procedure even in high-risk patients with clotting problems
  • reduction of the duration of catheterization

Side effects: bothersome urinary symptoms (painful or frequent urination) can last for 4-6 weeks after surgery. Retrograde ejaculation (i.e. the semen during orgasm does not escape outside but pours into the bladder and is excreted in the urine following sexual intercourse) appears in 75% of patients undergoing TURP and THULEP.

Suggestions for convalescence: In the period following the surgery, a period of sober life is suggested. The patient should reduce physical stress, restrict sports and sexual activity, moderate the diet, undergo urinary antiseptic therapy for a period varying according to the extent of urinary disorders.
This should not be considered as a period of illness for mutual purposes, which pertain to the general practitioner. For those who are discharged with indwelling catheter it is suggested to perform bladder training, following the urination urge.
The normal working activity can be resumed in about a week, avoiding long journeys in the car and the use of motorcycles and bicycles.
An adequate intake of liquids is recommended.
In case of fever: the patient can go to his family physician, who will then decide whether to take antibiotics or consult the urologist.
In case of urinary retention or important hematuria (presence of abundant blood in the urine, or cherry red colored urine) the patient should contact the urologist or possibly go to the emergency room.