Fewer complications after laser therapy

Recent meta-study shows benefits for advanced laser procedures in the treatment of benign prostatic hyperplasia

Despite the possible complications, the enucleation of the prostate (transurethral resection / TURP) remains the standard procedure for the treatment of benign prostatic hyperplasia. A recent meta-study published in the European Journal of Urology, showed that the photo-selective laser therapy (PVP) in comparison to TURP resulted in fewer postoperative complications. "Conventional prostate enucleation can now be replaced in most cases by the less invasive laser procedure”, commented Dr. Stephan Neubauer of the West German Prostate Center in Cologne, the current results of the largest comparative study.

What type of therapy is the most beneficial to patients with benign prostatic enlargement depends primarily on the type and severity of the symptoms. "If it comes to repeated urinary tract infections, urinary bleeding, or the patient is discontent with the urinary conditions despite the prescribed medication, usually a surgical procedure is required”, so Dr. Stephan Neubauer. In addition to the open operations, which are more rarely today, the enucleation of the prostate (transurethral resection / TURP) remains the standard procedure.  Here a special endoscope is inserted into the urethra, and the glandular portion of the prostate is hollowed around the urethra out with an electric wire loop. Although this method has been improved significantly in recent years as a result of medical progress, complications such as bleeding can occur. In rare cases, the patient may also incur impotence and a permanent urinary incontinence.

For the first time, results of conventional enucleation were compared with a modern form of laser therapy (PVP = photo selective laser therapy) in a large-scale meta-analysis1. Australian scientists assessed data for the period 2002-2012 provided by the American Urological Association (AUA) concerning postoperative complications and length of hospital stay. Overall, they compared the treatment results of 441 patients treated with TURP and 448 patients treated with photo selective laser therapy.

The results of the meta-analysis show that laser therapy is associated with significantly fewer complications than traditional enucleation.  Significantly fewer patients received blood transfusions required due to excessive blood loss after laser treatment. Furthermore, the risk that the urethra is blocked by blood clots after surgery will occur significantly less often after laser therapy. In addition, after laser treatment patients experiences a shorter hospital stay and period of catheterization.

"The study clearly shows that in many cases the classical enucleation of the prostate can today be replaced, by careful laser procedures such as the greenlight laser therapy or the diode laser technology”, says Dr. Neubauer, a specialist in the field of urological surgery. Instead with electric current, excess tissue is evaporates using laser energy. "This has the advantage that bleeding can be avoided almost entirely. Side effects such as impotence and incontinence are also virtually non-existent in the laser process, "says the Cologne urologist.

Essentially, every man with an enlarged prostate benefits from laser therapy. "Especially for patients who are taking blood-thinning medications, laser treatment should definitely be a consideration”, says Dr. Neubauer. With the especially powerful Evolve 150 diode laser system, patients with a large prostate can be treated without any problem. Another benefit is that patients can leave the hospital generally after two days, or can even be treated on an outpatient basis.

1Thangasamy IA, Chalasani V, Bachmann A, Woo HH.: Photoselective Vaporisation of the Prostate Using 80-W and 120-W Laser Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Systematic Review with Meta-Analysis from 2002 to 2012; Eur Urol. 2012 May 4. [Epub ahead of print]