Less complications after laser therapy
Current metastudy proves advantages for modern laser procedures with benign prostate enlargement
Despite possible complications, the removal of the prostate gland (transurethral resection / TURP) is still regarded as a standard procedure for the treatment of benign prostate hyperplasia. A recent metastudy recently published in the European Journal of Urology showed that photoselective laser therapy (PVP) leads to fewer postoperative complications compared to TURP. In most cases, conventional prostate peeling can nowadays be replaced by more gentle laser procedures,"said Dr. Stephan Neubauer of the West German Prostate Center in Cologne, commenting on the latest results of the largest comparative study to date1.
Which therapy is suitable for patients with benign prostate hyperplasia depends primarily on the type and severity of their symptoms. If urinary tract infections, haemorrhage, or if the patient is dissatisfied with urination despite medication, surgery is usually required,"emphasizes Dr. Stephan Neubauer. In addition to the currently rarely used open operations, the removal of the prostate gland (transurethral resection / TURP) is still considered the standard procedure. A special endoscope is inserted into the urethra and the glandular part of the prostate is hollowed out with an electric loop around the urethra. Although this method has been significantly improved in recent years thanks to medical progress, complications such as secondary haemorrhage or, in rare cases, impotence and permanent urinary incontinence can occur.
For the first time, the treatment results of conventional peeling were recently compared with a modern form of laser therapy (PVP=photoselective laser therapy) in a large-scale metastudy1. To this end, Australian scientists subjected data from the American Society of Urology (AUA) from 2002 to 2012 to a detailed examination of postoperative complications and the length of hospital stay. In total, they compared the treatment results of 441 patients treated with TURP and 448 patients receiving photoselective laser therapy.
The results of the metastudy show that laser therapy is associated with fewer complications than classical peeling. Significantly fewer patients received blood transfusions after laser treatment due to excessive blood loss. The risk of clogging of the urethra after surgery with blood clots is also significantly reduced after laser therapy. In addition, the length of hospitalization and catheterization time for patients after laser therapy is shorter.
The study makes it clear that the classic peeling of the prostate can nowadays be replaced in many cases by gentle laser procedures such as greenlight laser therapy or the diode laser procedure,"emphasizes Dr. Neubauer, a specialist in urological surgery. Instead of the electrical current, excess tissue is vaporized by means of laser energy. This has the advantage that postoperative bleeding is almost completely avoided. Side effects such as impotence and incontinence can also be virtually ruled out with laser procedures,"explains the Cologne urologist.
Basically, every man with an enlarged prostate benefits from laser therapy. But especially in patients who take blood thinning drugs, laser treatment should definitely be considered,"said Dr. Neubauer. Even patients with a large prostate can be treated with the high-performance Evolve 150 diode laser without any problems. Another plus point: Patients can usually leave the clinic after two days or can even be treated on an outpatient basis.
Thangasamy IA, Chalasani V, Bachmann A, Woo HH.: Photoselective Vaporisation of the Prostate Using 80-W and 120-W Laser Versus Transurethral Resection of the Pros-tate for Benign Prostatic Hyperplasia: A Systematic Review with Meta-Analysis from 2002 to 2012; Eur Urol. 2012 May 4th[Epub ahead of print]