Laser procedure gives men a new lease on life

It’s not life threatening, but an enlarged prostate can certainly make life miserable for men as they age.

In fact, nearly 80% of men will experience an enlarged prostate—benign prostatic hypertrophy (BPH)—though the symptoms and degree of discomfort may vary greatly.

“An enlarged prostate doesn’t put you at greater risk for prostate cancer,” says Paul Sieber, MD, from Urological Associates of Lancaster. “But it can impact your quality of life. So treatment is usually driven by the patient’s wishes, and what he feels he can live with.”

Dr. Paul Sieber, from Urological Associates of Lancaster, displays the tiny laser he uses for Photoselective Vaporization of the Prostate (PVP). Patients usually notice improved urine flow right away, and experience little pain or discomfort from the procedure.

Symptoms can include a slowness of the urine stream, difficulty starting to urinate, frequent urination and a sudden urgency to urinate, says John Bartges, MD, from Lancaster Urological Group.

“We start with an imaging study to determine if the symptoms are being caused by an enlarged prostate,” Dr. Bartges says. He said they test bladder function, and may use a cystoscopy—a thin scope inserted into the urethra to determine if the prostate is encroaching upon the bladder.

Dr. Sieber says patients fill out an International Prostate Symptom Score (I-PSS) questionnaire during each visit, where they rate the degree of discomfort in seven areas, plus overall quality of life.

“It helps us determine how severe the problem may be, and if a treatment is working,” Dr. Sieber says.

Treatment options

If there’s an obstruction that causes severe disruption in your life, several treatment options can reduce or eliminate the discomfort.

Urologists will usually use medication to shrink the prostate and improve urine flow. But if that is ineffective, several other options are available for consideration, including minimally invasive treatments like Transurethral Microwave Thermotherapy (TUMT), a heat therapy to reduce the size of the prostate; and Transurethral Needle Ablation (TUNA), which uses radio frequency energy through two needles to burn away areas of the prostate.

For some people, surgery is necessary to fully relieve the symptoms. The most common surgery is Transurethral Resection of the Prostate (TURP), which removes the tissue blocking the urethra. Long the most effective treatment option available, potential side effects include impotence, incontinence and bleeding.

Laser surgery

Recently, another option has emerged and is quickly becoming the treatment of choice: Photoselective Vaporization of the Prostate, or PVP.

Dr. John Bartges, from Lancaster Urological Group, prepares for PVP at Lancaster General Hospital. Using this laser for the procedure, he is able to reduce the size of the prostae and improve a patient's quality of life.

This new laser procedure is a less invasive form of surgery than TURP, yet is producing outstanding results in the elimination of the symptoms caused by an enlarged prostate.

The laser is inserted through a catheter and vaporizes the tissue of the prostate. The laser causes the blood to clot immediately, reducing bleeding.

During the first two years PVP has been available at Lancaster General, both Dr. Sieber and Dr. Bartges say the results are getting high marks from patients.

Over 200 PVP procedures have been completed at Lancaster General Hospital. “The outcomes have been very good,” says Dr. Sieber. “PVP is a major, amazing advance in treating an enlarged prostate.”

“It has several advantages over TURP, including a shorter hospital stay, rapid recovery, and less potential for bleeding,” Dr. Bartges says.

Most patients require no more than an overnight stay at the hospital following the procedure. And after recovery, Dr. Sieber says most patients report a stronger urine stream and a less frequent need to urinate.

“Some patients have asked me if anything was done, because they’ve experienced no pain or discomfort after surgery,” Dr. Sieber said. “Though they do notice the improved urine stream right away.”

TURP may still be the only option for some men, if their anatomy makes it difficult to use the lasers effectively, or if tissue is needed for further analysis and diagnosis. But in most cases, PVP is giving men with enlarged prostates a new lease on life.