Lasers in the treatment of benign prostate hyperplasia
In 1996 the FDA (the North American agency responsible for the regulation of medical procedures) approved lasers for the treatment of obstructive BPH. Since then, many kinds of lasers have been developed.This technique destroys prostate tissue by producing thermal energy that is conducted through a fiber inserted through the urethra, which is used to cut, coagulate and vaporize the tissue and convert it into CO2 and water vapor.
The most frequently used lasers are Ho:YAG (holmium laser), KTP (potassium titanil phosphate or green laser), LBO (lithium triborato), and SCD (semiconductor diode laser).
This laser uses a fiber that allows the tissue to be simultaneously cut and vaporized, allowing it to be used on large prostates.BPH tissue is cut into 2 or 3 pieces that, by use of a shredder, are separated into small pieces, which are later removed. The advantage of this technique is that patients who have received anticoagulant treatment and who have large prostates can be treated as in open surgery, but with much less bleeding and with a shorter time of hospitilization, between 1 and 2 days. This laser technique does not provide advantages in the treatment of smaller prostates over TUPR (transurethral prostate resection).
KTB is popularly known as "green laser" and works with a maximium energy of 80 W, while LBO needs 120 W. Both techniques allow for adequate tissue destruction by vaporization.
The procedure can be monitored by endorectal prostate ultrasound, a technique which we pioneered and have practiced since 2007, which allows us an appropriate view of the photovaporization process. (youtube video). The rate of vaporization is approximately 6 grams in 10 minutes. The procedure can be used on prostates up to 80 grams in weight and in patients that are on anticoagulants. Twenty-four hours after the procedure the urethral probe is removed and the patient is discharged.
Also known as "red laser," this laser requires a maximum energy of 120 W. Its primary advantage is that it has the highest rate of vaporization, approaching the destruction of 7 grams in 10 minutes, as well as stronger coagulation than other laser models. (Put video). This laser can treat prostates up to 80 grams in weight and the procedure can be monitored by ultrasound. Twenty-four hours after the operation the probe is removed and the patient is discharged.
Absolute anhydrous alcohol (ethanol) is injected into the prostate in liquid or gel form through the urethra or the perineum. The alcohol destroys the BPH and can be applied to large prostates. This is a very rapid procedure (15-20 minutes) and can be used on patients with concomitant severe diseases and those that cannot undergo prolonged and profound anesthesia. It is carried out with local anesthesia or intravenous sedationand ultrasound. The patient is discharged the same day. The urethral probe is left in for between 5 and 7 days. 26% of patients need to be re-treated within 3 years of the procedure.
Photo (before ethanol) - Photo (6 months later)
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