No Cut Operation for Benign Prostatic Hyperplasia and Prostate Cancer
Benign Prostatic Hyperplasia (BPH), or prostate gland enlargement, is common in males over 50. Over half of men older than 50 years old have this condition. Enlargement of the prostate gland may obstruct the bladder neck and section of the urethra that traverses the prostate.
Symptoms
- Men with BPH may or may not have urgency
- Frequency
- Nocturia
- Weak urinary stream
- Straining to void
- Hesitancy
- Post-voiding symptoms of sensation of incomplete bladder emptying
- Post-micturition urinary dribbling.
Treatment
Treatment of symptomatic BPH usually starts with medications but sooner or later may require prostate surgery due to progressive severe obstructive symptoms affecting the quality of life.
Urological testing to confirm the diagnosis and evaluate the severity of BPH includes post-void residual urine volume to assess the ability of the bladder to empty; uroflowmetry to measure the average urine flow rate, the shape of the voiding curve, duration of micturition, and maximum flow rates; pressure flow studies in some patients; and prostatic imaging to determine the size and shape of the gland that helps with choosing the optimal approach of treatment.
Cystoscopy, an endoscopic examination, may be needed to confirm if the prostatic blockade causes the voiding problem.
Indications for surgical treatment
- Moderate to severe voiding symptoms due to BPH refractory to medical treatment, or those who do not want to continue medication.
- Refractory acute urinary retention and recurrent urinary tract infection attributed to BPH.
- Bilateral hydronephrosis with renal function impairment.
- Recurrent gross hematuria.
- Bladder calculi.
The prostate gland is an organ, comparatively hard to access for surgery. In the past, open operation with large incisions was commonly performed through various approaches such as perineal, sacral, and retropubic, which can cause considerable bleeding complications, mineral-salt disturbance, impotence, and scarring. These make many patients reluctant to go for surgery. Traditionally, for BPH, a benign prostate condition, the operations are performed via transurethral endoscopy with electrocautery wire loop cutting of prostatic tissue. The procedure can be attended by prolonged bleeding requiring continuous bladder irrigation through an indwelling catheter to prevent blood clot accumulation.
One of the newer procedures without cutting is to use a green light laser called photo-selective vaporization of the prostate ‘’PVP Green Light.’’ This procedure is done via a cystoscopy with a side channel for fiber optic bundles to deliver a green light laser to make part of obstructed prostate tissue disappear by vaporizing. There is no need to cut or remove the tissue from the bladder. This procedure is preferred because of the lower risk of bleeding and the need for transfusion. Some patients taking anticoagulation/antiplatelet therapy may not need to interrupt the treatment for the procedure.
The PVP technique diminished the complications that happened with previous prostate surgery, such as:
- Minimal bleeding obviates the need for blood transfusion.
- No mineral-salt disturbance “TUR syndrome”.
- Less scarring.
- Not causing erectile dysfunction problems.
- Less catheter time (usually one day).
- Shorter hospitalization (just one-night hospital stay).
- Less pain (Postoperative painkiller is rarely needed).
- Can be done as an outpatient.
No Cut Operation for “Prostate Cancer”
Early prostate cancer has been treated with open radical prostatectomy for decades. Through advancements in surgical instrumentation and equipment, less invasive operations are now the norm with keyhole (laparoscopic) or robotic (Da Vinci) surgery. However, side effects and complications such as incontinence, erectile dysfunction, scarring, bleeding, and lengthy hospitalization with a catheter remain a possibility in half of the patients, adversely affecting their quality of life.
Nowadays, another treatment modality with an internal source of radiation called Brachytherapy or Radioactive Seed Implants affords the patient another option of a minimally invasive procedure with a treatment success rate as high as radical prostatectomy surgery, but with far fewer side effects.
The brachytherapy procedure involves the placement of the radioactive needles into the prostate tissue according to a computerized treatment plan. The needles deliver short-range, differential high-dose radiation to kill the cancer cells while minimizing radiation and sparing damage to adjacent healthy tissue. The patients only need a one-night hospital stay, or they can go home on the same day and resume their daily activities, including sexual activity, on the next day.
The advantages of brachytherapy include:
- No incontinence
- Shorter hospital admission (up to 1 night or outpatient surgical procedure)
- No bleeding. No blood transfusion is required.
- No immediate erectile dysfunction
- Less pain and discomfort
Current technological and equipment advances supplant previous treatments of benign and malignant prostate issues with less invasive methods that better meet the patient’s preferences by virtue of having fewer side effects, long-term morbidities, and most importantly, help maintain a good quality of life.
