Greenlight Laser PVP: Prostate surgery technology.
Pioneering treatment and restoring quality of life.
Benign prostatic hyperplasia (BPH), common in elderly males, is a condition that develops as part of the natural aging process. Although difficult to prevent, it is a manageable condition that can improve quality of life.
This article recounts the conversation with Dr Paibul Boonyapanichskul, a urologist specializing in the urinary and reproductive system. He is a pioneer in the use of PVP Greenlight Laser technology for the treatment of enlarged prostate, being the first in the Asian region. The aim is to provide understanding and valuable information about the current technology for treating enlarged prostate.
Enlarged prostate: Condition that is challenging to avoid.
Enlarged prostate, or benign prostatic hyperplasia (BPH), can occur in men as they enter old age, typically becoming more prevalent in those aged 50 and above. The likelihood of encountering an enlarged prostate is around 50% for men in their 50s and increases to 60% for those in their 60s. As age advances, the chances of developing this condition further escalate. It is considered an intrinsic factor that is challenging to avoid.
Another factor, aside from age, is the hormone testosterone. Excessive testosterone in males can stimulate the enlargement of the prostate. Individuals receiving elevated levels of this hormone are often those undergoing treatment for sexual dysfunction or men experiencing andropause (male menopause). The use of such male sex hormones is an external factor that can be controlled or managed under the supervision of a specialized medical professional.
“When the prostate enlarges, it often compresses the urethra, making urination difficult. Common symptoms include a weak urine stream, hesitancy, incomplete emptying, nocturia (frequent nighttime urination), and the need to wait for a while before urine starts flowing. If untreated, it can lead to urinary retention, where urine cannot come out. Therefore, if elderly males experience these symptoms, they should consult a doctor.”
Many people may worry that an enlarged prostate is related to prostate cancer. Dr Paibul gives a clear no because the factors leading to each condition differ.
“An enlarged prostate does not increase the risk of prostate cancer. The size of the prostate, whether small or large, does not affect the likelihood of developing prostate cancer.”
Treatment continues to evolve and improve over time.
The treatment of an enlarged prostate depends on the stage and severity of symptoms. Doctors may consider medication to alleviate symptoms in mild or early-stage cases. Alpha-blockers, for example, can help relax the urinary tract, making urination more convenient. These medications do not have a significant impact on the prostate itself.
Another group of drugs can reduce the size of the prostate, but this often requires several months of use to see a reduction of approximately 20-30%. While this approach is beneficial in mild cases, it may not provide significant relief for more severe enlargement of the prostate.
“The medication works by blocking male sex hormones from reaching the prostate. In some cases, this can lead to sexual dysfunction, affecting approximately 10 to 15% of individuals. Consequently, some patients may be reluctant to take the medication due to potential side effects.”
“When the prostate enlargement is significant, merely reducing its size with medication may not be sufficient. The prostate may continue to obstruct the urinary tract. Surgical intervention is often necessary in such cases. It is advisable not to delay surgical treatment, as prompt action yields better results. Performing the surgery on the markedly enlarged prostate is more challenging, with an increased risk of side effects and complications. Allowing the condition to progress to that point should be avoided.” Dr Paibul explains.
When it comes to surgical treatment approaches, Dr Paibul explains that initially, open abdominal surgery was the norm to remove the enlarged prostate. However, this method carries a relatively high risk of complications. Subsequently, the approach shifted to endoscopic surgery using a small-sized camera (Resectoscope). This procedure involves guiding the camera to visualize and cut the enlarged prostate tissue that obstructs the urinary tract. This technique is known as Transurethral Resection of the Prostate (TUR-P) and is a standard surgery widely used today.
This method has its drawbacks, as it leads to significant bleeding during or after surgery. Additionally, there is a risk of electrolyte imbalance, with severe cases posing dangers such as low blood pressure, confusion, kidney failure, liver failure, and even coma. This surgical approach requires the insertion of a large-bore urinary catheter for approximately three days post-surgery. The catheter helps drain urine mixed with blood from the bladder, with flushing performed through it. The catheter insertion can cause discomfort, pain, and a general feeling of unease for the patient. Furthermore, this surgical method carries the risk of developing sores at the bladder neck or urethral stricture.
Next is minimally invasive surgery, where the physician may use techniques like microwave, radiofrequency, ultrasound, steam, or laser to treat the enlarged prostate. These methods involve using heat to induce tissue death in the prostate, potentially causing the recently treated tissue to swell, leading to temporary urinary retention post-surgery. Additionally, after the surgical intervention, some individuals may still have trouble urinating. This approach is suitable for patients with a moderately enlarged prostate who prefer not to take medication or undergo traditional surgery.
“When traditional surgery falls short of yielding optimal results, we explore new techniques or technologies to enhance its effectiveness, leading to improved outcomes and increased patient satisfaction.”
Dr Paibul had the chance to investigate the application of the GreenLight laser in surgery and led the first Green Light Photoselective Vaporization of the Prostate (PVP) Laser Procedure in Asia for enlarged prostate glands.
GreenLight laser with enhanced surgical effectiveness.
White light consists of a spectrum of seven colored lights. Each color of light has different wavelengths and interactions with tissue. Traditional electrical tissue cutting using white light may cause uneven wounds and collateral damage to the surrounding tissue, resulting in internal wounds.
The GreenLight Laser is a green laser with a narrower wavelength spectrum. It precisely cuts tissue in one plane, minimizing damage to surrounding areas. It vaporizes tissues without contracting or shrinking the remaining prostate, resulting in an effective and minimally invasive treatment for enlarged prostates. Furthermore, the procedure helps seal blood vessels in the cut area, reducing bleeding significantly.
“With this method, surgeries can be performed more safely. It effectively addresses prostate issues with reduced side effects and complications. The recovery time is minimal, often requiring just one night at the hospital. Patients can quickly return to normal life, with restored urinary function and preserved sexual health, significantly enhancing patient satisfaction.”
In any case, it is unwise to take BPH for granted, thinking technological advancement means easier surgeries, and there is always a way out regardless of how hard the treatment will be. Dr Paibul emphasizes throughout the interview that early surgical intervention is crucial. Regardless of the advancements in technology, if the condition progresses extensively, especially with an enlarged prostate, surgical treatment becomes challenging and complex. Success depends on the skill, experience, and expertise of surgeons.
“Back then, this technology was new, and I must thank the patients who largely trusted it, making this treatment widely adopted and still in use today. It has been over 20 years, proving its effectiveness as a surgical treatment. The outcomes are relatively stable, establishing it as one of the time-tested surgical methods still in use nowadays.”
“Advanced treatment technology tends to breed higher expectations. However, in some patient groups, success may not be as expected. This is not due to inferior technology or lack of skill from the doctors, but rather, the health issues may not solely originate from an enlarged prostate. Factors such as advanced age or other underlying health conditions can affect the urinary system.”
How do you envision the future of surgery for enlarged prostates?
“I believe that further reduction of the operating time may be challenging. The surgical process involves individual expertise and experience, which can vary among surgeons. Human surgery calls for meticulous care, which entails a lengthier duration. However, advancements in Artificial Intelligence (AI) may play a role in the future by aiding in calculations for precise positioning and optimal laser targeting. Nonetheless, such advancements must always be under the supervision and control of skilled and experienced medical professionals.”
Is benign prostatic hyperplasia preventable?
“To be honest, I must say that BPH is quite difficult to circumvent,” answered Dr Paibul. He then explained that a prostate naturally becomes more enlarged with aging, an inevitable internal factor.
“Preventing prostate enlargement is quite challenging, as it is mainly a natural aging process, an intrinsic factor not easily controlled,” responded Dr Paibul.
The advice is to avoid external factors, such as consulting a doctor if hormone therapy is needed and abstaining from alcohol consumption, as it may exacerbate prostate enlargement. Dr Paibul suggests being vigilant about any urinary symptoms, and if difficulties arise, even before reaching the screening age threshold, seeking medical attention to identify potential causes and get screened for prostate cancer, even though they are not related. Early detection and prompt treatment can alleviate symptoms, especially if it turns out to be, in some cases, prostate cancer.
“Men over 50 should have screening for prostate enlargement and prostate cancer. However, if there is a family history of prostate cancer, screening should start at age 40. There is no need to fear health check-ups, as early detection facilitates easier and more effective treatment for most diseases.”
