Laser TURP

By Richard A. Santucci, MD, FACS

The prostate is one of the main organs of the male reproductive system. For many men in their 50s, the prostate begins to grow, and it may continue to grow for the rest of their lives.

As the prostate grows, it puts pressure on the urethra—the tube that carries urine and semen out of the body. This increasing pressure on the urethra can lead to bothersome urinary symptoms and future problems such as surgery on your prostate.

An enlarging prostate is common…

The prostate continues to increase in size throughout life by about 2% a year. That means that many older men have some enlargement of the prostate, and many of these men have urinary difficulties from this prostate enlargement. Medical therapy is available, but surgical therapy is still considered the “gold standard.”

Medicine can help some men with prostate problems. However, some men do not tolerate medication, or they do not work, or the patients are simply tired of the idea of taking 1-2 pills a day for the rest of their life. Those men with really severe prostate enlargement causing a complete inability to urinate might not even be good candidates for medical therapy and will need surgery.

In these cases, surgical therapy to decrease the size of the prostate is needed. There are many, many types of treatments, but the most common is an old fashioned operation called a “TURP” or TransUrethral Resection of Prostate”. The blocking part of the prostate is shaved out with an electrically charged coil, through a telescope which is placed in the urethra.

This procedure works very well, but there have been many, many updates and improvements in this operation, and these improved procedures are NOT performed at every medical center. Currently, standard TURP is considered to be a “first generation” procedure.

A “second generation” improvement is the GYRUS bipolar TURP which results in less bleeding and earlier catheter removal.

A “third generation” improvement is the laser TURP such as the PVP or “Greenlight” laser TURP, but new and improved advanced lasers represent the cutting edge, most effective treatment for enlarged prostate.

Laser TURP, a 4th generation improvement for the 21st Century…

The most modern and improved form of TURP is to use a laser to remove the blocking portion of the prostate. This procedure has many advantages: Bleeding is minimized, and the time that a urinary catheter must be left in is decreased.

This procedure can be performed safely on those who are taking blood thinners such as aspirin, Plavix, or even coumadin (warfarin) without concern for bleeding. The most modern form of laser available today is the “Greenlight HPS” (High Performance System) which works even more quickly and effectively than older “Greenlight” lasers. This laser is used because it is FOUR GENERATIONS more advanced than the standard TURP still performed at many hospitals – a procedure that was developed almost 100 years ago.

It is important for a patient to discuss prostate surgery options with their physician to determine which procedure is right for them. Ultimately, the end result is to have a successful outcome that represents the physician’s goal, and the patients’ needs.

Dr. Santucci is Chief of Urology at DMC Detroit Receiving Hospital and an associate professor at Wayne State University School of Medicine.