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"A New FDA-Approved BPH Treatment, Known As Photoselective Vaporization of the Prostate, is Changing the Way Doctors Treat Benign Prostatic Hypertrophy." ; Laser Makes Mens' Lives Easier

Posted on: Thursday, 5 January 2006, 09:00 CST

By Dr. Rallie McAllister

A man's wisdom isn't the only thing that increases with age. In most cases, the size of his prostate gland does, too.

The prostate is a sex gland that lies between the base of the bladder and the rectum. In response to the hormonal changes of puberty, the prostate undergoes a growth spurt, and by the age of 20, the gland is normally about 10 times larger than it was at birth.

In their young adult years, most men won't give their trouble- free prostates much thought. For many men in the fifth decade of life, however, the gland begins to enlarge again, resulting in a condition known as benign prostatic hypertrophy, or BPH.

The National Institutes of Health reports that BPH affects more than half of all men over age 60, and as many as 90 percent of men over the age of 70. Although the exact cause of BPH is unknown, most experts believe it is associated with hormonal changes that occur as men age.

According to Kevin L. Billups, assistant professor of urology at the University of Minnesota and a specialist at the Epicenter for Sexual Health and Medicine in Edina, "Benign prostatic hyperplasia is an enlargement of the prostate gland that can cause a lot of problems, but it isn't cancer."

Problems occur when the prostate gland becomes so enlarged that it begins to interfere with the passage of urine from the body. Urine is carried out of the bladder through the urethra, a tubular structure that runs through the prostate gland.

"The urethra is a lot like a straw," explained Billups. "As the enlarged prostate squeezes it, there is a reduction in the normal flow of urine."

Symptoms of BPH include straining to begin voiding, a decrease in the force of the urine stream, and frequent urination, especially at night. Men with the condition may also experience a sensation of incomplete bladder emptying and leakage of urine.

In some cases, drug therapy may effectively eliminate BPH symptoms. "Some medications work by relaxing the prostate, while others affect hormone levels and cause the gland to shrink in size," Billups explained.

The actions of both types of drugs allow the urethra to widen, improving the flow of urine. On the downside, medications used to treat BPH may have unpleasant side effects, ranging from headaches and dizziness to a lowered sex drive and erectile dysfunction.

Before BPH drugs became widely available, a surgical procedure known as transurethral resection of the prostate, or TURP, was the treatment of choice for the condition. The surgery involves inserting an instrument through the urethra, and using an electrically charged wire to cut and burn away the offending tissue.

"This type of surgery is very effective in restoring urinary flow," said Billups, "But it typically requires general anesthesia and a hospital stay of one to three days."

Afterwards, men are often required to wear a catheter for several days, and can expect their recovery period to last for about four to six weeks. Erectile dysfunction may follow TURP, and the condition may persist for weeks or months.

A new FDA-approved BPH treatment, known as photoselective vaporization of the prostate, is changing the way doctors treat BPH, and reducing the occurrence of dangerous and unpleasant side effects in men treated for the condition. "Photoselective vaporization of the prostate involves the use of a high-powered laser, called the GreenLight Laser, to vaporize the enlarged prostate tissue," said Billups.

During the procedure, a thin fiber is inserted into the urethra, delivering green laser energy to the prostate. Because light of this wavelength is effectively absorbed by the blood vessels in the area, damage to surrounding, unaffected tissue is minimized.

"There's very little bleeding or scarring with this procedure," noted Billups, "and there is an increase in urine flow right away."

Patients treated with GreenLight Laser therapy are often allowed to go home within a few hours, or after an overnight stay.

Billups said that to date, no patients treated with the photoselective vaporization procedure have required blood transfusions, and none have suffered loss of bladder control or loss of sexual function, side effects that are more commonly associated with TURP.

Dr. Rallie McAllister is a family physician in Kingsport, Tenn.

Source: Buffalo News

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