NONSURGICAL TREATMENTS FOR BPH: LASER SURGERY
This treatment involves inserting a laser probe into the prostatic urethra to vaporize tissue. It is done quickly, avoiding the trauma often associated with surgery. Compared with a TURP, laser surgery causes almost no bleeding, requires less anesthesia, and results in less incontinence.
The disadvantage is that relief is not immediate. Destroyed tissue must be sloughed off through the urine, which takes two to six weeks. The laser does not remove tissue instantly, so a catheter is used for a short period of time after the treatment. Many urologists want to see the long-term results before they use laser surgery instead of the TURP.
As with other methods of treatment, laser surgery is not for everyone. Patients with an extremely large prostate or with prostate cancer are not candidates for this technique. Patient selection begins with a careful examination by the urologist.
Most surgeons agree that lasers, which are already in use, will play a growing role in treating BPH in the future. But they say that more information is needed before they can determine who is a suitable candidate for the procedure, what the optimal energy level and duration of laser use are, and whether ultrasound guidance is really needed.
A study of 235 patients at ten medical centers, using the laser procedure, was initiated in 1990, and it was reported on at the meeting of the American Urological Association. Men in the study showed an average of 69 percent improvement in their urine flow, and a 67 percent improvement in overall symptoms. Their average hospitalization was 1.4 days, with 85 percent of the patients either staying overnight or going home the same day.
Compared with traditional surgery, laser surgery is cost-effective and requires less anesthesia, medication, and time. Other advantages include minimal blood loss, shorter convalescence, and no reported serious complications. A 1992 announcement from the Stanford University Medical Center stated that patients who underwent laser surgery for BPH could go home immediately after the half-hour procedure.
Several years later, the same enthusiasm for this process is expressed further by researchers at Stanford University, who claim that one treatment of BPH by this process is just as effective and safer than the popular TURP.
The outcome of using a Neodymium Yag laser to burn away the excess tissue was most impressive. Of the 227 men who received this treatment in one study, 85 to 90 percent showed considerable improvement in ease of urination. This is comparable to results obtained with the TURP, which is considered the gold standard by many surgeons.
Transurethral Ultrasound Laser Incision of the Prostate (TULIP)
This technology is for treating noncancerous enlargement of the prostate. It has been developed by Dr. Robert Roth, a Lahey Clinic urologist, in conjunction with Intra-Sonix, Inc. of Burlington, Massachusetts. It uses a miniature ultrasound device to guide the laser to the site of prostate obstruction inside the urethra, where it can heat and distroy excess prostate tissue. It causes no bleeding, which eliminates the need for irrigating fluid that can cause heart and lung complications following traditional surgery.

Visual Laser Ablation of the Prostate (VLAP)
This technique involves inserting a microscope and a laser into the urethra. The laser heats the prostate tissue, which is slowly eliminated, relieving the symptoms of BPH.
The advantages are that it can be done on an outpatient basis with local anesthesia. There is very little risk of impotence, incontinence, or retrograde ejaculation.
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