What types of laser therapy are available

A variety of laser therapies are available. Not every urologist or every hospital has access to every laser available on the market. The following are some of the laser therapies used to treat BPH:

Interstitial laser coagulation: This procedure is performed under local anesthesia on an outpatient basis. The Indigo Laser Optic Treatment system is used with a cystoscope through which a fiberoptic probe is inserted into the prostate. The prostate is heated via the probe for about 3 minutes and this coagulates the obstructing prostatic tissue. The procedure can be repeated in different areas of the prostate. The procedure takes about 30 to 60 minutes to perform. After the procedure is performed an indwelling foley catheter is placed which is usually removed in a few days. It is not uncommon to see some blood in the urine after the procedure, which usually clears in a week. Rarely, erectile dysfunction, retrograde ejaculation, and incontinence can occur.

Photoselective vaporization of the prostate (PVP):

This procedure uses a special high-energy laser (e.g., GreenLight PVP™ Laser) to vaporize excess prostate tissue and seal the treated area (Figures 25a and b). The procedure is performed on an outpatient basis in a hospital or surgical center and may be performed under local, spinal, or general anesthesia. The procedure takes about 30 minutes to perform, depending on the size of the prostate, and patients are usually discharged within a few hours. As with interstitial laser coagulation, the procedure is performed via a cystoscope. Many patients do not require a catheter after PVP, and those who do typically are catheterized for less than 24 hours.

HoLAP (holmium laser ablation of the prostate):

This procedure involves using a laser to vaporize obstructive prostatic tissue. The decision whether to use HoLAP or HoLEP (holmium enucleation of the prostate) is based primarily on the size of the prostate. Ablation usually is performed when the prostate is smaller than 60 cc (cubic centimeters).

HoLAP offers many of the same advantages as HoLEP when compared to traditional surgery (e.g., TURP). These potential benefits include a shorter hospital stay, less bleeding, and shorter catheterization and recovery times. Patients who undergo HoLAP usually do not

(a)

Figure 25 (a) Formation of lesions in the prostate. (b) Multiple lesions formed in the prostate.

Figure 25 (a) Formation of lesions in the prostate. (b) Multiple lesions formed in the prostate.

Courtesy of Medtronic, Inc. © Copyright 2003.

require overnight hospitalization and in most cases, the catheter is removed the same day or the morning following the procedure.

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