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Breakthrough Treatment for Enlarged Prostate Has Men Cheering

URMC Urologists Lead Effort to Bring New Laser Procedure to Rochester

Wednesday, December 11, 2002

The treatment for the most common ailment for men over 50 is undergoing a transformation. On Friday, the University of Rochester Medical Center will host a seminar for community urologists to learn how to perform a new minimally invasive surgery to treat Benign Prostatic Hyperplasia (BPH), a benign enlargement of the prostate gland.

Almost half of all men over 50 experience some symptoms related to BPH, a condition where the prostate increases in size, gradually pinching the urethra, leading to a host of uncomfortable and painful symptoms. Depending on the frequency and severity of the symptoms, treatment options can include medication, devices, or an invasive surgery that usually requires three to five days of hospitalization.

More than 400,000 of these transurethral resections of the prostate occur each year, and it is the second most common operation performed on American men over 60 (cataract extraction is first). For most men, this surgical procedure will be replaced by a new minimally invasive procedure, called Photoselective Vaporization of the Prostate (PVP).

 Utilizing a high-powered laser transmitted through a fiber, the laser evaporates the prostate tissue, clearing up any obstruction with minimal blood loss. Depending on the size of the enlarged prostate gland, the procedure lasts between 20 to 50 minutes, and can be done under local anesthetic on an outpatient basis. For the past decade, physicians have experimented with different lasers to treat BPH, but have been unsuccessful up until now.

“This new laser technique is a breakthrough treatment for BPH surgical candidates. It greatly decreases the risk of serious complications from the surgery, and allows patients to quickly recover with little to no pain, turning a four-day hospital stay into an outpatient visit,” Erdal Ertuk, M.D., associate professor of urology at the University of Rochester Medical Center, said. “By introducing area urologists to this technique, we can help to make the laser procedure a standard treatment for the thousands of men in the Rochester region who suffer from BPH.”

A Common Condition

While the exact cause of BPH is still unknown, it is thought to be a natural part of the aging process in men, and thus, a very common condition. Men over 50 have a 50 percent chance of having BPH, while men over 80 have a 90 percent chance of having the condition. Current estimates show approximately two million men currently receive treatment for BPH.

Symptoms of BPH vary from man to man, and worsen over time as the prostate gland continues to enlarge. As the gland gets bigger, it squeezes the urethra, causing a multitude of urinary problems, and if left untreated, can cause bladder infections, bladder stones, and, in rare cases, kidney damage.

Upon diagnosis of BPH, men typically undergo a period of “watchful waiting,” as the urologist tracks the increasing size of the prostate, and monitors the severity of the symptoms. Medications are usually the first line of proactive treatment, even though they are only successful in 60 percent of the cases.

Transurethral resection of the prostate has long been the primary choice of treatment for the past 50 years for BPH surgical candidates, and usually is suggested after home treatments and medications fail to reduce their symptoms. Performed under anesthetic, the obstructing portions of the prostate are removed, requiring up to four days of hospitalization. Strenuous activity and sexual activity must be avoided for about six weeks, and long-term side effects can include urinary incontinence and impotence.

This contrasts with the PVP procedure, which uses a laser to quickly vaporize prostate tissue, removing the obstruction completely and leaving an open and bloodless urethral channel. The amount of pain experienced by patients is significantly reduced, and the recovery period is dramatically decreased. Not all men are candidates for the laser technique; size and condition of the prostate are key determinants.

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Germaine Reinhardt

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