Green Light for the treatment of Prostatic Hypertrophy

Laser - Gabriele Antonini MD PhD © Antonini Urology - Mini Invasive Uro-Andrological Surgery

Benign Prostatic Hyperplasia (BPH) can cause severe trouble in urinating with age. About 50% of men will experience a radical change in urinating during their lives because of this benign growth.

Surgical treatment of benign prostatic hyperplasia (BPH), a treatment method being used from the past 20 years is based on transurethral resection of the prostate (TURP). The treatment is undergoing revolution in terms of its nature with the advent of laser technology. In fact, the non-negligible percentage of post-operative complications related to TURP (persistent macrohaematuria, post-TURP syndrome, anemia), has resulted in the industry’s ever increasing interest in search of the ideal method for resolving the obstruction of prostatic hyperplasia, a system whose main features should be minimal invasiveness, absence in the problems of intraoperative reabsorption of liquids, absence of bleeding, possibility of the total removal of the prostatic adenoma, shorter duration of stay in the hospital and the reproducibility of the results. The application of the laser technology to prostate the surgery is itself a sign of significant improvement in the ideal surgical approach used until the last decade. The new standard for the surgical treatment of Benign Prostatic Hyperplasia is the photoselective vaporization of the prostate using the GREEN LASER, more commonly called “GreenLight laser prostatectomy”. 

It is a minimally invasive procedure that results in significant improvements in the urinary symptoms.

A thin fiber is inserted into the urethra through a cystoscope, an instrument that allows the doctor to examine the bladder and the prostate. The fiber delivers green laser energy that quickly evaporates and removes the prostate tissue. The urologist is able to view and check safely the area of treatment, by adapting to one’s anatomy and needs. Since the prostate tissue is vaporized and removed, it creates a wide channel: as a result, the flow of urine is immediately restored and all the urinary symptoms gets relieved.

The green laser light used in the vaporization has a wavelength that gets easily absorbed by the hemoglobin present in the red blood cells. Due of this, the tissue which has blood in it (such as the prostate) gets selectively vaporized. Once the capsule of the prostate is reached, vaporization tends to cease and the procedure gets completed, in fact, the prostatic capsule is fibrous and has no hemoglobin and is therefore protected from the laser.

The ADVANTAGE of this procedure in comparison to TURP is that in this procedure, the prostate tissue gets vaporized selectively, rather than cutting-off. In fact, when the prostate tissue gets cut off in the TURP procedure, the prostate bleeds much more abundantly. Conversely, during the photo selective vaporization, the prostate tissue does not bleed at all.

The GreenLight laser exploits the capability of the tissue vaporization by lithium triborate crystals with the consequent advantage of an operation which is mini-invasive in nature, bloodless, without any probability to cause problems in the resorption of fluid and requires short duration stay in the hospital. The advantages of GREENLIGHT XPS 180 watt manufactured by American Medical Systems, Inc are numerous.

  • With the use of intraoperative saline, the BPH treatment has become more successful (risk of resorption of liquid is minimal or absent);
  • Owing to the great coagulation capacity of GREENLIGHT XPS that allows the removal of the urinary catheter and the secretion of the discharge to flow in the first or the second day, the number of days required for hospitalization for availing the treatment has reduced significantly;
  • Absence of intra and post-operative bleeding complications which can result into re-operations;
  • Possibility of treating anti-coagulated patients, without suspension of the same (non-insignificant advantage in an era of an ever increasing use of antiplatelet therapies related to cardiovascular events);
  • Elimination of problems due to blood transfusions;
  • Possibility of the treatment of the patients with pacemakers, since no electric energy is used;

Quicker functional recovery of the patient.

The results are equivalent to those of TURP with fewer side effects and complications.

  • Rapid and significant improvement in urinary flow.
  • Treatment given to patients with varying severity in symptoms.
  • Further studies support the use of GreenLight on the large sized glands, on anti-coagulant and high-risk patients.
  • One Day Surgery Procedure (one night of hospitalization).

Much lower risk compared to TURP; no significant risk of TURP syndrome.

  • Catheterization of the average duration of 72 hours.
  • Mild irritative symptoms that last for short duration only.
  • Quick resume of normal activities.

The safety and effectiveness of photoselective vaporization with GREEN LASER has seeped in a revolution in the traditional treatment of Benign Prostatic Hyperplasia (BPH).