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Greenlight Laser Therapy
A state of the art bloodless surgical treatment for men with urinary problems caused by enlargment of the prostate glandis now available at Hollywood Private Hospital.
The new treatment, known as GreenLight Laser Therapy, uses 100-120 watt laser energy from the green light band to vaporise the prostate tissue that obstructs the outlet of the bladder.
Urologists Stan Wisniewski and Syd Weinstein have successfully treated a number of men since the hospital purchased Western Australia’s first GreenLight Laser Therapy unit several weeks ago.
According to Mr Wisniewski, the purchase is timely because a second generation machine is now available that is more powerful than the original version. The improved facilitation of energy means treatment time is reduced because the laser energy can be delivered more rapidly to a larger area.
“We now feel happy that we have something with the right verve to introduce this new therapy to our patients and our community,” he said.
Almost half of all men over the age of 60 suffer from benign prostatic hyperplasia or BPH. This age-related enlargement of the prostate gland is not malignant but causes a number of troublesome urinary symptoms.
As the prostate grows, it compresses the tube called the urethra which drains urine from the bladder and interferes with the normal flow of urine.
Men suffering from this condition typically experience at least one of a number of symptoms which can disrupt their lifestyle by interfering with their usual daily activities. BPH symptoms include frequent urination, a weakened urinary stream, the need to get up at night to pass urine and a feeling that the bladder has not been completely emptied.
Historically, BPH has been treated with medication in the early stages or by having an operation known as a transurethral resection of the prostate (or TURP) if the condition becomes more severe.
The surgery involves cutting away slices of the enlarged gland to relieve the pressure on the urethra at the neck of the bladder. TURP is an effective treatment for BPH because it provides long-lasting relief of symptoms.
However the operation involves staying in hospital for 2-3 nights and because of the risk of bleeding in the post-operative period, it is necessary to stop taking blood thinning medication prior to surgery.
The advantage of GreenLight Laser Therapy is that it provides a less invasive surgical alternative that is just as effective but has far fewer side effects than conventional TURP surgery. Instead of cutting away sections of the enlarged prostate gland, the doctor inserts a telescope up the urethra to the level of the prostate then guides a laser fibre through the scope.
The prostate tissue that is obstructing the outlet of the bladder is then vaporized into gas using a high powered laser. The treatment is much less traumatic than conventional surgery because it involves no cutting.
According to Mr Weinstein, unlike some other types of laser, energy from the green light band does not cause any deep burning or coagulation while vaporising the prostate tissue so there is no deep scarring.
“There is absolutely no evidence of nerve damage with this technique because it goes nowhere near the nerves.”
He describes the GreenLight Laser Therapy as a ‘virtually bloodless procedure’ which almost eliminates the risk of problematic post-operative bleeding. Sexual side effects, such as retrograde ejaculation, and urinary side effects are also considerably less in previously healthy men following the laser treatment than with TURP surgery.
Improvement in the flow rate of urine occurs almost immediately after the laser therapy. There is no need for catheters or washouts and patients can return to normal activity more rapidly. The length of the hospital stay is reduced from the usual two to three-nights following a TURP to just an overnight stay.
It is likely to become a day surgery procedure in the near future and, according to Mr Wisniewski, the new method of treatment will ‘change the face of prostate surgery in this hospital’.
Another major benefit of the laser treatment is that it can be used on patients who take anti-coagulant medication. Traditionally drugs such as warfarin must be stopped prior to surgery because of the increased risk of bleeding during the operation - but stopping the medication can increase other vascular risks. This aspect is of particular importance because the population who are most likely to be on anticoagulants are the same over-60 year olds who typically suffer from BPH.
GreenLight Laser Therapy is well tried and tested. Over 250,000 cases have been performed in different countries around the world and more than 80 articles have been published. Now that the treatment is offered at Hollywood Private Hospital, Western Australian patients will no longer have to travel interstate for the procedure.
Not all patients with urinary flow problems are suitable candidates for GreenLight Laser Therapy at present but the new procedure can generally be used on those who would previously have been treated with a TURP. Patients are referred by their GPs to a urologist who will base the method of treatment on a clinical evaluation.
Mr Wisniewski believes GreenLight Laser Therapy will become the gold standard treatment of the future and that in 10 years time, most prostate surgery will be done this way.
“There’s no question that in an age where bloodless surgery will become the norm, if you’ve got something that can provide that, then that’s the road we should all be going down.”