Like many areas of medicine, the field of Urology has seen dramatic advancement in minimally invasive techniques. After years of research and development, these techniques have been used in the treatment of several urologic disorders, including Benign Prostatic Hyperplasia (BPH), Prostate Cancer, Renal Cancer and Incontinence. This article concentrates on the use of minimally invasive techniques to treat Benign Prostatic Hyperplasia.
The prostate gradually increases in size as a natural part of aging. This can result in voiding symptomatology. According to the National Institutes of Health, BPH affects 50% of men over age 60 and as many as 90% of men over age 70. There are three treatment categories for BPH - drug therapy, surgery and minimally invasive techniques.
There have been major developments in minimally invasive therapies, which are based on advanced technology. The advantages to these techniques are improved patient comfort and satisfaction, less complications, fewer side effects, and solely outpatient activity. As a result, an evolution of BPH therapy has developed. The Transurethral Resection of the Prostate (TURP) has been the gold standard. Techniques have developed with a goal to achieve TURP equivalency while being minimally invasive. Two categories have emerged. TURP alternatives and therapies are considered to be TURP equivalents.
The minimally invasive therapies that are alternatives to TURP can be done in an office setting. They are performed utilizing oral sedation and local anesthesia. These include: Interstitial Laser Coagulation (ILC) (Indigo Laser Therapy); Transurethral Microwave Therapy (TUMT) (Targis, Prostatron, TherMatrix,CoreTherm); Water Induced Thermal Therapy (WIT) (Thermoflex); and Transurethral Needle Ablation (TUNA). These are thermal therapies, which employ heat to treat the prostate. The treatment time varies from 15 to 45 minutes with these treatments. The Indigo (ILC) utilizes laser energy to heat the prostate, TUMT uses microwave energy, WIT uses water heated to 60 degrees Celsius, and TUNA uses radiofrequency.
One of the major benefits of the Indigo Laser therapy (ILC) is that it is done under direct cystoscopic visualization. The laser fiber is inserted directly into the prostate by the urologist. Confidence that the proper area is being treated is achieved. The length of treatment time is lower with the Indigo therapy. These techniques are generally more effective at relieving lower urinary tract symptoms than medications are. The average symptom score improvement is 10-12 points. 70% of patients have significant improvement in urinary flow rates.
The TURP equivalent that has emerged is Laser Photovaporization of the Prostate (PVP) (Laserscope). The Laserscope Greenlight laser PVP is a high power KTP laser. A laser probe is placed under continuous direct cystoscopic visualization into the prostatic urethra. The side firing laser vaporizes the obstructing prostatic tissue in a hemostatic fashion. The end point is a TURP-like cavity. It offers superior hemostatsis, it is nearly bloodless, and can be done in anticoagulated patients. Further, there is no risk of fluid absorption resulting in hyponatremia. This procedure is done in an outpatient setting, and does require anesthesia. It is comparative to the TURP with definitively fewer side effects and complications, no hospital stay, more rapid recovery and less cost. Improvement in urine flow is noticed immediately and symptom scores improve an average of 15 points.
The benefits of these minimally invasive techniques are a higher degree of safety, lower complication rates, and increased patient satisfaction. Procedures are performed in an office or outpatient setting with reduced costs. Other urologic minimally invasive procedures include "No Scalpel" vasectomy, microscopic varicocelectomy, microscopic vasectomy reversal, laparoscopic techniques including robotics, and incontinence procedures.
Urology is a model specialty in which technologic advancements have been utilized in developing minimally invasive techniques, which dramatically improve patient care.
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