It is effective, minimally invasive; patients are requesting it
with increasing frequency; and the reimbursement is fair. Importantly,
TUMT allows urologists to successfully treat BPH in the physician
In the past, some urologists were reluctant to embrace TUMT due
to their doubts about its safety and effectiveness, as well as the
need for IV sedation. Today, oral sedation is sufficient, results
are durable and manufacturers have addressed relevant safety concerns.
Advancements in TUMT have also improved patient comfort during the
procedure and reduced treatment times to approximately 30 minutes.
With the aid of a qualified technologist and proctoring in advance,
TUMT is relatively easy to perform. Experience demonstrates that
it is critical when evaluating prospective candidates for TUMT to
adhere closely to the published patient selection criteria (size
of gland, length of prostatic urethra, etc.). TUMT is ideal for
many younger BPH patients because it preserves bladder neck function
and, for this reason, is one of the least sexually disruptive treatments
Why should urologists consider PVP as another effective
Some background is necessary to put this question in perspective
and provide a complete picture. Urologists define a Transurethral
Resection of the Prostate (TURP) as the 'gold standard' for the
surgical treatment of BPH. In turn, this endoscopic procedure historically
defined the practice of urology. TURP reached its peak in the mid-1980s
when physicians annually performed approximately 500,000 of these
operations. Since then, that figure has declined dramatically to
about 200,000 per year.
Meanwhile, over the past 15 years, many in the medical community
have also embraced drug therapies or watchful waiting as popular,
non-surgical standards of care for BPH patients. One consequence
of using drugs and prolonged monitoring to delay surgery is that
more BPH sufferers will present to the urologist exhibiting advanced
prostatism. These individuals will require surgical therapy. For
patients who display a dramatic increase in residual urine, the
choice for definitively relieving obstruction will become one between
TURP or PVP.
Photoselective Vaporization of the Prostate (PVP) or laser treatment
of BPH using the GreenLight PV surgical laser system (an 80-watt
KTP laser) offers BPH patients a meaningful alternative to TURP.
A significant advantage of PVP compared to TURP is the lack of intra-operative
and post-operative bleeding. In addition, laser surgery usually
requires no post-operative irrigation. PVP patients require post-operative
catheterization for a short duration of generally less than 24 hours
after laser surgery.
When combined, these characteristics of the GreenLight Laser System
offer the patient a shorter post-operative recovery period, quicker
healing and a speedier return to normal activities than does TURP.
Urologists can now offer BPH patients this unique form of laser
therapy in an outpatient setting. Operating time is less than or
equivalent to TURP. Most importantly, clinical results to date are
as good as TURP in improving Uroflow Rates and AUA Symptom scores.