Significant Symptom Improvement After Laser Treatment for Enlarged Prostate
Enlarged Prostate Symptoms
Urologists at Mayo Clinic in Jacksonville report that about two thirds of the men they have treated for benign prostatic hyperplasia (BPH) experienced significant improvement in their urinary symptoms within 6-12 months following treatment with interstitial laser coagulation. The series of 100 men, who were treated between July 2003 and May 2005, is the largest reported group of patients treated with the newest technology available from the Indigo Optima interstitial laser system.
Interstitial laser coagulation with the Indigo laser is one of several minimally invasive surgical alternatives available to men with bothersome symptoms due to BPH. Mayo Clinic urologist Dr. Todd Igel and his colleagues perform the procedure. He says most men with mild to moderate prostate enlargement are candidates. "This is an alternative to medical therapy," he says, "particularly for men whose symptoms don't improve with medical therapy, experience objectionable side effects or don't want the ongoing expense of taking medications."
The office-based procedure takes about 20- to 30- minutes. Most patients require only a local anesthetic before Igel or one of his colleagues threads a thin fiber optic laser through the patient's urethra and into the prostate gland. The physician then turns on the device to deliver controlled laser energy to selected parts of the patient's enlarged prostate. The laser destroys a zone of tissue that is absorbed by the patient's body. The prostate begins to shrink over time, offering patients potential relief of symptoms such as a weak urine stream, difficulty in starting urination, urine flow stopping and restarting during urination, frequent nighttime urination and the inability to completely empty the bladder.
Transurethral microwave thermal therapy (TUMT) is another minimally invasive procedure used to treat BPH. It uses microwave energy to destroy prostate tissue. However, Igel says interstitial laser coagulation "is more versatile because it has the potential to be more precise. "You see where you're putting the fiber into the prostate. You're actually watching what you're doing. It's a visually targeted therapy," he says. With TUMT the physician relies on ultrasound image guidance to place the catheter used to heat the prostate tissue. In addition, Igel says microwave therapy cannot treat the middle lobe of the prostate.
The most common surgical treatment for BPH, transurethral resection of the prostate (TURP), requires a one-to three-day hospitalization. Patients may expect marked symptomatic improvement soon after the procedure. However, there is a small, but greater risk of side effects with TURP than there is with interstitial laser coagulation. These side effects may include incontinence, impotence and retrograde ejaculation.
BPH is a common condition affecting about 50 percent of men over the age of 50 and up to 90 percent of men over the age of 80. Doctors usually advise a watchful waiting approach until symptoms become bothersome.