Prostatic laser surgery, the definitive solution?

The doctor. Villacampa is an expert in urinary tract infections, urological oncology, prostatism and urinary incontinence. He is a member of the Spanish Association of Urology, the European Association of Urology and the Madrilenian Urological Society. In the following article he explains the different techniques of prostatic surgery

It is predicted that prostate growth will reach more than 80% of males (Brigham K. Urol Clin N. Am 2016). This growth, mainly of the most internal and central part of the prostate, affects fundamentally the quality of life of the male , being seldom due to malign causes.

In the case that a male begins with prostate symptoms (loose stream, difficulty urinating, getting up at night to urinate ...), from the EGR Institute of Medicine we recommend that you go to the urologist, who will do the most appropriate study to rule out causes malignant. Usually this study often neglects the presence of cancer, focusing on the most common cause is benign prostatic hyperplasia (growth of the inner part of the prostate that compresses the output of urine and affects the bladder and, subsequently, to the quality of life of the patient when causing the symptoms already commented).

How to treat benign prostatic hyperplasia

The first approach to this problem should be with medical treatment. There are several types of medications that get adequate relief of symptoms, in addition to being well tolerated, so they can be maintained for long periods of time.

However, some patients do not respond satisfactorily , or over time they stop responding to medication. When this happens, the possibility of ending up with a bladder catheter to be able to urinate, frequent urinary infections or even permanent damage to the kidneys are elevated. It is in these cases where the surgery of the prostate is especially indicated.

Surgery for benign prostatic hyperplasia

The surgery is based mainly on the removal of the prostatic central tissue until achieving a good urinary flow, without removing the rest of the prostate.. This surgery is classic, has been performed for many years with very good results both openly, through the abdomen, or through the urethra by transurethral resection.

However, despite the good results of these surgeries, the great problem they generate is that normally the postoperative period is quite uncomfortable: catheter, infections, bleeding, days of admission ... This makes that, although effective, prostate surgery can be delayed or even suspended if the patient is unwilling or unable to cope postoperatively.

Prostatic laser surgery

In recent years this has changed to better. The development of laser energy (of different types, green, holmium, thulium ...) allows us to remove the central prostatic tissue through the urethra effectively with less aggressiveness.

It has been shown that laser surgery, provided that the urologist has experience in the technique, is similar in efficacy to classical techniques. However, the fundamental difference is that the laser facilitates a much more pleasant and uncomplicated postoperative period. Not only is there less bleeding, but you can remove the catheter before, there are fewer days of admission ... All these factors have made the standard of prostate surgery have been changing from the usual techniques to laser energy, where it is available and the urologist has experience. At the EGR Institute of Medicine, we offer this technique to our patients with excellent results.

The only factor pending to be elucidated is the duration of the effect of the surgery. In studies of classic surgery, transurethral prostatic surgery was considered to have an approximate expiration of about 10 years on average, so that some patients might need a second surgery after several years.. This aspect is beginning to be published already in the main medical journals: with more than 6 years of follow-up, the quality of life of the patients operated with laser (in this case green laser) is as good as after the surgery, and only 4 patients of every 100 need some type of surgery (Calves J. EurUrolFocus 2017).

All these data can really be summarized in four key points:

• Go to your trusted urologist to check your prostate;
• If you have symptoms, follow the medical treatment proposed by the urologist;
• If this treatment was not enough, there are very effective surgical alternatives and;
• If it is necessary to operate, the laser techniques are effective, durable and less aggressive than those available.

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