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Q: transthermal incision of prostate ( Answered 5 out of 5 stars,   0 Comments )
Subject: transthermal incision of prostate
Category: Health > Men's Health
Asked by: wfc-ga
List Price: $20.00
Posted: 25 Apr 2004 10:37 PDT
Expires: 25 May 2004 10:37 PDT
Question ID: 335939
i am a healthy 40 year old male.  i have been diagnosed with
constrictive BPH.  Transthermal incision of the prostate by high
energy ktp laser has been recommended by my urologist as a treatment. 
what have been the results of this procedure for this problem? What
are the risks and side effects?  How safe is this procedure?  What are
the risks of developing erectile dysfunction?  Does the procedure
increase my risks of having prostate cancer?
Subject: Re: transthermal incision of prostate
Answered By: crabcakes-ga on 25 Apr 2004 17:49 PDT
Rated:5 out of 5 stars
Hi wfc,

Before you read through the answer, please be aware of some
potentially confusing terminology. The transthermal incision surgery
technique is called ?The Niagra PVP procedure?, while the instrument
itself is called a KTP laser machine, sometimes called a PVP machine
or instrument. PVP (Photoselective Vaporization of the Prostate) is
the application of high-power KTP laser energy to vaporize benign
obstructive prostatic tissue that develops with BPH. The PVP procedure
was invented at the Mayo Clinic in 1997, but the KTP laser has been
around since the 1980s. KTP stands for Potassium Titanyl Phosphate
(KTiOPO4) and is the type of crystal used to emit the laser energy.

?As a man ages, his prostate continues to grow. Consequently, an
enlarged prostate is as common to the aging process as, say, gray
hair. Ninety percent of men in their 70's and 80's have symptoms of
BPH, or Benign Prostatic Hyperplasia.?
Ohio Health

I?m going to answer your last question, first. ?Does the procedure
increase my risks of having prostate cancer?? The short answer is
?No?. No data was found that risk of cancer is increased by KTP laser

BPh is a *non-cancerous* growth of the prostate tissue, while prostate
cancer usually affects the outer periphery of the prostate gland. As
BPH progresses, the overgrowth begins to constrict the urethra, making
urinating difficult, and at times, impossible. Hormones, defective
cell death, or some kind of unknown ?switch? that signals other cells
to increase cell replication are theories as to the cause of BPH. The
exact cause remains unknown.

From the University of California, Davis, Medical Center (This is a
very informative page, with all kinds of information about BPH and
other prostate disorders):
?On occasion, prostate cancer can mimic BPH, since both conditions may
cause obstruction of the urethra. Bladder cancer can sometimes cause
urinary bleeding, frequency of urination, or a sense of urgency, also
symptoms of BPH?

?BPH and prostate cancer occur in men in the same age groups and BPH
causes prostate enlargement. Many men are concerned, therefore, that
BPH may be related to prostate cancer. Fortunately, current evidence
indicates that there is no link. The two conditions develop in
different parts of the prostate: BPH occurs in the inner transition
zone, while cancer tends to develop in the peripheral outer zone.
A ten-year study found no higher risk for prostate cancer in men with
BPH. Unsuspected prostate cancer is detected during surgery in about
15% of BPH patients, but the risk of this slow-growing cancer is high
in all older men. Some estimates suggest that up to one-third of all
men over age 50 have at least microscopic prostate cancer. Still,
screening tests for prostate cancer (digital rectal exam and a PSA
test) are often recommended for men who have lower urinary-tract

?What are the risks and side effects?  How safe is this procedure??

 ?Laser therapy can be performed on nearly all patients. Because laser
surgery yields fewer postoperative complications than TURP in men with
chronic urinary retention, it may be preferable for such patients who
are willing to accept lower effectiveness in return for lower
complication rates and shorter hospital stays. The procedure may also
be a good choice for men with small-sized BPH and certain high-risk
medical conditions, such as heart disease. The laser procedure results
in minimal blood loss and excellent control of bleeding, and so may be
particularly advantageous for men who require anticoagulation therapy.
·use KTP or holmium lasers, can actually cut and vaporize the tissue. 

Vaporization is effective right away. Vaporization also may pose lower
risks for prolonged urinary retention and reoperation rates than
coagulation. (Holmium lasers are also being investigated for treatment
of severely large prostate glands, which otherwise may require removal
with open prostatectomy, a major operation.)
Comparisons with TURP. Important studies are now reporting that while
laser surgery is not as effective as TURP, hospital stays are shorter
and complication rates are lower, particularly in men with chronic
urinary retention. And, laser surgery is still beneficial. A US study
comparing TURP to laser reported the following results after twelve
·Peak flow rate increased by 107.8% in laser patients, and by 150.7%
in TURP patients.
·Symptom scores declined by 69.5% for laser patients, and by 80.9% for
TURP patients?

?Complications. Studies have been mixed on whether laser surgery poses
any risk for sexual dysfunction. In one study, TURP had a lower risk
for sexual dysfunction, although the risk from either procedure was
very low and it wasn't clear that lasers had even been responsible for
this complication. Temporary incontinence and retrograde ejaculation [
see above ] are still common in this procedure. After laser
procedures, and especially after coagulation, the prostate often
temporarily enlarged and caused obstruction and irritation. Sometimes
these symptoms were severe. Most men require a temporary catheter to
drain urine after laser procedures.?

Not a risk nor side effect, but a problem with KTP therapy, according
to Mayo Clinic?s Dr. Nseyo. ?The problem I see with current minimally
invasive therapies is the delayed effect of the treatment and the need
for catheterization for prolonged periods of time. None of the new
minimally invasive procedures have been able to withstand the test of
time. Within 2 to 5 years, the effects seem to wane, requiring

Because the KTP therapy kills off hyperplastic prostate tissue, but
does not remove it, results may be slower to see. The dead tissue will
be absorbed by the body, but it is not immediate. For some men, this
?trade-off? is acceptable for fewer complications, if any, and less
hospital time.

?The 20-minute procedure, performed under local anesthetic, reduces
recovery time from weeks to days, is virtually bloodless and is almost
half the cost of traditional invasive surgery. The procedure yields
immediate results with almost no complications or negative sexual side
?Niagara PVP allows a much less invasive, and therefore, much safer
surgical experience for BPH patients. We expect the Niagara PVP
procedure to completely replace existing BPH procedures in the next
several years," Dr. Hai explained.

Because of its unprecedented high power, the KTP laser pulses,
delivered through a fiber the thickness of a hair inserted in the
urinary passage, completely vaporize obstructive prostate tissue. The
laser seals the surrounding area creating a virtually bloodless
procedure. The procedure generally takes around 20 minutes and is
generally done under local anesthetic. Recovery time is reduced from
three weeks to two days. Patients can return to work the day after the

 As you probably know, TURP (transurethral resection of the prostate)
has been considered the ?Gold Standard? for PBH treatment. However,
TURP requires a hospital stay of 1-3 days, has a recovery time of
about 5-6 weeks (depending), more post-operative pain, bleeding,
incontinence, retrograde ejaculation, impotence, and possibility of
bladder neck contractures. This Urology Times, May, 2002 newsletter
states ?In recent years, Dr. Reza Malek and colleagues at the Mayo
Clinic have pioneered the use of a high-power
Potassium-Titanyl-Phosphate (KTP) laser for photoselective
vaporization of the prostate (PVP) to treat BPH. The high power KTP
laser instantly removes tissue by vaporization of cellular water. Only
a thin 1- to 2-mm rim of coagulated tissue remains. The KTP laser is
now available with 80 watts of average power and 240 watts of peak
power, which allows for larger amounts of adenomatous tissue to be
quickly vaporized and removed with minimal blood loss and coagulation.
The KTP laser is available as the Niagara PV System from Laserscope,
San Jose, California.?

The Niagara system had been used, investigationally for about 5 years
before the first commercially available product, the Niagara PV
System, began arriving in hospitals  in January 2002. Results have
been favorable.

?This type of surgery has been extensively studied, and proven to be
both safe and effective in practice. Both early and late complications
of laser prostatectomy are significantly fewer than observed after
other forms of prostatectomy, and the safety and ease of these
operations allows them to be performed on an outpatient basis instead
of the usual two to three day hospitalization after surgery for BPH.
However, the trade-off for this very safe technologic approach to
prostate surgery is a relatively prolonged postoperative
period--typically several weeks--before the patient experiences
significant improvement in urinary symptoms. This combined with many
other factors tend to limit the use of this operation among American
urologists.Other factors which have prevented more urologists from
offering this type of surgery have included, but are not limited to, a
relative lack of training in this kind of laser surgery and problems
with reimbursement from some insurers for the laser operations.?

In another Urology Times Newsletter, Jan. 2004, discusses three
studies, with excellent outcomes, related to KPT laser treatment:

In the first, 29 men with PBH who had not had success with previous
medical therapy, were ?zapped? with the KTP. None of the patients
needed to receive donor blood via transfusion, and all but one was
released from the hospital within one day after surgery.

In another study, 52 patients, with BPH-induced urinary retention 
were treated with KTP. Two weeks after surgery, only 2 of these
patients still required a catheter, and there were no complications.
Another study, from the same article, 85 men with BPH were followed
after KTP laser surgery. No complications ensued during their hospital
stay, and blood loss was very low. Only one patient, with a history of
prostate cancer developed a stricture.

?Compared with other minimally invasive procedures, PVP requires 1
session of therapy. You couldn't treat a 100-g prostate with
transurethral needle ablation or microwave in a single session.
Interstitial laser prostatectomy coagulates the prostate, allowing it
to scar over time and open up the urinary tract. This means that the
patient has acute inflammation, must wear a catheter, or be subjected
to significant irritable voiding symptoms. These issues are not seen
with PVP.?

?KTP Laser Therapy 
A number of different laser therapy procedures have been developed for
to treat BPH. Mayo Clinic urologists have been using high-energy KTP
laser therapy, which vaporizes overgrown prostate tissue to provide
more immediate relief of symptoms. While laser therapy requires some
form of anesthesia, it is considered minimally invasive, with much
lower complication rates than conventional surgery. Patients generally
go home the same day or stay in the hospital overnight.?

Speaking of the newer therapies, including KPT, TUNA, and microwave
thermal therapy, this Mayo site states: ?These minimally invasive
therapies tend to produce similar side effects. They all result in
some degree of swelling of the prostate gland, which may interfere
with urination. This problem can be easily managed by occasional use
of a urinary catheter for days to weeks after the procedure.?

? PVP is a form of laser procedure that is most effective in
vaporizing prostatic tissue. The KTP laser is photoselective and has
an attractiveness towards hemoglobin, sealing off the blood vessels so
there is no bleeding at all. The laser also has a very strong effect
in vaporizing the prostatic tissue; in essence, the tissue turns into
vapor without leaving any residue or charring effect. The depth of
penetration with this laser is very controlled-it only affects tissue
1 to 2 mm in depth. There is no extensive damage beyond what is
vaporized. These are the reasons why PVP is a very successful

"We haven't had any patients with incontinence or impotence," he says.
Dr. Malek has performed more than 100 PVP procedures. Two-thirds of
the patients require a catheter for 24 hours or less; the rest do not
need a catheter. Dr. Malek published his results in medical journals
in 1998 and in 2000.?

What are the risks of developing erectile dysfunction?
?Depending on the procedure, some men also have changes in the amount
of semen they ejaculate because injury to the bladder neck may allow
semen to flow backwards into the bladder. Major complications such as
impotence (erectile dysfunction) and incontinence are almost never
seen with these less invasive procedures.?

According to German Medicine, there is almost no chance of impotence.
Note the cost of the procedure!)? New KTP Laser Minimum Invasive
Prostate Surgery for benign prostate adenoma (completely unbloody, can
be done in one day as day case, practically no risk of incontinence
and impotence, risk of post-op infection greatly reduced): 4000 Euros

On this site, you can watch a 14 minute video on the Niagra PVP KTP
surgery. Select the icon that represents your internet connection.

See some illustrations of the effects of the laser:

Click on the ?Patient Brochure? link, found to the right of the
illustration of the laser instrument to read a fact sheet on the KPT
surgery. Note: Laserscope manufactures the KPT laser instrument.

In summary, only your doctor can decide the best therapy for you. It
sounds as if he/she has decided the KTP is the best for you. With that
in mind, and the above research, I would conclude that this procedure
will suit you well. You?ll have less, if any bleeding, a quick
recovery time, and very little, if any, chance of suffering from
impotence. The one caveat is that the procedure may need to be
repeated after some years, or if the BPH progresses.

If any part of my answer is unclear,of if I have duplicated
information you already had, please request an Answer Clarification,
before rating. This will allow me to assist you further, if possible.


Search Terms
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wfc-ga rated this answer:5 out of 5 stars
this was my first time using this service.  I am very pleased with the
extensive, well organized and timely result.

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