The Department of Urology offers a wide range of surgical therapies for prostate obstruction syndrome (synonym: benign prostatic syndrome, benign prostate enlargement). Depending on the extent of the enlargement and existing secondary diseases, we can determine and implement the optimal therapy option for each individual patient. In addition to various electrical procedures (mono- and bipolar TURP, bipolar plasma vaporization), we also use laser procedures (GreenlightTM Laser, Thulium Laser).
GreenlightTM Laser Vaporization of the prostate is a particularly gentle procedure with a low bleeding-risk that allows us to perform low-risk surgery even on patients with ongoing blood-thinning medication or patients with severe secondary cardiac diseases. The operation has been performed in our clinic for many years and since 2012 with the most modern 180W Greenlight XPSTM laser.
Enlargement of the prostate
Benign prostatic hyperplasia (BPH) is one of the most common diseases in men and increases in frequency and severity with age. The cause of this disease is still not clearly understood. The nodular enlargement of the prostate tissue leads to a progressive narrowing of the urethra, which passes through the prostate. This can lead to various disturbing symptoms that are part of the so-called benign prostatic syndrome (BPS). These include:
- Delayed start of urination
- Weak urinary stream
- Prolonged urination
- Residual urinary sensation
- Frequent urination of small amounts
- Sudden urge to urinate
- Nocturia (urination at night)
- Disturbing after dribbling
With increasing enlargement, however, more serious symptoms can occur. In addition to acute painful urinary retention, these include chronic deterioration of kidney function, prostate bleeding tendency, and loss of bladder muscle function.
Treatment of benign prostate enlargement
The need for treatment arises as soon as the symptoms become disturbing for the patient, or if the symptoms become severe. As a rule, the first treatment is medication. If the patient does not respond to medication, surgical therapy is usually recommended. A number of surgical procedures are available for this purpose. In the classic electro-resection of the prostate (so-called TUR-P), the prostate is peeled out through the urethra with an electric snare. Alternatively, in recent years, various laser operations have also become established, which have significant advantages over TUR-P, especially with regard to the tendency to bleed. In our clinic we offer the so-called photoselective vaporization of the prostate with the GreenLightTM laser as a minimally invasive therapy for benign prostate enlargement (synonyms: PVP, green light laser vaporization, KTP laser vaporization).
Vaporization of the prostate with the GreenLight laser
In 2002, as one of the first urologists worldwide, former clinic director Prof. Dr. T. Sulser performed the GreenLightTM laser vaporization of the prostate with the 80W KTP laser. Since then, this surgical technique has been successfully performed and scientifically investigated under his direction (see below). Since 2012, our clinic has been operating with the 180W GreenLightTM XPS laser. This most powerful GreenLightTM laser shortens the operation time and optimizes the treatment by removing the prostate tissue even more effectively. In a recently published randomized study, GreenLightTM laser vaporization was shown to be non-inferior to classical TURP in terms of symptom improvement with a significantly reduced side effect profile (Bachmann A. et al., J Urol 2015).
During surgery, a special laser fiber is delivered to the prostate via the urethra under video guidance. The high-energy green laser light is absorbed by the prostate tissue, which is well perfused, resulting in vaporization of the excess prostate tissue. At the same time, there is immediate hemostasis in the underlying tissue layer, so that the operation is virtually bloodless. This results in a number of advantages of laser surgery over electroresection of the prostate (TUR-P):
- Treatment of patients who are unable to discontinue blood-thinning medications (e.g., Aspirin/ASS, Plavix, Marcoumar).
- Treatment of patients with severe secondary diseases where TUR-P is not possible
- Short catheter indwelling time
- Short hospitalization time
- No wash-in syndrome (so-called TUR syndrome)
- Equivalent functional results compared to TUR-P
Practically no impairment of erectile function is observed after GreenLightTM laser surgery. Retrograde ejaculation (so-called dry ejaculation), which regularly occurs after surgery, can be avoided by modifying the surgical technique (so-called ejaculation-protective surgery). In case of an increased risk of recurrent constriction of the prostate, this option must be discussed in detail prior to surgery.
Research and quality assurance
The GreenLightTM laser surgical method has been scientifically studied in our clinic since 2006. The results of these investigations have been published in a number of high-ranking international journals and presented at the most important urological congresses worldwide (see below). The research work was awarded poster prizes by the German and European Society of Urology at several congresses and the prestigious Mauermayer Prize of the German Society of Urology in 2009.
The results of this research work have contributed, among other things, to the fact that this surgical method has become established worldwide. For quality assurance purposes, three-dimensional ultrasound examinations of the prostate are performed in our clinic as part of the GreenLightTM laser surgery. These are used to determine the extent of the prostate tissue removal and to ensure that the excess tissue is removed as completely as possible.