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LASER TURP

Dr. Mohan KeshavamurthyMBBS,MS, MCh(Uro),FRCS(C),FASTS

SENIOR CONSULTANT UROLOGIST & TRANSPLANT SURGEON

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BENIGN PROSTATIC HYPERPLASIA

BPH-age related/androgen dependent

Increase in cell numbers or impaired programmed

cell death

Prostate has perpetual response to androgens unlike

any other organ

Familial predisposition/autosomal dominant

inheritance in younger patients needing surgery

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BPH

Destabilises reservoir ,weakens the pump and

increases pipe resistance

Detrusor instability- frequency/urgency Decreased detrusor contractility- poor

stream, hesitancy, increased residual urine

Increased urethral resistance retention ofurine

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BASIC TOOLS

Clinical evaluation

DRE

TRUS PSA

Urine culture

Co morbid factors-diabetes/hypertension/coronory disease

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COMPLICATIONS

Bladder stones

UTI

Bladder decompensation Incontinence

Hematuria

Acute retention

Compromised renal function/azotemia

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TREATMENT OPTIONS

Do nothing/alternative medicine????????

Medical management

Surgical management Innovative individualised methods

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MEDICAL MANAGEMENT

Alpha blockers

Androgen suppressors

Aromatase inhibitors Plant extracts

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MEDICAL THERAPY

Irritative symptoms > obstructive

No complications

Lifetime commitment Periodic followup

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SURGICAL MANAGEMENT

LASER TURP GOLD STANDARD

CONVENTIONAL TURP

TUIP

Open prostatectomy

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SEARCH CONTINUES..

IN 2004,AFTER CONVENTIONAL TURP,

MORBIDITY 15-20%MORTALITY 0.2-2.5 %

TRANSFUSION RATE 5-11%

2nd INTERVENTION 10-15%

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LIFE

LASER INDUCED FLOW ENHANCEMENT

AS A NEW GOLD STANDARD FOR BPH

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ADVANTAGES-LASER TURP

No Blood loss

No need to stop blood thinners

Ideal for large glands> 100 g

Safe in High risk patients

After Joint replacement Flexible scope,Flat position

No TURP Syndrome

Short Stay Procedure

Small calibre resectoscope. 18 Ch

Small calibre foley for shorter duration

No late Urethral Strictures

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LIFE SLV

Excellent hemostasis

Faster ablation rate

Unrestricted probe lifelarge glands possible

Absorption in water along with Hb decreases risk of

bladder/ureteric orifice damage

Invisible to human eye. Does not impair vision during

procedure

Smoother cavity surface left

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RESECTION TIME

Conventional wisdom of resection time beinglimited to 60 min

Conventional TURP . 1g/min

Holmium Laser... 0.5 g/min

KTP Green Light. 1-2 g/min

Diode 3-4 g/min

upto 160 wattsrevolutionary design

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Depth of Laser Penetration

Biggest drawback of Nd:Yag laser was the

extensive depth of penetration

Holmium is a contact laser..predictabledepth of penetration but no control

DIODE. What u see is what u get

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Seite 17

Transmission of different wavelengths

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DIODE LASER

Mobile equipment

No specific power requirement

No warmup time

Sturdyresets automatically with power outage

AnyOT ,anypatient ,anywhere ,anytime

Versatile

Local service support

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PATIENT DETAILS

Elderly gentleman

Diabetic, Hypertensive

Coronary artery stenting 2 years prior

Acute Retention of urinecatherised

TURP deferred since patient was on blood thinners

Cardiologist worried about the ongoing UTI

colonising the stent

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CONVENTIONAL TURP

Blood thinners to be stopped a week prior

Heparin to be started to cover the week

Heparin to be stopped 6 hours prior to surgery

Procedure usually requires blood transfusion

Patient to be managed I the coronary care unit (CCU)

postoperatively

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LASER TURP

Patient was admitted at FORTIS hospital with urinary

catheter in place

Blood thinners were not stopped

LASER TURP was performed under short lasting

laryngeal mask general anaesthesia

Procedure lasted 20 min

Uneventful recovery

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CONCLUSION

LASER TURP is a safe ,short stay procedure for

benign enlargement of prostate.

Ideal for High risk patients

Cost Effective

Fortis Hospitals has the entire laser armamentarium

as well as core competence to perform laser

urological procedures