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Minimally invasive prostate enlargement treatment vs. more minimally invasive treatment. GreenLight Laser vs. Rezum.

popeye-the-sailor-bluto

The GreenLight uses laser energy to vaporize prostate tissue. The obstructing prostate tissue is destroyed or removed at the time of the procedure.

Rezum uses radio frequency generated steam injected into the prostate tissue to bring about changes that will over time shrink the prostate tissue away from the channel men urinate through.

The effect of the GreenLight procedure is for the most part immediate. The effect of the Rezum occurs over time.

The Rezum is “more” minimally invasive because it takes less time to perform, nothing is cut or destroyed and essentially very little risk of bleeding. There is usually 2-4 nine second treatments with Rezum and the steam is injected through a small catheter by way of puncturing the prostate.

So…who should choose which?

You can do the GreenLight with good results on most any obstructive prostate. However is a patient has been in retention (can not urinate at all and has a catheter) or is having  significant obstructive urinary symptoms and is near retention…then the Rezum is not an ideal treatment. In this scenario the patient needs relief of the obstructing tissue now and not a slow resolution over time.

For that patient who would be a poor candidate for anesthesia, is having moderate prostrate enlargement symptoms, the prostate is moderately sized, and likes the option of an in office procedure, then the Rezum fits the bill. In other words if there is some time necessary for the steam to affect and open the channel then a patient with impending retention needs a procedure that the effect is immediate i.e. destruction of tissue at the time of the procedure. With the GreenLight no evolution of the prostate tissue is necessary.

The patient’s voiding history and the findings of cystoscopy will dictate the procedure best suited for the patient and the one recommended by the urologist.

Northeast Georgia Urological Associates offers both of the above forms of treatment as well as the traditional  prostate procedures. If you are having voiding symptoms due to prostate enlargement, you can contact us 24/7 using the form below. Include your phone number and we will call you with a time for your consultation.

 

 

Restoring flow to bring rapid relief

The alternative to traditional treatments of benign prostatic enlargement.

Inside Health

urologyFrom the age of about 40, men will start to develop changes associated with an enlarging prostate and may suffer from symptoms such as frequent urination, difficulty starting and a weak urine flow, urgency and incomplete bladder emptying.

An enlarged prostate, known as a benign prostatic hyperplasia (or BPH), is a condition in which the prostate changes shape and size and narrows, blocking the urethra (the tube that carries urine from the bladder through the prostate).

Urologist Dr Shane La Bianca from Perth Urology Clinic says symptoms associated with BPH can be difficult to ignore and can interfere with living a regular, healthy life.

“Frequent urination can disrupt your sleep, as well as your partner’s, and lead to tiredness and irritability,” Dr La Bianca says.

“In older patients, it can also increase their risk of falls during the night as they get up to find the toilet.”

“Having a constant need to urinate and then not being able to pass urine properly during the day can really affect a…

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What is the verumontanum and why is it important during GreenLight Laser procedure?

The verumontanum is an important anatomical landmark for the urologist doing any operative procedure on the prostate. It represents the stopping point of resection or laser treatment in prevention of post operative incontinence.

Northeast Georgia Urological Associates

There are four features of the prostatic urethra seen immediately below. Furthest from view is the median lobe of the prostate which is positioned horizontally. Proximal to this is the bladder which cannot be seen due to the obstructive components of the prostate. Closer to the viewer are the median lobes of the prostate which come in to the channel of the prostate on the left and right and in addition to the median lobe cause the obstruction of urine flow. Then in the foreground is the verumonatum which is raised area in the prostate and where the seminal vesicles empty fluid from the seminal vesicles and testicles.

The significance of veru is that this represents the point of the prostate where the urologist stops the resection or laser treatment. Beyond the veru is the external sphincter and if this is resected or damaged then there is a risk of…

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Tomatoes and prostates? A tomato a day will keep the urologist away.

Saw Palmetto and tomatoes (lycopene) not a bad combo for prostate enlargement in the male with voiding symptoms.

Northeast Georgia Urological Associates

The apple ain’t got nothing on the tomato!

download-2-toma

Article Reviewed: Lycopene Inhibits Disease Progression in Patients With Benign Prostate Hyperplasia. Schwarz S, Obermuller-Jevic UC, et al: J Nutr; 2008; 138 (January): 49-53.

Lycopene Inhibits Disease Progression in Patients With Benign Prostate Hyperplasia.

Schwarz S, Obermuller-Jevic UC, et al:
J Nutr; 2008; 138 (January): 49-53

Background: Lycopene is a carotenoid found in a variety of healthy foods such as tomatoes, watermelon, and pink grapefruit. It has garnered interest in the area of prostate cancer prevention, but has yet to receive adequate attention in the area of benign prostate hyperplasia (BPH). Objective: To determine the serologic, tissue, and clinical impact of higher plasma lycopene levels in patients with histologically proven BPH. Design/Methods: This was a randomized trial of 40 patients who received 15 mg per day of lycopene from a dietary supplement or a placebo for 6 consecutive months. Patients…

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Why haven’t urologists embraced the GreenLight Laser for enlarged prostate?

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Traditionally urologists have surgically treated an enlarged prostate associated with obstructive voiding symptoms by performing a TURP (transurethral resection of the prostate).  When you do a TURP you don’t have to wear glasses (the GreenLight Laser glasses change the color of everything the surgeon sees and can be uncomfortable) and the action of the urologist’s fingers on the resectoscope has a direct effect on the resectoscope loop which does the removal of the obstructing prostate tissue. The TURP is one of the signature procedures that all urologists perform in residency and it is still considered the “gold standard” for the treatment of BPH.

Enter the GreenLight Laser-You have to wear the uncomfortable glasses which changes the color of everything (including blood-it is no longer red), the instrument you use is smaller than a resectoscope and so there is less volume of the irrigation fluid which affects visibility, the fiber does not cut like a TURP but vaporizes, the laser comes off at an angle (so unlike the resectoscope and TURP the action of the laser does not match the fingers and is an unnatural maneuver for the urologist accustomed to a TURP), at times because of the angle of the laser light goes away from the fiber and the urologist’s field of vision it is sometimes difficult to actually see where the  laser is contacting the prostate, and finally because of the smaller instrument and as a result less irrigation fluid-any bleeding makes a much bigger difference in visibility than the same amount of bleeding with the TURP.

So…if the GreenLight is so “bad and difficult” why do some urologists-like yours truly- prefer it as their BPH surgical modality of choice?  It takes less time to perform, there is less bleeding, the catheter can come out sooner and it can be done almost exclusively on an out patient basis. For our practice, the ability to offer this procedure to our patients in our ambulatory surgery center represents a vast advantage in not having to go to the hospital and what that entails.

We do GreenLights all the time at our surgery center look forward introducing you to the procedure anytime.  Contact us 24/7 and leave your number below and we’ll call you for the consultation.  Below the contact form is an actual GreenLight procedure performed by Dr. McHugh if you want to see what the urologist sees.

Causes and Statistics of BPH-Georgia GreenLight Laser

Causes and Statistics of BPH.

What are the causes and statistics?

Causes

Prostate enlargement occurs naturally as a man ages. No one knows exactly why the condition occurs, but it is one of the most common diseases among aging men.1

Statistics

BPH affects approximately 50% of men between the ages of 51 and 60 and up to 90% of men over the age of 80.2 BPH affects more than 27 million men over 50 each year in the United States3 Up to 95% of men with moderate symptoms are unhappy and don’t want to spend the rest of their life with these symptoms4 If left untreated, BPH can lead to complications including infection; renal failure; and urinary, bladder, or kidney stones.2,5


The evolution the laser for the treatment of prostate enlargement. Northeast Ga Urological Assoc.

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My dog Penelope has nothing to do with the laser of the prostate although dogs, males that is, have a prostate too. I just liked the “green” in the picture. She has just taken a swim to “get her stick” and is just “skakin it off.”

In regards to the evolution of the laser in the treatment of the prostate, the following article is very interesting and informative. It discusses PVP, which is the type of laser the GreenLight is, and other forms. In my thirty years of practicing urology, I have used about all of them. The GreenLight to me is by far the most beneficial in terms of ease of using, lack of bleeding, outpatient, and limited need for post operative catheter.

What’s on the horizon? Well there is now the Urolift and Rezum. One uses a device to pull the prostatic urethra apart and the other uses steam. I’ll talk more about them later.

The evolution of the laser in the treatment of BPH.

Moma was right! Eat your vegetables and help your prostate.

Vegetable Intake May Reduce BPH

Urology – November 15, 2007 – Vol. 23 – No. 07

A diversity of plant-based foods are heart healthy and prostate healthy.

Article Reviewed: Fruit and Vegetable Consumption, Intake of Micronutrients, and Benign Prostatic Hyperplasia in US Men. Rohrmann S, Giovannucci E, et al: Am J Clin Nutr; 2007; 85 (February): 523-529.

Fruit and Vegetable Consumption, Intake of Micronutrients, and Benign Prostatic Hyperplasia in US Men.

Rohrmann S, Giovannucci E, et al:
Am J Clin Nutr; 2007; 85 (February): 523-529

Background: Heart disease and various urologic conditions are both based partially on a chronic inflammatory process. Nutrients in healthy foods may not only be heart healthy but also prostate healthy. Objective: To evaluate the impact of fruit, vegetable, and nutrient consumption on the risk of benign prostatic hyperplasia (BPH). Design/Methods: One of the largest prospective epidemiologic studies in the world is the Health Professionals Follow-Up Study (HPFS). The average age of the men was 52.54 years, and every 2 years, the health status of the participants was determined by questionnaires and medical records for a period of >14 years. BPH cases were men who reported having surgery or who had an American Urologic Association symptom index (AUASI) of 15 to 35 (n=6092). Men without BPH (controls) had an AUASI score of >7 (n=18,373). Men with an AUASI of 8 to 14 were not included in this study (n=7800). Results: Intake of vegetables were significantly (P =0.03) and inversely correlated with BPH, with the highest consumption being associated with 11% reduction in risk. However, fruit intake was not associated with the risk of BPH. The most significant reduction in the risk of BPH was found for increasing vitamin C intake from food (P =0.009). Vitamin E intake from foods was not associated with the risk of BPH. Conclusions: A diet high in vegetable intake may lower the risk of BPH. Reviewer’s Comments: The highest intake of fruits and vegetables was almost 10 servings a day in this study! However, I find it most interesting that men with the highest intake of healthy foods also were less likely to smoke, more likely to drink in moderation, more physically active, and had the highest intake of dietary fiber per day.

In other words, this study sends two very important messages: (1) the sum of what one does in moderation provides a bigger benefit than one or two healthy behavioral changes in extreme, and (2) life is not about pomegranate versus tomato juice but a diversity of fruits and vegetables is the best behavioral method. The patient should pick what they like in terms of fruits and vegetables, and not what just looks good on the nightly news (Reviewer–Mark Moyad, MD, MPH).