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.

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).