Question

Describe LASER treatments in BPH.

Hint:

Laser treatments in BPH are effective for reducing prostate volume and improving symptoms, with minimal bleeding and quicker recovery times compared to traditional surgery.

Answer 1

Step 1: Introduction to LASER Treatment:
Laser therapy is a minimally invasive treatment option for benign prostatic hyperplasia (BPH) that uses focused light to remove or vaporize prostate tissue. LASER therapy is used for patients who do not respond to medications or prefer a less invasive option than surgery.

Step 2: Types of LASER Treatments:
1. Holmium Laser Enucleation of the Prostate (HoLEP): This is one of the most effective laser techniques, where the prostate tissue is enucleated using a holmium laser and then removed with a morcellator.
2. Greenlight Laser Vaporization (PVP): This method uses a high-powered laser to vaporize prostate tissue, shrinking the prostate and improving urinary flow.
3. Diode Laser Vaporization: Similar to Greenlight, it uses a diode laser to vaporize tissue but may be associated with less bleeding.

Step 3: Indications for LASER Therapy:
- Enlarged prostate causing urinary retention.
- Refractory to medical management.
- Patients who are poor candidates for invasive surgery due to comorbid conditions.

Step 4: Advantages of LASER Therapy:
- Minimal bleeding: LASER treatment minimizes bleeding, making it ideal for patients on anticoagulants or with clotting disorders.
- Faster recovery: Most patients experience a shorter hospital stay and faster recovery compared to traditional surgery.
- Improved urinary symptoms: LASER therapy effectively improves urinary symptoms such as frequency, urgency, and nocturia.

Step 5: Complications of LASER Therapy:
- Bladder neck contracture: A narrowing at the bladder outlet, which may require further intervention.
- Urinary incontinence: Temporary or permanent incontinence may occur in some cases.
- Erectile dysfunction: There is a small risk of sexual dysfunction, particularly with more invasive laser techniques like HoLEP.