How does it work?

Although we had in TURP a very good and tested operation, there are side effects and costs associated with it. This led to many minimally invasive approaches over the last decade. Sadly most of these were abandoned due to or a high risk of pain or other side effects compared to TURP, or because they simply did not work!

Previous Attempts with Lasers

Many laser energies have been used in the prostate before now, but limitations on laser power have meant removal of significant amounts of prostate tissue (the real test) has been impossible or unfeasibly slow. The only two contenders for the TURP crown up until now have been prostate electrovaporisation (easy to learn but higher risk of infection, impotence and incontinence) and holmium laser prostate enucleation (as effective as TURP but extremely difficult to learn and associated with severe operative complications in all but the most expert hands).

The Greenlight HPS system from AMS addresses this problem by means of delivering a very powerful modulated  laser beam which is absorbed by the haemoglobin pigment in tissue. This means that when the laser is applied to prostate tissue massive localised heating of the tissue occurs resulting in instantaneous vaporisation: due to the laser -  characteristically bleeding is close to zero.

Our results show that prostates of any size can be treated, with most men seeing their symptoms improve by two or three fold in the first six weeks. Many men have continuing benefits developing up to nine months after surgery

The technique allowsrapid creation of a generous prostate cavity with almost no bleeding.  More than 50% of men can leave hospital on the day of surgery without a catheter, with most others having a soft small catheter for around 18 hours at home (many men remove this themselves)Althoughwe placed catheters post operatively in our initial evaluation period, only a few men have had to have a catheter for more than 12 hours (these have usually been in urinary retention patients, and nearly all have voided extremely well on final catheter removal.  Strikingly, very few patients report pain after the procedure: pain and burning on urinating have limited both laser techniques and TURP in the past. About one man in ten will get some burning which may need a fe weeks of simple painkillers to ease the discomfort. Sexual side effects are reduced compared to the standard technique.  While very long term results are awaited, the figures after five years of follow up show improvements in symptoms and urological measurements comparable to historical TURP data (about one man in fifty requiring reintervention each year).  In particular it appears the prostate tissue removal seen at the time of surgery is genuine when assessed by post-operative prostate ultrasound (between 40-60% of tissue reduction is seen).  

Post operative bleeding and discomfort can occur, but aremuch  less than with standard TURP, and many men have gone back to work or normal activities within a couple of days, with sport and other activities being possible within a week or two. Of course, some men do take longer to recover and those men with very overactive bladders or catheters pre-operatlively may take some time to settle afterwards.

Anticoagulation, large prostate size (>100g) and poor cardiac status are not contraindications to the procedure, even as a day case.

Our results have been presented at a number of international meetings including the European Association of Urology and the American Urological Association Meeting. In particular our data on large prostates and the absence of absorption of irrigating fluid has attracted much interest. Mr Muir isa founder member of the International GreenLIght Users' Group, which seeks to fine tune and improve further the results from this therapy.

IPSS Symptom scores changes following PVP to one year

The initial score of 23 on the IPSS system shows that most men were suffering severe symptoms which reduced by almost threefold within sixweeks.

Urine flow rates at the same stage and out to five years in our series showimprovements of more than 100%.  

GreenLight Training Courses at King's College Hospital

(for urological surgeons wishing to learn the technique)

Course director: Gordon Muir, Consultant Urologist

The course will be in the format of small group teaching with a mixture of didactic presentations linked to live 2 way videoconferencing observing a number of prostate vaporisations in the operating theatre downstairs from our conference room.. There will be an opportunity to visit our state of the art integrated operating theatres during procedures to observe the set-up and logistical issues relating to prostate laser surgery.

The objectives of the course will be that at the end of the course participants will be able to:

• Understand the indications and contraindications for GreenLight PVP
• Explain the mechanism of action and efficacy of high power KTP-YAG laser energy
• Control an operating theatre with a GreenLight laser installation
• Apply their understanding of the GreenLight PVP procedure to their clinical practice

Topics covered in the course include:

GreenLight PVP results

Previous lasers: problems and successes

Why green light? Laser physics and safety

Live cases

Theatre and nursing issues

Discussion: how to startup, avoiding complications

Certificates of GreenLight laser training and CME credits will be awarded to those who have successfully completed the training course. CME accreditation has been applied for.

Refreshments and lunch are included in the course fee

Course dates at King's College Hospital

6th April 2009

11th May 2009

8th June 2009

6th July 2009

Training video (NB this is NOT a substitute for attending a properly run course and having mentoring for the surgical technique)

for further information on courses contact [email protected]

Copyright (c) 1999-2001 GH Muir. All rights reserved.
[email protected]