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Laser surgery replacing TURP
The standard surgical treatment for bladder outflow obstruction caused by
benign enlargement of the prostate gland is Trans Urethral Prostatectomy (TURP). Now, it is
increasingly being replaced by laser surgery.
The early work with lasers in prostatic disease was disappointing. Most
centres that evaluated laser prostatectomy at that time gave it up after a couple of years.
The utilisation of the Holmium-YAG laser by urologists Mark Fraundorfer and Peter Gilling in New
Zealand proved a more robust method and they and others have developed their technique over the
past ten years.
It is now possible to shell out individual lobes of the prostate using
the end fire laser as a dissecting and cutting tool (Holmium Laser Enucleation of the Prostate,
HoLEP). In this way much larger prostates can be treated without the significant risks of
bleeding or fluid absorption seen with TURP. The long term benefits have been proven in
randomised clinical trials and the procedure is now recognised by the National Institute of
Clinical Excellence (NICE) in the UK.
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Surgeon's view of the laser fibre being used to cut away part of the
prostatic tissue
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Initial experience at Guys and St Thomas’ Hospital with the Holmium laser has
been encouraging. It has allowed us to treat patients who would otherwise be considered
unfit for prostate surgery. Although the procedure takes appreciably longer the advantages
of reduced bleeding, reduced catheter time and reduced inpatient stay are obvious.
The rapid progress in laser prostate surgery over the last few years is
challenging the place of TURP as the gold standard operation for patients with bladder outflow
obstruction. It is still early days but urological progress is led by technological advance
and I have no doubt that laser prostatectomy will change the face of surgery for bladder outflow
obstruction.
Rick Popert MS FRCS (Urol)
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