News

Laser Surgery to Treat Prostate Problems

(December 8, 2011) Until recently, men taking blood thinner medication had no surgical option for treating urination problems caused by benign prostatic hyperplasia (BPH) or prostate cancer. This group includes men who are on anti-coagulants because they have atrial fibrillation or cardiac stents, and those who take blood thinners to prevent stroke, heart attack, deep vein thrombosis or pulmonary embolism.

The only treatment choice for these men was to take additional medications to relax the prostate to make it easier for them to urinate. The disadvantages of managing urinary problems with medications include side effects such as impotence, breast enlargement, hypotension and cardiac arrhythmias – not to mention the cost, which can be prohibitive.

Now, all men with BPH can benefit from a new, more powerful type of laser treatment that has been offered at Phelps since September 2011. Even men taking blood thinners can receive treatment that allows them stop taking prostate medications permanently.

Phelps urologists Jack Hershman, MD, and Arno Housman, MD, had been using earlier versions of this laser system for years, but those lasers were not powerful enough to treat men on blood thinners or those with larger prostates. The new system, called Green Light XPS, is powerful enough to treat even large glands rapidly and it results in far less bleeding than older types of surgery because it seals blood vessels more efficiently as it works.

What Is BPH?

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate. The prostate is a gland in males that is located below the bladder and surrounding the urethra, the tube that carries urine from the bladder through the penis. The prostate grows to the size of a walnut by the teenage years, but may begin to grow again when a man reaches middle age. By 80 years of age, 80 percent of men have enlarged prostates due to BPH, which often causes symptoms. Untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems.

Symptoms of an Enlarged Prostate

An enlarged prostate presses on the urethra, which can cause obstruction of the flow of urine. This obstruction can cause problems including:

• Frequent urination, especially at night
• Weak urine flow
• Sudden urge to urinate
• Trouble starting and stopping urine stream
• Inability to completely empty the bladder
• Pushing or straining to urinate
• Pain or burning during urination

TURP—the Traditional Telescopic Surgical Method

Trans-Urethral Resection of Prostate (TURP) has been the gold standard of prostate surgery. During this surgery, performed while a patient is under general or spinal anesthesia, a surgical instrument is inserted into the urethra through a cystoscope, a very thin telescope that allows the doctor to see inside the bladder and trim away excess prostate tissue that is blocking urine flow. It is an operation that generally requires at least a one- to two-day stay in the hospital, continuous bladder irrigation while the patient is hospitalized to prevent blood clots, and leaving a catheter in place to drain urine from the patient’s bladder for one to three days. TURP is generally used to treat moderate sized prostates.

How Is Laser Surgery Done?

During laser surgery, a laser instrument is inserted into the urethra via a cystoscope while the patient is under general or spinal anesthesia. The laser delivers high-powered energy, which heats up tissue in the enlarged prostate and causes it to “vaporize,” resulting in a large channel for urine to pass through. The procedure takes from 30 to 90 minutes, depending on the size and anatomy of the prostate. The therapy has been shown to provide relief for at least five years.

Although an overnight stay is not necessary, many patients of Dr. Housman and Dr. Hershman remain overnight in the hospital. The next morning the catheter is removed and patients leave the hospital.

“Compared to TURP, this is a painless operation with reduced post-operative discomfort,” says Dr. Hershman. “Most patients can resume normal activities within a couple of days, and strenuous activities, including sex, within two to three weeks.”

“The real advantage to these patients is getting them off the prostate medications,” says Dr. Housman. “This is a safe, quick, well-tolerated procedure. Men who have been afraid to have surgery, or for whom surgery was previously not considered as an option, are now excellent candidates.”

Urlogists who perform prostate surgery with the Green Light XPS

Jack Hershman, MD, is board certified in urology. He attended medical school at Mount Sinai Medical Center. He completed a residency in general surgery at Lenox Hill Hospital followed by a residency in urology at Montefiore Hospital and Medical Center. Dr. Hershman has offices on the Phelps campus at 777 North Broadway, Suite 309 (914-631-3331) and at 132 Maple Street in Croton-on-Hudson (914-271-9331).

Arno Housman, MD, chief of urology at Phelps, is board certified in urology and serves on the hospital’s medical board. He hosts a local access cable TV show on medical topics called “Vital Signs,” which is produced by Phelps and also available for viewing on the hospital’s website (www.phelpshospital.org). Dr. Housman attended medical school at SUNY Downstate. He fulfilled his general surgery requirements at Kings County Hospital Center, followed by a residency in urology at Yale University School of Medicine. His private office is at 325 South Highland Avenue in Briarcliff Manor (914-941-0617).