The “gold standard” treatment procedure is a TURP (also known as a “roto-rooter”), first performed in the US in 1926. While there have been advances in this treatment technique, it is still very invasive. The average blood loss from a TURP is 500 cc (half a liter), and it requires a hospital stay. A camera and cutting device are advanced into the penis. The prostatic urethra and the internal urinary sphincter are carved out and the urologist will continue cutting out tissue until he or she feels an adequate amount has been removed. While this is an effective procedure, approximately 90% of men have retrograde ejaculation and approximately 5-10% of men have erectile dysfunction at some point following a TURP.
Because of the large amount of blood loss associated with TURP, GreenLight laser was developed. It is very similar to a TURP, except that instead of using a cutting device, a very high-powered laser is used to literally vaporize the prostatic urethra and tissue beyond.
In order to minimize the risks of BPH treatment, Prostate Laser Center, PLLC uses an FDA approved laser system to insert a very thin (1.85 mm) laser fiber through the rectum into the prostate under MRI guidance. By monitoring the laser energy in two different planes in real time, Dr. Karamanian can see the neurovascular bundles (responsible for erectile function) and ejaculatory ducts and avoid hitting them. This laser system is so precise, that its most common use is in the brain. While there are no guarantees in medicine, risks to the neurovascular bundles, internal urinary sphincter, and prostatic urethra are minimized. With this treatment option, the risk of retrograde ejaculation is less than 10% and the risk of erectile dysfunction is minimal.
Because we do not carve through the underlying anatomy, but rather ablate the excess tissue, initially patients urinary function gets worse before it gets better (due to swelling). This is why our BPH patients will keep the urinary catheter in for a week after the procedure. Most men return to baseline urinary function in three weeks and have significant improvement 6-8 weeks following the procedure.
The Prostate Laser Center, PLLC is the first center in the US to perform an IRB approved clinical trial for MRI guided transrectal laser ablation for BPH.
For more information on this trial, please visit the link below: