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Laser TURP

Laser Transurethral Resection of Prostate for treating Enlarged Prostate

Located in front of the rectum and just below the urinary bladder, a prostate is a walnut-sized gland made of two lobes which is found in the male reproductive system. The prostate surrounds the urethra. Urethra is a tube-like structure through which urine passes out of the body.

In a condition called Benign Prostate Hyperplasia (BPH) which is also known as Benign Prostate Enlargement (BPE), the prostate gland starts growing in size. This happens over a period of time with age.

Sometimes the enlargement is sufficient enough to compress the urethra. When this happens the flow during urination is obstructed leading to signs and symptoms like the need to urinate frequently, blood in the urine, dribbling after ending urination etc.

A minimally invasive surgery for Enlarged Prostate-Laser TURP

Laser TURP is usually performed under aseptic precautions and short-acting general anaesthesia. A small calibre cystoscope is introduced into the bladder under camera control. A laser fibre, in this case Diode 980, is then introduced through the side channel of the cystoscope and laser ablation of the prostate is performed by delivering a several bursts of energy. The energy used is between 120 – 140 watts with an intensity level of II to III. A Foley catheter is placed in the bladder at the end of the procedure, and the same is removed after 24 – 36 hours. Normal saline is used as an irrigation fluid throughout the procedure.

Technology

The high power Diode 980 laser is used at our network hospitals for Laser TURP. Diode 980 laser is an advanced technology that has many advantages over other laser technologies available. Some of the important advantages are:
  • The Diode 980 Laser can burn the extra prostatic tissue at a much faster rate.
  • It has lesser depth of penetration of about only 0.001 mm and hence it is a safer procedure.
  • It can remove even the prostate gland larger than 60 g in just single sitting thus saving time stress.
  • It is a efficient technology since does not impair the doctor’s vision during the procedure
With the use of this diode laser, there is a lower morbidity and better outcome measures such as increase in flow rate and significant improvement in the International Prostate Symptom Score.

Advantages

Laser TURP is a minimally invasive technique and hence offer the following advantages over the conventional TURP technique:
  • There is no blood loss during the procedure and hence this Laser TURP is particularly beneficial in cardiac patients and patients with renal dysfunction who are at a higher risk of bleeding secondary to platelet dysfunction
  • The hospital stay for this procedure is much shorter. The average duration of hospital stay is around 36 hours for laser surgery, whereas in conventional TURP it extends up to 4-5 days
  • Laser TURP is deemed safer since the irrigation fluid used in the operating field is normal saline. Conventional TURP is rarely safe when the operating time exceeds 60 minutes due to the risk of TURP syndrome, a condition with high morbidity and mortality which results from absorption of the irrigation fluid such as glycine.
  • Laser TURP allows larger glands (>60 g) to be resected endoscopically. The very low risk of TURP syndrome and the ability of the diode laser to vaporize 3-4 g/min of the prostate gland is a major advantage against conventional TURP. In experienced hands, prostate glands of even 100 g or more can be tackled endoscopically using laser energy.
  • Postoperative stricture formation is avoided with laser TURP as small-calibre resectoscopes are used in this surgery. In contrast, conventional TURP surgery requires large-calibre rigid scopes.
  • Additionally, lithotomy position (a position in which the hips and knees are fully flexed with legs spread apart and raised and the feet resting in), which is mandatory for conventional TURP, but contraindicated after joint replacement, is not absolutely necessary for laser TURP.
  • Laser TURP is safer in cardiac patients. Anticoagulants or blood thinning agents, such as aspirin or clopidogrel, should compulsorily be withdrawn at least 10 days before the conventional TURP. This puts patients with a history of myocardial infarction at greater risk. The hospital stay is prolonged as the patient may require coronary care unit (CCU) postoperatively.
  • Laser TURP can be done under short general anesthesia, which is ideal in patients who are at high risk for anaesthesia. Conventional TURP requires general or spinal anesthesia.

Risks

TURP syndrome: It is one of the complications od conventional TURP surgery. Due to the irrigation fluid entering the bloodstream, the patient may develop certain symptoms such as temporary blindness, and rarely lead to seizures, coma, and death. There may be a manifestation of toxic shock and internal haemorrhage due to bacteria entering the bloodstream, although very rare.

Laser TURP, being a safer and faster procedure compared to conventional TURP can be offered to almost any patient with symptomatic BPE. However, it is specifically recommended for:
  • Patients on blood thinning agents such as heparin, aspirin and clopidogrel
  • Patients with renal dysfunction
  • Patients who have a prostate gland larger than 100 g
  • Male patients who have cardiac complications and are diabetic
  • Patients who have high risk for anaesthesia
  • Patients who have undergone joint replacement surgery
Laser TURP Package

Inclusions

  • Airport Pick-up and Drop
  • Hospital Stay in a Private Room as indicated above. One attendant can stay with the patient.
  • Nursing & Diet charges.
  • Routine lab tests
  • Admitting Consultant's visit charges
  • Surgeon’s Fees and OT Charges

Exclusions

  • Hospital stay after the said period.
  • Visit charges after the said period.
  • Cross consultations, if any.
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