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I am 87 years old, with a problem of the prostate gland. Before I met Dr. Baum, I went to the bathroom every 30-60 minutes. After Dr. Baum's treatment on my prostate, I go only 5 times per day and only 1 time at night! You turned my life around. I am so very grateful!

-Sidney Daigle


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-Gerald Wallace

 


Treatment of the Enlarged Prostate With the Green Light Laser

Most men over the age of 50 years have a condition called the enlarged prostate gland or BPH which stands for benign prostate hyperplasia.  In this video, we will describe the function and purpose of the prostate gland, the symptoms of the enlarged prostate gland and what treatment options are available for this common condition that affects nearly 14 million American men.

The prostate gland is a walnut sized organ located at the base of the bladder and surrounds the urethra or tube inside the penis that transports urine from the bladder to the outside of the body.  This enlargement of the prostate gland is a benign condition and is not to be confused with prostate cancer, which is a malignancy and an entirely different disease.  The prostate gland produces the fluid that mixes with sperm and exits the body as semen at the time of ejaculation and orgasm.  When men reach middle age, for reasons not entirely clear, the prostate gland enlarges.  As it enlarges it compresses the urethra, the tube in the penis that transports urine from the bladder to the outside of the body.  As a result of this compression, men have difficulty with urination.  The symptoms include frequency of urination, urgency of urination, a decrease in the force and caliber of the urinary stream and getting up at night to urinate. 

The diagnosis of prostate gland enlargement is made by a careful history and physical exam including a digital rectal exam.  A few tests such as a urinalysis and PSA or prostate specific antigen blood test is performed to be sure that the symptoms are not due to a urinary tract infection or to prostate cancer.  Additional tests may include a cystoscopy, which is a look into the bladder with a tiny lighted tube.

One treatment option is watchful waiting or no treatment and have the man return on an annual basis for a symptom check, a digital rectal exam and a PSA test.  This option is for men who have mild to moderate symptoms, a negative digital rectal exam and a normal PSA test. 

First line treatment usually consists of medication.  There are two classes of drugs that are used to treat the enlarged prostate gland.  They are alpha-blockers and 5-alpha reductase inhibitors.  Alpha-blockers relax the muscles in the prostate and the urethra which improve the flow of urine through the urinary tract.  The 5-alpha-reductase inhibitors block a hormone that actually causes the prostate gland to shrink in size.  These drugs are effective but may lose their effectiveness with time and they also have side effects such a decrease in the volume of the ejaculation and becoming lightheaded. 

Minimally invasive procedures include microwaves and radio frequency that heat the prostate gland and increase the opening in the urethra to promote the flow of urine from the bladder to the outside of the body.  The procedure requires the sue of a special catheter which delivers the microwave energy to the prostate tissue.  The catheter is inserted through the penis and positions the microwave energy source next to the prostate tissue.  A small sensor is placed within the rectum to monitor the rectal temperatures and to prevent rectal injury during the procedure.  The advantages of the microwave treatment include: 1)  that it can be accomplished in the office or outpatient setting.  2) The procedure does not require a general anesthetic but is done with a local anesthetic inserted into the urethra a few minutes before the procedure.  The actual procedure takes about 30 minutes.  The disadvantages of the microwave procedure is that the heat generated by the microwaves causes swelling of the prostate and thus most men require a catheter for a day or two after the procedure.  Also large prostate glands or those men with prostate glands that have grown into the bladder cannot be adequately treated with microwave therapy. 

Surgical therapy includes transurethral resection of the prostate gland or TURP and surgery that requires an incision to remove the blockage that causes the symptoms.  The TURP has been the standard of care for nearly 50 years.  The procedure consists of the insertion of special instrument that allows visualization of the prostate gland and then an electric current is transmitted to a wire that cuts through the prostate tissue.  The procedure takes 30-60 minutes and requires a spinal or general anesthetic and hospitalization for 1-3 days and several weeks of restricted activity.  One disadvantage of this procedure is that it results in loss of the ejaculation at the time of orgasm where the semen goes back into the bladder and then is passed in the urine at the next urination. 

An open surgical procedure is reserved for very large prostate glands.  This procedure requires hospitalization for 3-5 days and 4-6 weeks of recovery before men can resume all activities. 

In 2005, a new treatment option became available for treating the enlarged prostate gland. A high energy source is used through a laser fiber to reduce the prostate tissue.  The GreenLightLaser Therapy is a procedure performed with a small fiber that is inserted into the urethra through a cystoscope, which is a small tube that is inserted in the penis. The fiber delivers high-powered laser energy which quickly heats up the prostate tissue, causing the tissue to vaporize. This process is continued until all of the enlarged prostate tissue has been removed. Natural urine flow is rapidly restored and urinary symptoms are quickly relieved in most patients immediately after the procedure has been completed. 

The Green Light Laser treatment is performed in the hospital or outpatient surgical center.  It is done with the patient asleep or after administration of a spinal anesthetic.  Most men leave the hospital after the procedure without a catheter and have marked improvement in their urinary symptoms.  The side effects after the procedure may include burning on urination, frequency of urination, and blood in the urine for a few days.  The procedure is very effective in 85% of patients and is known to have results that last for many years.  The procedure is much less invasive with fewer side effects than the standard transurethral resection of the prostate or TURP.   There have been nearly 400,000 men who have received the GreenLight Laser throughout the world. 

Before treatment your physician or anesthologist may give you medication to help you relax during the procedure. You will also receive an antibiotic before the procedure to avoid infections.  You will be asked to use an enema before the procedure so you will not have to worry about having a bowel movement for a few days afterwards.  Ask your doctor about your medications such as blood thinners and even aspirin which may be stopped for a few days before the procedure.  If you take regular medications, you need to inform the doctor as you may be able to take these medications with a sip of water before you come to the hospital.  You will be asked to avoid taking any other food or fluid after midnight before your procedure.  It is suggested that you wear loose or comfortable clothing and that you have a ride home after the procedure. 

Let’s look at what you can expect if you have a GreenLight Laser procedure. You will be provided anesthesia that will allow you to sleep through the entire procedure and not experience any pain or discomfort. Once you are asleep or the anesthesia block takes effect, your physician will insert a cystoscope, which is a small, lighted tube through the urethra.  The laser fiber is introduced through the cystoscope and advanced into the urethra at the location of the prostate. With the laser fiber in the proper position, the doctor uses the fiber to vaporize or remove the enlarged prostate tissue until the obstruction is completely relieved.  The procedure requires 30-60 minutes to complete.  At the end of the procedure the physician may place a temporary catheter to let urine drain from your bladder.  You will then be taken to the recovery room until the anesthetic wears off and given an opportunity to urinate after the catheter is removed.  If you can urinate, you will be discharged from the hospital or the ambulatory treatment center. 

The side effects after the procedure may include a small amount of burning on urination, frequency of urination, and blood in the urine.  Most of these side effects will subside within a few days after the procedure.  You may pass some prostate tissue for several days or weeks after the procedure.  The procedure is very effective in 85% of patients and is known to have results that last for many years.  The procedure is much less invasive with fewer side effects than the standard transurethral resection of the prostate or TURP.  

If there is bleeding after the procedure, you are coming from a great distance from your home to the hospital, or if you are on certain medications such as blood thinners, the doctor may decide to leave the catheter for a few hours or over night and have the catheter removed the next day.  If the doctor decides to leave the catheter in place, heshe will tell you when to come back to the office for the removal of the catheter or the tube. 

You can expect to return to normal activities including sexual intimacy in three to four weeks after the procedure.  Your doctor will probably recommend that you avoid bicycle riding for several additional weeks because the bike seat can irritate the prostate gland. 

The risks and side effects of the GreenLight Laser include a small amount of bleeding, a slight risk of a urinary tract infection which can be treated with antibiotics, backward ejaculation where the semen moves into the bladder at the time of orgasm and then is evacuated with the next urination.  The GreenLight Laser procedure does not effect potency or your erections. Erectile dysfunction is a rare side effect of the procedure.  Finally, the procedure, which is usually very successful in improving your urinary symptoms, may not improve the symptoms and another procedure needs to be performed to treat the urinary problem. 

So what will the procedure accomplish?  You can expect an immediate improvement in your urinary symptoms.  This means an improvement in the force and caliber of your urinary stream, less getting up at night to urinate, less frequency and urgency of urination.  The bottom line, is that you can expect a marked improvement in your over all quality of life. 

In summary, prostate enlargement is a common condition that affects most men after age 50.  The diagnosis is easily made and there are several treatment options for treating the enlarged prostate gland.  One of those options is the GreenLight laser.  For more information, talk to your doctor.