The diagnosis is confirmed by a rectal examination, transrectal ultrasound and PSA assay that can determine the volume of the adenoma, its effect on the urinary bladder and in particular the vesical, and to differentiate it from cancer.
Treatment of prostate adenoma (benign prostatic hyperplasia) does not necessarily imply resorting to surgery. For treatment of prostate hyperplasia causing minor and harmless troubles, regular checks are generally sufficient. If there is discomfort in the patient’s quality of life, medical therapy may be prescribed. In cases where these measures are insufficient, surgery should be considered.
BPH (benign prostatic hyperplasia) surgery in most cases is carried out endoscopically, by accessing the prostate without opening the abdomen, through the urethra canal, with the help of an operative tool of reduced caliber, a resectoscope. Endoscopic resection of the prostate adenoma enables us to empty the gland by breaking the adenoma into fine shavings from the center to the periphery, while respecting the capsule of the prostate. The surgeon cuts the shavings while handling the resectoscope trolley with a loop connected to the current section and electrocautery coagulation. However, the prostate gland is richly vascularized.
Despite the hemostatic effect of electricity transmitted through the handle of the resection, there is usually bleeding that may be important in achieving during this surgery and there is also a risk of major bleeding in the post operative phase of this procedure. Especially for cardiac patients who are taking anticoagulants or antiplatelet medication, classic resection may represent a serious risk of hemorrhage.
At the end of the procedure, the surgeon places a vesical catheter to drain the bladder for washing practice and this catheter is removed when the urine is clear.
The REVOLIX laser radiation is transmitted by a silica fiber introduced at the end of the resectoscope. Prostate tissue is vaporized by the laser current with great precision and in a controlled manner. The tissues are fully respected as the thickness of the necrosis induced by laser cutting is only 0.2 mm.
The RevoLix, of German production is a surgical laser. The basic principle is the absorption of laser radiation 2 microns by water molecules present in tissues. At a sufficient power density to select a tissue, the necrotic area is less than 1 millimeter. The surgeon has various processing parameters which allows him to modulate his technique and the effect of the laser on tissue
This laser vaporization provides complete blockage of blood vessels. There is no bleeding. There is little hemodynamic disruption, especially for cardiac patients who are on anticoagulants and who can benefit through laser surgery for BPH with minimal trauma.
There is very little liquid flow irrigation in the blood circulation because the blood vessels are blocked immediately by the power of the RevoLix laser coagulation. Reabsorption syndrome is avoided. Therefore, cardiovascular problems during laser surgery are rarer than conventional techniques.
BPH surgery with laser RevoLix is a vapo-resection that raises prostate tissue and achieves an anatomo-pathological examination confirming the benign nature of the lesion.
As the laser allows bloodless prostate resection, the vesical catheter can be removed much faster than in conventional electric resection and the patient can usually go home the next day without the catheter.
In conclusion, the advantages of vapo-resection laser are:
- atraumatic surgery. Only pathological tissues are vaporized with precise control of the laser. Almost all prostate tissue left in place is not affected by the effects of the laser beam.
- Perfect Haemostasis: perfect for patients on anticoagulants. No risk of reabsorption syndrome.
- Obtain tissue samples for histological examination.
- Duration of hospitalization and use of vesical catheter permanently shortened.
Dr DAVODY speaks on his own behalf and does not benefit from any sponsership from the LISA LASER company.