Transurethral resection of prostate

Transurethral resection of prostate and laser prostatectomy

Transurethral resection of the prostate remains the gold standard for treatment of bladder outflow obstruction due to benign prostatic hypertrophy. It has low morbidity and mortality generally, however, the following disadvantages

• Irrigation, 2-3 days stay. Large catheter!
• Causes bleeding, infection, fluid re-absorption, re-admissions, strictures, sexual dysfunction
• Current role for large prostates and if tissue is required for histology

The aim is to remove the bulk of the prostate gland whilst leaving compressed normal peripheral tissue which minimises the risk of bleeding from the subcapsular venous plexus.

Divots or chips of tissue are excised using a rectoscope with a cutting diathermy wire loop.

The operation is undertaken with a continuous glycine solution infusion (monopolar TURP) or saline (bipolar TURP) The prostatic chippings are sent for histology and occasionally prostate cancer is diagnosed.

Laser prostatectomy (GreenLightXPS)

• Evaporation of prostate using laser, rather than removing chips.
  • Less bleeding, less hospital stay
  • Safer with similar outcomes -GOLIATH study
  • Recommended by NICE
  • More definitive and for prostates up to 100 ml any shape
• procedure can be done either as day-case or inpatient treatment. A laser fibre is passed through a cystoscope to vaporise the enlarged prostate, leaving a clear urethral channel. In 'coagulation' mode, GreenLight XPS can also seal (cauterise) any bleeding vessels that may result from photoselective vaporisation
• GreenLight XPS laser operates at a shorter wavelength (532 nanometres) than other laser systems used to treat BPH. Shorter wavelength light is absorbed by oxyhaemoglobin (in blood and tissue), which vaporises the tissue, leaving no fragments behind. GreenLight XPS uses a proprietary MoXy laser fibre, which is actively cooled using a flow of saline to improve fibre durability.

Holmium Laser Enucleation of Prostate (HOLEP)

• a laser is used to enucleate prostate endoscopically, similarly to the open techniques for prostates over 100 g in size

Reference:

• 1) NICE (June 2016). GreenLight XPS for treating benign prostatic hyperplasia