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Medical Forum / Diseases and Disorders / Prostate BPH / January 2006PVP and TURP in same procedure
I am a 49 year old with pretty severe BPH symptoms and have been managing these over the past four years with flomax. But lately the urgency has gotton pretty severe and flow is very difficult especially at night. I have been seeing a urologist the entire five years and have visits every six months with an ultrasound and flow measure each time. My prostate is about 50 grams or so and I have a part of the prostate that sticks out like a flap over my urethra making urination difficult. Especially when my bladder is full. Recently the uro recommended a cyctoscopy and he didn't find any strictures in my urethra, but did confirm that the prostate is indeed obstructing the urethra. He said the prostate was "longer" than he had guessed it was based on the ultrasound. So we are now discussing the next steps. I have decided to have a procedure to have the prostate reduced. He hasn't given me his final recommendation yet, but after the cystoscopy he mentioned that he might recommend both a TURP and a PVP in the same procedure. I have been telling him about what I've read about PVP and the good results. He has used PVP as well as HOLAP but he is not an expert in PVP. One thing he told me about why TURP would be used is that this would give us a chance to get a biopsy of the prostate tissue. The other is that since I am relatively young, he would want the operation to have a long term benefit to me and not require another procedure. I will certainly ask more questions when we get together later this month to discuss how to proceed, and I told him I may even want to get a second opinion from a doctor who has a lot of PVP experience. Is combining PVP and TURP common? Does it make sense for a younger person? Should I just insist on the PVP or HOLAP without a TURP? He also gave me a reprint from Urology Times Sept. 2005 that compares HOLAP to PVP and seems to say the two are equivalent but the conclusion is that HOLAP is superior. > He > also gave me a reprint from Urology Times Sept. 2005 that compares > HOLAP to PVP and seems to say the two are equivalent but the conclusion > is that HOLAP is superior. This article may be found online at: http://ut.adv100.com/urologytimes/data/articlestandard/urologytimes/362005/17766 4/article.pdf I haven't read it yet. Will comment more when I do. But, I did notice that it was funded by a grant from Boston Scientific. Boston Scientific markets the Holmium laser manufactured by Lumenis. So, the authors *may* be biased towards saying good things about the Holmium laser. It is my rule of thumb when reading articles funded in such a manner to give greater weight to negative things said about the funded product (if any) and positive things said about the competition (if any). Positive comments about the funded product and negative comments on the competition must be read very carefully. As if to underscore this, this article was not really part of the September 2005 issue of Urology Times. It was distributed as a separate supplement. Regards, Lee Dear bph, I think there is no need in combining TURP with PVP if the surgeon is ready to be aggressive with PVP. I believe surgeons tend to be more and more efficient vaporizing tissue with experience, and also tend to be more and more aggressive with experience. If your prostate weights 50 g, PVP can be as radical as a TURP. Combining TURP and PVP transforms a minimally invasive operation (PVP) into a more complex one, you have to use electric current for the TURP and this adds the risk of sphincter and erectile nerve damage. I would not recommend it. I have no record of any paper mentioning this combination, although combination treatments have been used in the past combining Nd-YAG laser and TURP, a reflection that Nd-YAG laser was not effective enough. Regarding HOLAP and PVP, I guess there is no mature data yet comparing both techniques, and also, the first studies on PVP are performed by non-expert surgeons, and thus, results are not optimal. HOLAP has been around for more than 10 years, and it has not cached up. Recently I went to bilbao, in the north of spain to train a group of urologists who were using holap on how to perform a proper PVP. They were amazed of the speed of vaporization. Holap is much slower than PVP and they concluded it could only be used in very small prostates. So in conclusion, I would choose a PVP for myself, a 50 gram prostate could be treated in 60-75 minutes, and you could expect a great result if your surgeon is experienced. All the best, Fernando Gómez Sancha http://drgomezsancha2.blogspot.com bph...why are you repeating your posts. You wrote 3 of the same thing in the thread above this, and now you write this one in a new thread which has been reworded, but still the same stuff you wrote in the other one > I am a 49 year old with pretty severe BPH symptoms and have been > managing these over the past four years with flomax. But lately the [quoted text clipped - 30 lines] > HOLAP to PVP and seems to say the two are equivalent but the > conclusion is that HOLAP is superior. Hello Pete, > bph...why are you repeating your posts. You wrote 3 of the same thing > in the thread above this, and now you write this one in a new thread > which has been reworded, but still the same stuff you wrote in the > other one I appologize for the duplicative postings. This is my first time posting to a newsgroup and the Google service I was using didn't post the initial message immediately, so I rewrote it and sent it again and when the second posting didn't happen immediately I used another posting service. Sorry! >> I am a 49 year old with pretty severe BPH symptoms and have been >> managing these over the past four years with flomax. But lately the [quoted text clipped - 30 lines] >> HOLAP to PVP and seems to say the two are equivalent but the >> conclusion is that HOLAP is superior. > Hello Pete, > [quoted text clipped - 8 lines] > and when the second posting didn't happen immediately I used another > posting service. Sorry! No problem...just thought I'd let you know :-) I am in the early stages of communication with a new urologist. He has also mentioned the possibility of a combined TURP/PVP, depending on what he sees in the cysto. In light of Dr.Sancha's comments, I am a little skeptical. I will be seeing him later this week -- I'll let you know how that goes. |
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