Thanks, Derry , for posting the URL for the NICE consultative
document. A couple of immediate thoughts after a first quick look:

- I wonder if their specialist advisers have ever observed a PVP
procedure - or even looked at the videos on the Laserscope website.

- They observe in passing that PVP is unlikely to replace TURP because
the equipment cost is too high. Provided PVP encounters no unexpected
late problems, I wonder if NICE realise the pressure which will build
up, especially from people like Derry and myself who are still
working, and for whom the recovery time from TURP is simply
unacceptable (quite apart from all that unpleasant business with
postoperative bleeding, bladder irrigation etc.)

Now from the general to the particular - me! I've had two attempts
already to sort out my BPH: Targis thermotherapy in mid-2000, and a
TUIP at the end of 2001. Both worked initially but didn't last. I'm
starting to get flow problems again, and a recent cystoscopy confirmed
quite a lot of obstruction. Till recently I'd have resigned myself
finally to the TURP I've been trying so hard to avoid; but after some
early scepticism I'm now convinced that PVP really is in effect a TURP
without many of the drawbacks.

It's not currently done here in Singapore, but it *is* offered at a
hospital I'm familiar with in Bangkok, and they'll have six months'
experience of doing it by December, when I've provisionally scheduled
surgery. (They've quoted a total cost equivalent to about US$5,000, by
the way.)

However, I've just had interesting news; a local hospital is about to
install a Gyrus PKVP machine. The initials stand for plasmakinetic
vaporisation of the prostate, and it's a high energy radio frequency
process which is claimed to achieve much the same results as PVP - a
TURP-like cavity without most of the TURP drawbacks.

I'm seeing the head of urology at the hospital on Saturday; if nothing
else, I'm interested to find out why they went for PKVP rather than
PVP. Has anyone currently on this group had experience of the
procedure, or investigated it thoroughly?

If you haven't heard of it, it's worth doing a search for 'Gyrus
prostate', in this group's archives in Google Groups and also in
Google itself. The material available is limited, but it's
interesting. It'seems 22 hospitals in the UK are using PKVP, and over
40 worldwide, with 1000+ patients treated.

Laserscope may possibly have a real rival - which would be healthy, I
think, impressed though I am with PVP.

Richard Slessor

Just had a look at this... not very impressed.
Apart from stating that TURP has relatively high morbidity, there is
no further comparison between methods. The document mentions "safety"
several times, as though PVP is hazardous. What is in fact meant by
safety is mostly short-term adverse side-effects, which tend to be
worse with TURP anyway.

The Specialist Advisors seem worried about need for training, learning
curves. What surgery does this not apply to?

They refer to three studies into PVP, one of which was in the UK in
1999. [Do we know anything about that one?]. They complain that these
are uncontrolled studies, but I don't see why they couldn't have found
a couple of sets of roughly comparable TURP before/after figures, so
readers could get an idea of the "safety" of TURP!

I'll send NICE my comments, just as soon as I can think straight. Got
this  irritating constant urge to pee at PVP+28 days, due possibly to
infection that's being treated with cipro.