A couple of days ago I posted to this group the submission I made in
response to a UK consultation document on PVP. I had to cut it quite a
lot to fit their length limitations, and it occurred to me that some
of the original version might be quite relevant to this particular
discussion. I'll quote it below.

I think the extract sums up quite neatly what I personally think of
TURPs - and why I've overcome some initial scepticism about PVP.

TUMT only worked for a quite short period for me - little more than a
year. I've noted one or two people posting similar comments here over
the past months; of course, those whose radio frequency treatments
were successful may not feel any need to be around here any longer, so
the posts may not be typical of overall results.

Tissue does seem inherently more likely to grow back after TUMT than
after PVP, though; one of the things I like about PVP is that it seems
to remove pretty much the same amount of tissue as a traditional TURP,
but with a lot less 'morbidity', as the doctors say.

Here's the extract:

I think it is important that decision makers should understand just
how much BPH patients dislike the TURP procedure. No doubt it is
effective for a reasonable period of time in most people, but its
image among many patients is that of a rather primitive procedure which
needs to be replaced as soon as a genuinely effective (and safe)
alternative is available.  Even your own consultation document refers
to 'the relatively high morbidity from this procedure'.

It seems to have become something of a mantra among urologists that
'TURP is the gold standard'; at best the gold is extremely tarnished,
and indeed it seems a little unwise for TURP's proponents to compare
it with something which was abandoned by the UK in 1931, and by the
USA over thirty years ago!

No doubt TURP procedures are a normal part of the weekly routine for a
urologist, but they are extremely disruptive of the routine of
patients. I suspect part of the problem is that BPH tends to be
thought of as a disease of inactive old men, who have nothing better
to do than take it easy and lie around waiting for the raw prostatic
cavity to stop bleeding and eventually heal.  In fact many BPH
patients needing more than just drug therapy, or tired of its side
effects, are men in their 50s and early sixties with fulltime jobs (I
am just one of them) - and in any case many retired men lead very full
and active lives.

For all of us the long recovery time after a TURP is a major problem,
and we monitor new developments with great interest in the hope that
we can avoid it. I myself have had radio frequency treatment and a
TUIP over the past few years, not least because it was extremely
difficult to clear the time for a TURP (quite apart from the
unattractive nature of the operation itself - the aftermath of my TUIP
was bad enough!).

It is therefore not surprising that a groundswell of support for PVP
seems to be building up among informed BPH patients. If you have not
yet done so, I would strongly recommend monitoring the newsgroup
sci.med.prostate.bph, and looking at its archives in Google Groups.
Patient after patient is reporting favourable results after PVP:
shorter operating time, much less bleeding, no postoperative saline
washout period, much shorter catheterisation time, and considerably
faster recovery overall than with a TURP - as well as less
postoperative discomfort than with some earlier, less controllable
lasers. Many procedures are being done on a day case basis, and some
with local anesthesia only. Serious after-effects seem extremely rare.

For over a year now I have been monitoring reports in the BPH
newsgroup and reading all the literature I could find on PVP, because
it was becoming clear that my TUIP (like the radio frequency treatment
before it) was not going to be a longterm solution to my own problem.
I am not by nature an early adopter, and I was initially sceptical
about PVP; but over the months I have become convinced that we may now
finally have the really effective alternative to a traditional TURP
which I and so many other patients have been waiting for. It appears
to create the same kind of cavity as a TURP, so that one can
reasonably expect the same kind of durability (and the limited longer
term experience so far appears to do nothing to undermine that
expectation). At the same time it avoids many of TURP's drawbacks, as
well as some of the risks and postoperative discomfort of earlier
laser treatment.

Of course studies are limited so far, and the prostate newsgroup
evidence is anecdotal, though cumulatively rather impressive. It is
always sensible to proceed cautiously with any new procedure, and
proper medium- and long-term studies are desirable. But unless some
unexpected late effect is suddenly found, or durability proves less
than currently seems likely, I think you are going to find rapidly
increasing patient demand for PVP, because the traditional alternative
is so unattractive. Mr Gordon Muir of King's College Hospital puts the
situation well on his website: 'Although a randomised trial against
TURP would be the ideal to evaluate this new technology, it must be
remembered that most surgical techniques are not scrutinised in this
way. If the apparent benefits of the Greenlight laser hold out over
the next 18 months I think it likely that patient pressure will make
such a trial difficult if not impossible to recruit to.'
(http://www.london-urology.co.uk/greenlight.html)

Certainly I have been sufficiently convinced by all I have read to put
my own future wellbeing on the line; I expect to have a PVP performed
within the next few weeks.

End of quote!

Richard Slessor