I have today posted the following on the NICE website:

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Comments on provisional recommendations:
 
Do decision makers realise just how much BPH patients dislike TURP?

Your own document refers to 'relatively high morbidity from this
procedure'. The long recovery time also disrupts patients' lives. It
is not just an operation for inactive old men; many BPH patients still
work fulltime, and many retired men lead very active lives.

So, not surprisingly, patient interest in PVP is growing. The
newsgroup sci.med.prostate.bph is reporting many favourable results:
shorter operations, less bleeding, no postoperative saline washout,
shorter catheterisation, and faster recovery overall than with TURP. A
TURP-like cavity is created, so durability seems likely; and major
problems seem rare.

Barring late problems, I think you will see increasing patient demand
for PVP. To quote Gordon Muir of King's College Hospital: 'Although a
randomised trial against TURP would be the ideal to evaluate this new
technology,...[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)

I expect to have a PVP soon.

Comments on the procedure:
 
The document's comments on the procedure seem oddly negative. For
example, it says, 'The Specialist Advisors noted the importance of
training in this procedure. They suggested that efficacy may be
related to the experience of the surgeon.' Surely that applies to any
procedure? Mr Muir comments on his website: 'One of the attractive
features of this laser is an intuitive technique for surgeons who are
already familiar with transurethral surgery'.

The document says complications include mild transient dysuria,
haematuria, retrograde (abnormal) ejaculation and soft bladder-neck
contracture, and that the specialist advisers 'listed potential
adverse events as inflammation, pain, urinary retention, retrograde
ejaculation, incontinence and infection'. However, most if not all
these features are at least as likely to occur with a traditional TURP
- in some cases markedly more so.

The advisers also 'noted that patients were likely to suffer
irritative bladder symptoms in the early postoperative period.' 'Mild
and transient' ones, probably, yes. But Mr Muir remarks: 'Post
operative bleeding *and discomfort* [my emphasis] has appeared less
than we would expect with standard TURP.'

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I'd like to have said more in one or two places, but the length of
comments in each of the two sections ('provisional recommendations'
and 'procedure') is limited to 1200 characters.

Richard Slessor