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Medical Forum / Diseases and Disorders / Prostate BPH / December 2003TUMT vs PVP
Have any of you contemplated a decision between microwave and laser? The decision for me now is between those two. This group has strongly supported PVP and that carries a great deal of weight with me because those of you who have had the operation know first hand. On the other hand my doctor, who does both microwave and laser says he will have the microwave done on him when it is his time for a procedure. He sees dozens of patients. It comes down to PATIENT VOLUME versus PERSONAL EXPERIENCE. Currently I am on one Flomax per day with about a 50 gram gland. Some days are reasonably symptom free but rarely can get more than 6 hours of continuous sleep. Other days are a parade to the head and a bladder that is never less than half full. The criteria I would like to see met: * Maximum return for minimal invasiveness. * Sustainable long term results with small, secondary, long term health risks. * Initial success from the procedure without the need for subsequent corrective measures. * If this is not asking for too much, I would like a winning lotto ticket. NOTE: I posted a similar message to this group recently but it was at the bottom of a long thread. Thanks to those who responded but I wondered if there would be a larger sampling of responses if the post had a different heading. Myron Myron, I'm a man who's life was turned around by PVP. As far as I can see, PVP meets your criteria. About you doctor saying " he does microwave and LASER" : keep in mind that while PVP is LASER the converse need not be true. That is, all LASER is not PVP. My local uro offered to do microwave on me but mentioned that they will soon be getting a brand new RUBY LASER in the office and I could be the first patient to have it done that way in their office if I wanted to. The RUBY LASER is old technology and is not as good as the green light PVP! I politely thanked him and quickly backed out of his office with my hands protecting my crotch! I then drove from Northern VA to mid FLA to find a doctor who knew how to perform a PVP. Just today I got another bill from the good doctors of Northern VA, (Drs. Gil Montero and Sehn). I was charged $193 consultation fee for that bad advice. I don't mind paying for bad advice. The real tragedy would have been if I had taken that advice. I can't provide a winning lotto ticket but then such a ticket will not provide a good night sleep like a PVP will. Dave > Have any of you contemplated a decision between microwave and laser? The > decision for me now is between those two. This group has strongly supported [quoted text clipped - 22 lines] > heading. > Myron I have had both and there is absolutely no comparison. One was 100% ineffective and the other was 1000% effective. Read my posts from November 2001 through November 2002. Have a PVP and forget the TUMT. Patrick > Have any of you contemplated a decision between microwave and laser? The > decision for me now is between those two. This group has strongly supported [quoted text clipped - 22 lines] > heading. > Myron > Have any of you contemplated a decision between microwave and laser? The > decision for me now is between those two. This group has strongly supported [quoted text clipped - 22 lines] > heading. > Myron PVP makes much more sense than microwave > > Have any of you contemplated a decision between microwave and laser? The > > decision for me now is between those two. This group has strongly [quoted text clipped - 27 lines] > > > PVP makes much more sense than microwave I'm a urologist in eastern North Carolina who has performed around 30 Greenlight laser procedures. I can honestly say I'll never do another regular TURP. This laser is truly amazing. Unlike the traditional TURP there's almost no bleeding, though about 20% of patients after the procedure will have some pinkish urine that's not bothersome. Also most patients don't complain of burning with urination. The most impressive thing, though, is flow rate improvement equals the gold standard TURP. Most patients I'm doing now have max flow rates between 5&10 cc/sec pre-op. Post-op the flow rates generally increase to 25-30 cc/sec. The patients are extremely satisfied. The main benefit of the TUMT is that it can be done in the office, and doesn't need anasthesia like the greenlight. There's no question the TUMT works, but in my opinion, I doubt it can match the improved flow rates of the greenlight. Also, the greenlight can be used in patients with massive prostates. I did one guy with a 200 gram gland that took 3 hours, it wasn't easy but it's doable. I think for patients who are very symptomatic, with larger prostates with incomplete bladder emptying greenlight laser is the way to go. But if your symptoms are mild to moderate TUMT is an excellent option. "Richard Hughes, M.D." wrote.. > I'm a urologist in eastern North Carolina who has performed around 30 > Greenlight laser procedures. I can honestly say I'll never do another [quoted text clipped - 17 lines] > with incomplete bladder emptying greenlight laser is the way to go. > But if your symptoms are mild to moderate TUMT is an excellent option. Thanks for your contribution to the group doctor. Best regards. Welcome to the group, doctor. Since the anecdotal evidence here suggests that most urologists are either unaware or uninterested in the PVP procedure, could you tell us how you became informed about it and what made you decide to start performing PVP? Also, how long have you been practicing? Thanks. Lee > I'm a urologist in eastern North Carolina who has performed around 30 > Greenlight laser procedures. I can honestly say I'll never do another > regular TURP. This laser is truly amazing. Unlike the traditional > TURP there's almost no bleeding, though about 20% of patients after > Welcome to the group, doctor. Since the anecdotal evidence here suggests > that most urologists are either unaware or uninterested in the PVP [quoted text clipped - 5 lines] > > Lee It's true most urologists are still unaware of PVP. It's understandable since there has been almost no advertising in the main urology journals--which is hard for me to understand. Also, urologists are quite a skeptical group. For a long time, every few years urologists were told there was going to be a new gold standard for BPH, eg. the original VLAP non-contact laser coagulation with a YAG laser, or transurethral vaporization, or more recently TUNA, TUMT or indigo laser. Prior to moving to Kinston, NC last summer I was practicing in Maryland, where I attended a seminar last year. My old practice had bought an indigo laser and I wasn't that impressed so was looking for an alternative. In fact my first few PVPs were done on indigo laser failures. There's no question PVP is a significant advance over the indigo laser. I finished my residency at Penn in '97. Since moving I've been doing a lot of PVPs-- no one else is doing them in eastern NC. Sincerely, Dr. Hughes > > > Have any of you contemplated a decision between microwave and laser? The > > > decision for me now is between those two. This group has strongly [quoted text clipped - 49 lines] > with incomplete bladder emptying greenlight laser is the way to go. > But if your symptoms are mild to moderate TUMT is an excellent option. I do hope you will stick around this board to answer questions I believe it would be heavily appreciated > > "bnd777" <bnd777@btinternet.com> wrote in message > news:<bqlo18$epu$1@titan.btinternet.com>... [quoted text clipped - 66 lines] > I do hope you will stick around this board to answer questions I believe it > would be heavily appreciated Yes, stick around. We've not had a doctor here since David Casey used to dispense his good advice, I wonder if he is doing PVP's? Derek. "Derek F" wrote: "We've not had a doctor here since David Casey used to dispense his good advice, I wonder if he is doing PVP's?" Denton Urology has a website, and there's no mention of PVP on that, so I think we must conclude Dr Casey doesn't do it yet. Like Derek, I welcome Richard Hughes's postings, and I too very much hope he will 'stick around'. We do need a doctor on this group - preferably more than one! - to provide an enlightened professional viewpoint. I realise regular monitoring takes time (as does posting), but it provides a really useful service to a lot of people. Dr Casey contributed to the prostate groups for several years, which clearly showed he wasn't just doing it for a bit of cheap advertising. (Don't get me wrong - if the contributions help someone to make a name and build a practice, I have no problem with that, but the point is that they then deserve it because of their commitment to helping prostate patients worldwide on a continuing basis.) Richard Slessor > "Derek F" wrote: > [quoted text clipped - 17 lines] > > Richard Slessor For all, below is my experience with HOLeP surgery which was what I decided to do versus PVP. I had Holmium Laser Enucleation of the Prostate (HOLeP) surgery on 3Dec 03. Surgery took 1 hour and 30 minutes. It took out 93 of the 118 grams of my prostate soft tissue. All was benign. The surgery was at noon on 3 Dec. Surgery started at 12:15 PM and was competed at 1:45 PM. I woke up at 1:50 PM in recovery and experienced bladder spasms for about 1 hour. The spasms were relieved by using pain medication and by turning off the bladder irrigation tube. The bladder spasms did not feel like a spasm to me. They felt more like my bladder was full and not emptying, even though it was draining adequately. My hospital stay was 23 hours for observation and the fact that I was an out of town patient. The catheter was taken out the next day, 15 hours after the surgery. I urinated 3 times and left the Hospital at 11am. Home in 3 hours. Surgery was a complete success. No blood at all after 5 days. Most of the blood was from urethrotomy part of the operation. An urethrotomy is when they cut the urethra to widen it when it is a little too narrow for the endoscope; this avoids you getting a stricture after the surgery. I had very little discomfort (less than getting a biopsy). My flow is very strong and I have very good control. Sexual function is TBD, but retrograde is known to be almost 100%. Dan Attention: Dr. Hughes I commend you for your interest in this BPH group - patients and customers from literally the entire world. I had Green light PVP Oct. 20.2003. IT was a miracle as compared to the TUMP [Positratom,1998 and Targis.1999] I endorse all you say 100%. I consider TURP no longer the "Gold Standard" I think PVP will soon eclipse TURP. One noble service I think you can perform for those of us who live in the United States is to have the AMA lobby for more financial Medicare coverage of PVP operations From preliminary estimates from my insurance carrier, Medicare covers only a small amount. My carrier will not pay anything until I exceed the minimum personal expense of $600.per year. I have not been sick other than the BPH so my share could be very large as I am well below the $600. I hope you can be helpful in this regard Regards, John Kutina > > Have any of you contemplated a decision between microwave and laser? The > > decision for me now is between those two. This group has strongly [quoted text clipped - 27 lines] > > > PVP makes much more sense than microwave Microwaves are for chickens! Derek. |
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