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Medical Forum / Diseases and Disorders / Prostate BPH / August 2003My ILC uro's opinion of PVP
My ILC uro's opinion of PVP: "Have been hearing more about the newer laser being marketed by laserscope, but haven't yet seen anything that makes me think that this will be substantively different from any of the other currently existent modalities.I'll wait to see how this does over time as the field of BPH treatment cont's. to evolve. This process of evolution will cont. long after I retire as there is constant re-invention of this particular wheel." (He's not yet 40, I believe.) Jack Crane > My ILC uro's opinion of PVP: > [quoted text clipped - 9 lines] > > Jack Crane Has he had a visit from a laserscope rep who might be able to explain the differences? I get the impression most uros havn't got the time or inclination to research this subject thoroughly. And as has been observed here before, if you've just invested so many thousand dollars in one system, you're not likely to be wildly enthusiastic about the latest rival. Derry On 7/24/03 12:33 AM, in article Xns93C257377F25Bderryadviegundogscou@130.133.1.4, "Derry Argue" <derry@adviegundogs.co.uk> wrote: >> My ILC uro's opinion of PVP: >> [quoted text clipped - 19 lines] > > Derry I think that many uro docs have seen so many new toys that have entered the market to treat BOO/BPH (few of which have stood the test of time) that they are just a little shy of a new gadget that seems to do about the same as the old tried and true TURP. There is a saying a surgery, "do not be the first to try a new thing, but do not be the last". Surgeons by nature are very conservative and for the most part want to see a large body of evidence that new kid on the block is better than what they are doing. When you cut people open as part of your job this conservative nature is generally a good thing. I think PVP is looking like a very strong treatment option that over time should win over lots of docs. From a urologists point of view it is not a wrong move to stand back and see how things play out with this over the next few years. For good or for ill this is the way new things filter into general surgical practice. Matt > On 7/24/03 12:33 AM, in article > Xns93C257377F25Bderryadviegundogscou@130.133.1.4, "Derry Argue" [quoted text clipped - 41 lines] > > Matt I am sure you are right. A personal friend was a professor of urology in an eastern block university. He is now retired. But he warned me against all modern procedures EXCEPT open surgery by a competent surgeon. He considered them total rubbish. He was so concerned about my welfare that he actually arranged for me to go over there to have the (open surgery) operation at a cut price (to coin a phrase!<G>) which was very kind of him, but I declined. I believe this man was at the top of his profession and knew what he was talking about. But that was pre-PVP. My father and a good friend both had open surgery (for straight BPH, no cancer) and they had no problems at all. Derry What is very clear is that for median lobe hyperplasia PVP offers the only chance of being restored to normal If they do a TURP on such patients the proceedure is so radical that any one of a host of side effects are possible/probable Theres too little differentiation made between what are essentially 2 different conditions Middle/median lobe enlargement acts like a ball valve blocking urinary outflow and does not respond to Proscar etc Whereas central Prostrate enlargement often does respond to drugs and maybe theres little difference in final outcome of either PVP or TURP > > On 7/24/03 12:33 AM, in article > > Xns93C257377F25Bderryadviegundogscou@130.133.1.4, "Derry Argue" [quoted text clipped - 54 lines] > > Derry > My ILC uro's opinion of PVP: > [quoted text clipped - 9 lines] > > Jack Crane Saw him again 7/30. I handed him the PR folder I'd received from Laserscope. He looked it over, seemed impressed, but said there seemed to be only 5 years of data, and wants to see a bit further out. Mentioned 7 years. What if PVP effect begins to reverse in patients after 7 years? Also, was negatively impressed by seeing that a PVP often takes 45 minutes, and that the uros reporting were using a general anesthetic, with patient out for 45 minutes. Can be dangerous, he said. Also said that he had seen a Laserscope rep a couple(?) of years ago. So it seems that for a while at least, he'll continue to offer only TURP and ILC, but will follow future reports about PVP. Jack Crane What is being overlooked here are the absolutely horrifying statistics attached to TURP. According to the National Institutes of Health, the probability of mortality for a man 65-69 years undergoing TURP is one in 250. Probability for permanent incontinence is one in 20 and for impotence is one in five. Although I've suffered from BPH for 15 years, I've considered such risks completely unacceptable and have waited until now, relying on medication which hasn't been very effective. From having monitored this newsgroup closely for more than a year, I've managed to learn quite a bit about PVP and have decided that this is the surgery for me. There's a uro in my city who recently bought the equipment, and I'm waiting until he's performed at least 100 procedures. My understanding from what I've read in this newsgroup and the data that's been published is that the known downside risks associated with PVP are retrograde (80%) or simply no noticeable improvement. I'm not aware of any reported cases of death, incontinence or impotence. Am I correct? > What is being overlooked here are the absolutely horrifying statistics > attached to TURP. According to the National Institutes of Health, the [quoted text clipped - 16 lines] > aware of any reported cases of death, incontinence or impotence. Am I > correct? I think my uro believes an ILC is safer than a PVP, from what he's seen so far. Jack Crane Jack in your response that your uro believes an ILC is safer than a PVP, is completely incorrect from both the physics of the two lasers and the published results. ILC lasers are cutting torches. The PVP laser is at a different wavelength that does burn but instead vaporizes prostate tissue. This is the key reason whu the PVP the procedure is much more effective and gentler on the patient. The results of five years of published studies with both lasers bear this out. PVP is much more effective than ILC and much more gentler on the patients in terms of side effects and recovery times/bleeding etc. Your uro is misinformed. Patrick > > What is being overlooked here are the absolutely horrifying statistics > > attached to TURP. According to the National Institutes of Health, the [quoted text clipped - 21 lines] > > Jack Crane > > What is being overlooked here are the absolutely horrifying statistics > > attached to TURP. According to the National Institutes of Health, the [quoted text clipped - 21 lines] > > Jack Crane Your uro is either blind daft or stupid to suggest that ILC is better than PVP I am day 10 after PVP for a 70cc middle lobe .....did not even need a catheter .....only odd drop of blood ....no pain ...strong stream ...just careful not to lift etc .....but its a breeze > Your uro is either blind daft or stupid to suggest that ILC is better > than PVP > I am day 10 after PVP for a 70cc middle lobe .....did not even need a > catheter .....only odd drop of blood ....no pain ...strong stream > ...just careful not to lift etc .....but its a breeze 10 days and you're an expert? Jack Crane > What is being overlooked here are the absolutely horrifying statistics > attached to TURP. According to the National Institutes of Health, the [quoted text clipped - 16 lines] > aware of any reported cases of death, incontinence or impotence. Am I > correct? NO ......retrograde is 20 % with PVP yet 80% with TURP Hospital time with PVP 3 to 4 hours as a day case TURP 3 to 4 days Soft flexible Catheter for 12 hours unlikely with up to 70cc size BPH and PVP Stiff catheter a certainty with TURP C > What if PVP effect begins to reverse in patients after 7 years? > Also, was negatively impressed by seeing that a PVP often takes 45 > minutes, If PVP reverses, I shall simply have another!<G> And from what I've heard it can take as little as 20 minutes. Depends on the size of the prostate. >So it seems that for a while at least, he'll continue to offer only TURP >and ILC, but will follow future reports about PVP. In other words, he'll continue to use the equipment he has invested in until his patients start going elsewhere? Derry > > What if PVP effect begins to reverse in patients after 7 years? > > Also, was negatively impressed by seeing that a PVP often takes 45 [quoted text clipped - 12 lines] > > Derry With any proceedure including TURP the possibilities of needing it done again are to do with the bodys metabolism not with what form of instrument is used to remove the obstruction PVP is way less damaging or invasive never mind less inconvienience and possible nasty side effects |
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