urologist

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You are right - and he seemed like a real cool guy -

Al
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From: Richard Hughes, M.D. (hughesgr@earthlink.net)
Subject: Re: PVP + 20 hours
View: Complete Thread (13 articles)
Original Format
Newsgroups: sci.med.prostate.bph
Date: 2004-02-29 14:03:06 PST

I would like to weigh in on the pros and cons of TURP vs. PVP.  I'm a
urologist in eastern North Carolina who has done roughly 60-70 PVPs,
and probably 300-400 TURPS. I posted a few times several months ago.
   There's no question that a TURP is a great operation, that's why
it's been referred to as the "gold standard" for 30 years.  "simple,
straightforward, painless "  a TURP is not!!! It is a technically
demanding, and difficult operation.   Bloody TURPs can be extremely
stressful. For the urologist, it's hard work.  TURPs on small to
medium glands are generally pretty straighforward.  TURPs on larger
glands are quite difficult. As a resident I witnessed a patient suffer
from TURP syndrome (from the absorption of irrigating fluid)and go on
to die--extremely rare, but can happen.  Fortunately, I've never had a
patient have a serious complication from a TURP.  Yet,  bladder neck
contractures, urethral strictures, impotence, and incontinence, need
for transfusions,etc. do occur with TURPs. Patients generally need to
stay in the hospital hooked to irrigation for 1-2 days. Also it's
generally not considered safe to do TURPs on prostates larger than 100
grams.  This is not a problem with PVP.  A TURP cannot be done as an
outpatient.
     Also 10 years ago 500,000 TURPs were done every year; now it's
less than 75,000.  Therefore, urology residents today are not learning
how to perform TURPs.  There's no question that learning how to
perform a good PVP is much easier and less risky than learning to
perform a good TURP.
Urology residents today are going to want to learn how to perform PVP.
     Without a doubt, a TURP in a well-trained urologist is a great
operation, with a low risk of serious complications.  There's also no
doubt that PVP achieves the same open outlet and great flow rates with
significantly less morbidity.

"I hope that he is not among the 1 in 10 who, after undergoing a TURP,
 are found to have Prostate Cancer."

The above is simply not true.  Prior to PSA testing 1 in 10 men may
have had prostate cancer diagnosed from a TURP.  In fact of the 150 or
so TURPs I've done in private practice I cannot not remember one
having had a serious cancer.  The vast majority of prostate cancers
are in the peripheral zone, which is not sampled during a TURP.  Most
cancers found on TURP specimens are incidental/low volume cancers that
don't need to be treated. Transition zone cancers occur but are much
less common.  With PSA testing and digital rectal exams, prostate
cancers are diagnosed at an earlier more curable stage.  Men having a
PVP laser instead of a TURP do not need to worry that a significant
prostate cancer may be missed.

Sincerely,

Richard M. Hughes,  M.D.
Kinston Urological Associates