Patrick is an able proponent of the PVP/Laserscope case. However, it's
worth noting that the manufacturers of holmium lasers would dispute it
- see

http://www.surgical.lumenis.com/wt/content/bph_holap

and

http://www.surgical.lumenis.com/pdf/Holmium_vs_KTP.pdf

Richard Slessor

This is a 'sci.med' group, and I think between us we have a duty to
make sure all claims made here are properly substantiated. That's why
I found the Lumenis comments on the Laserscope claims to unique virtue
particularly interesting.

First of all, Lumenis make a distinction between holmium ablation
(which is what they are comparing to PVP) and holmium enucleation.
They claim the former is 'an easy to learn outpatient procedure',
whereas enucleation 'has a more difficult learning curve'. That seems
to have relevance to Bob's comments - he seems to be talking about the
enucleation procedure, I think?

They also say that with holmium ablation, 'patients are routinely
released in less than 24 hours, and without a catheter. Additionally,
the procedure is performed with little, if any, fluid absorption or
loss of blood.' That directly contradicts Patrick's statements that a
catheter is mandatory with holmium 'for several days' because of
swelling, and that there is 'much more' bleeding with holmium.

Laserscope have (rightly) made much of the fact that the PVP laser is
more precisely targetable than earlier lasers, which often did a lot
of unintended peripheral damage. However, Lumenis comment that the PVP
wavelength penetrates tissue *more* than holmium (1-2 mm as opposed to
0.5 mm). They therefore claim that 'because holmium provides a
"what-you-see-is-what-you-get" tissue effect, there is less risk of
thermal damage to surrounding tissue.' In other words, they are
claiming that what PVP does well, holmium does even better.  Sounds
plausible?

Finally, Lumenis say the exact opposite of what Patrick does in his
recent message about operation time - that is, that is, that because
of the shallower penetration of the holmium wavelength, holmium
ablation in principle takes *longer* than PVP. (However, they advance
reasons why in practice the difference is more apparent than real.)

We know that Laserscope marketing can be, shall we say,
over-enthusiastic. It may be that Lumenis are equally capable of
gilding the lily! We therefore need proper unbiased comparative
studies comparing these new procedures in terms of effectiveness,
'morbidity' (short-term negative effects) and durability. Precisely
because they are all quite new, it's not easy to find that kind of
information. I note Patrick says that there are 'well-documented
superior results' for PVP compared to holmium. Could he give us some
references?

What I think is unarguable, anyway, is that we need to make sure we
keep up to date in this group on *all* the interesting recent
developments in BPH treatment, and that it doesn't just become
'sci.med.prostate.pvp'. (For the same reason I was pleased to see the
recent thread on Gyrus.) PVP shows every sign of being a valuable
addition to the BPH treatment options, but we must make sure we give
full attention to other contenders too, and in particular ensure that
they get a fair hearing.

Richard Slessor