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Medical Forum / Diseases and Disorders / Prostate BPH / December 2004A Patient's View on PVP
PVP is a relatively new surgical procedure that reduces the size the Prostate by essentially boiling and vaporizing excess tissue. It appears to be, at least, as successful as other BPH reduction procedures and probably more so in many instances, as the blood loss is kept at a minimum. Many men have reported a virtually trouble free post-surgical experience while others struggle with more problems to a greater or lesser extent. Although post-surgical catheterization is less common than in older surgeries such as TURP, it is not without incidence inPVP. Pain, urgency and frequency of urination are also side effects of PVP and can last for as little as days, but in some cases for weeks....... or even months. It is important to understand that in PVP surgery, the urethra is essentially destroyed by the laser and must rebuild itself. This can take several months and according to some urologists, 90 days is a ballpark figure for this healing to take place. Although PVP is considered "minimally invasive" there is nothing "non-invasive" about it. Patients should understand that the bladder may have been already damaged from years of being stretched by a certain amount of retention caused by BPH and may, or may not, return to its normal contractility. Like any surgery, it is good to have a positive, hopeful attitude about its outcome, but at the same time not to necessarily expect the kind of recovery that advertisements and promoters of the procedure.... especially those with vested interests..... may have us believe. Expecting too much will only bring disappointment and distress. Patience, and a thorough understanding that the recovery rates in this particular surgery vary widely, are highly advised. Marcus, Not bad. Clear and informative. good post. Thanks. Patrick . > PVP is a relatively new surgical procedure that reduces the size the > Prostate by essentially boiling and vaporizing excess tissue. It appears [quoted text clipped - 31 lines] > that the recovery rates in this particular surgery vary widely, are highly > advised. Thanks Marcus. Comments like these are true and helpful. Ron > From: "Marcus" <orealius@comcast.net> > Organization: Comcast Online [quoted text clipped - 29 lines] > that the recovery rates in this particular surgery vary widely, are highly > advised. Marcus, while your post was informative you didn't mention the most important consideration for any surgery, the skill and experience of the surgeon. I don't believe that, "in PVP surgery, the urethra is essentially destroyed". Enlarged yes, as it is in all BPH surgery, but not destroyed. Jack > PVP is a relatively new surgical procedure that reduces the size the > Prostate by essentially boiling and vaporizing excess tissue. It appears [quoted text clipped - 31 lines] > that the recovery rates in this particular surgery vary widely, are highly > advised. My understanding is that it (the Urethrea) must be "rebuilt".... I was told by a couple of URO's that it is essentially destroyed by the laser. Marcus > Marcus, while your post was informative you didn't mention the most > important consideration for any surgery, the skill and experience of the [quoted text clipped - 40 lines] > > that the recovery rates in this particular surgery vary widely, are highly > > advised. How can you destroy tissue of the prostate with a tool which is located in the urethra without destroying that part of the urethra which separates the tool from the prostate ? SNIP >I don't believe that, "in PVP surgery, the urethra is essentially >destroyed". Enlarged yes, as it is in all BPH surgery, but not destroyed. > >Jack My understanding is that it's the prostatic urethra that's destroyed during the PVP - obviously not the lower part that's in the penis. The laser creates a new (larger) channel from the bladder through the prostate area which becomes in a sense, the new prostatic urethra. This takes some time to heal after surgery. Ron > From: Charles <spamless@spamless.com> > Organization: BT Openworld [quoted text clipped - 12 lines] >> >> Jack After my PVP, I was given pictures of before and after. The prostate was cored out and the urethra within the prostate was evaporated away. If I remember right, with TURP this part of the urethra is mechanically ripped, snipped and burned away with a hot wire loop. I had my PVP in May 2003 and it was very successful. Flow is still very good, about 20ml/sec, but some times less and others higher depending on looseness of my body. I was the 13th patient of my uro and I had no problem with this. Frankly, I think that an young uro using a new procedure might try harder to do a good job than an old TURP-hand who switches to PVP to preclude loss of business. This is just my opinion. I was young at one time too. Now I'm 68 and I enjoy peeing freely again. Fred Henzi > My understanding is that it's the prostatic urethra that's destroyed > during [quoted text clipped - 4 lines] > heal after surgery. > Ron My understanding is similar to Ron's. My understanding is that the prostatic urethrea isn't a tube going through the prostate. The prostatic ureatra actually isn't a separate structure within the prostate. The prostate tissue instead has a channel going through it. The PVP opens this channel into a much larger diameter channel by vaporizing the tissue. The healing process is for the opened up channel to heal into a soft edge tissue. Patrick > My understanding is that it's the prostatic urethra that's destroyed > during [quoted text clipped - 22 lines] >>> >>> Jack The prostatic urethra IS a separate structure From urologychannel.com "In men, the urethra is roughly 8 to 9 inches long and extends from the bladder neck to the end of the penis. The male urethra is composed of three parts: prostatic, membranous, and spongy. The prostatic urethra is the widest part of the tube and passes through the prostate gland. It is made up of fibrous tissue, muscle fibers, and tiny glandular openings that connect to the prostate. The membranous urethra is approximately three-quarters of an inch long and lies between the triangular ligaments of the pelvis. The spongy urethra is the longest part and extends through the penis to the glans (tip of the penis). The corpus spongiosum is the lower area of the penis that surrounds and protects the urethra. " > My understanding is similar to Ron's. > [quoted text clipped - 34 lines] >>>> >>>> Jack Jay, That's an incorrect description of the prostatic urethra. In the prostate, the outer surfaces of the lobes of the prostate is the prostatic urethra. The prostatic urethra is not a seperate tube going through the prostate. Patrick > The prostatic urethra IS a separate structure > [quoted text clipped - 50 lines] >>>>> >>>>> Jack Pat, The urethra is a discrete structure...there are many descriptions of it's morphology. It is characterized by a mucus membrane incorporating longitudinal muscle fibres. It is different from the bulk prostate composition. The urethral wall also contains pain sensors. Debulking surgeries remove the urethral wall...it is not optional because there is no other way to transurethrally remove prostatic material except by removing the urethral wall. Debulking procedures are done using anesthetic (general or spinal) because of the urethral wall pain sensors...and other reasons. Most, but not all, ablation procedures attempt to preserve the urethral wall by means of cooling the wall during the prostate ablation. Therefore, some ablation procedures can be done under local anesthetic. Jay From: http://www.becomehealthynow.com/article/bodygenito/779/ "Structure of the Urethral Wall The urethra of the male is a tube of mucous membrane supported on a submucous layer and an incomplete muscular coat. The membrane forms longitudinal folds when the tube is empty; these folds are more prominent in the membranous and spongy parts. There are many glands in the mucous membrane, and they are more common in the posterior wall of the spongy part. The submucous layer is composed of fibroelastic connective tissue containing numerous small blood vessels, including more venules than arterioles. The thin muscular coat consists of smooth (involuntary) and striated (voluntary) muscle fibres. The smooth muscular layer, longitudinally disposed, is continuous above with the detrusor muscle of the bladder and extends distally as far as the membranous urethra, where it is replaced and partly surrounded by striated muscle of the external sphincter. The somatic nerves to the external sphincter are the efferent and afferent components of the pudendal nerve, arising from the second, third, and fourth sacral segments of the spinal cord. The female urethra has mucous, submucous, and muscular coats. As in the male, the lining of the empty channel is raised into longitudinal folds. It also shows mucous glands, mentioned in the preceding paragraphs as existing in the male urethra. The submucous coat resembles that in the male, except that the venules are even more prominent. In both sexes, but especially in females, this layer appears to be a variety of erectile tissue. The muscular coat extends along the entire length of the female urethra and is continuous above with the musculature of the bladder. It consists of inner longitudinal and outer circular layers, and fibres from the latter intermix with those in the anterior wall of the vagina, in which the urethra is embedded." > Jay, > That's an incorrect description of the prostatic urethra. In the prostate, [quoted text clipped - 56 lines] >>>>>> >>>>>> Jack The word destroy means to ruin, annihilate, put out of existence. None of these are done to the urethra in any BPH procedure. Yes you remove by cutting, burning or vaporizing some of the prostate tissue that surrounds the urethra as it passes through the prostate. The urethra does not have a tubing surrounding it as it passes through the prostate or the penis. It is simply and opening or channel through which urine flows from the bladder. The reason why the flow rate, urgency etc are symptoms of BPH is because as the prostate grows it narrows that channel. The reason why some uro's use the word destroy is that they are referring to the prostate tissue that is removed so as to enlarge the urethra channel to hopefully its diameter when we were 35 for most of us. However some as eraly as 35 have been diagnosed with BHP. My objection was to the phrase that said "the urethra is essentially destroyed". If that happened we would have very serious problems. Jack > How can you destroy tissue of the prostate with a tool which is > located in the urethra without destroying that part of the urethra [quoted text clipped - 6 lines] >> >>Jack Thank you - an excellent clear exposition, However, does it not come down to a question of semantics i.e that the word 'urethra' is shorthand for 'urethral channel' ? However I do agree that the use of the word 'destroy' is not correct in this context. It is nice to learn something new - which I can believe :-) >The word destroy means to ruin, annihilate, put out of existence. None of >these are done to the urethra in any BPH procedure. Yes you remove by [quoted text clipped - 25 lines] >>> >>>Jack Charles, I have been lurking and reading all the great answers to your post. It turns out that I asked these same questions of my urologist who was about to do a PVP on about a two years ago. I asked him, "how much of the prostate do you burn out?" "Isn't there a danger it would collapse if you take too much out?" He answered me by saying, "We try to take out all the tissue within the prostate. It does collapse, we expect it to. Soon the rough, charred tissue within the prostate is replaced with smooth urethra like tissue." I forget the time frame he gave me for this healing to occur. I think it was 18 months, maybe much quicker? The doctors name was Dr. Dumont. It ended up that he did not operate on me. I found a more experienced doctor. Dumont was just starting to do PVPs back then and I wanted and NEEDED a VERY experienced doctor. I'm sure by now he is very experienced with PVP and probably a world class PVP surgeon. Dave > Thank you - an excellent clear exposition, > [quoted text clipped - 41 lines] >>>> >>>>Jack > Charles, > [quoted text clipped - 15 lines] > > Dave Does anyone know how smooth the urethra is after a TURP and is that healing time more or less? Derek. |
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