HEALTHPLAN MAGAZINE

Hospital Zarzuela which is part of the Sanitas network is the first hospital in Spain to use the newest technique involving lasers in urology, called Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser.

This procedure involves a high-power 80-watt KTP laser with a 550-micrometre laser fiber inserted into the prostate. This fiber has an internal reflection with a 70-degree deflecting angle. It is used to vaporize the tissue to the pro-static capsule (2g per minute). KTP lasers target haemoglobin as the chromophore and typically have a penetration depth of 2.0 mm (four times deeper than holmium).

Sanitas Clients can expect the following for the treatment:

* Outpatient or in-patient at the hospital for between 6 and 24 hours.
* prevention of coagulation; that is, it stops the blood from clotting.
* Quick Symptomatic relief and healing
* Catheterization limited to a few hours.
* Vaporisation of up to 2g. per minute.
* 100% success rate as per the Mayo Clinic.

Statistics

The prostate gets larger in most men as they get older, and, overall, 45% of men over the age of 46 can expect to suffer from the symptoms of BPH if they survive 30 years. Incidence rates increase from 3 cases per 1000 man-years at age 45–49 years, to 38 cases per 1000 man-years by the age of 75–79 years. Whereas the prevalence rate is 2.7% for men aged 45–49, it increases to 24% by the age of 80 years.

For some men, the symptoms may be severe enough to require treatment.

Signs and symptoms

Benign prostatic hyperplasia symptoms are classified as storage or voiding.

Storage symptoms include urinary frequency, urgency (compelling need to void that cannot be deferred), urgency incontinence, and voiding at night (nocturia).

Voiding symptoms include weak urinary stream, hesitancy (needing to wait for the stream to begin), intermitency (when the stream starts and stops intermittently), straining to void, and dribbling. Pain and dysuria are usually not present.

BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in stasis of bacteria in the bladder residue and an increased risk of urinary tract infection. Urinary bladder stones are formed from the crystallization of salts in the residual urine. Urinary retention, termed acute or chronic, is another form of progression. Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends. Some patients that suffer from chronic urinary retention may eventually progress to renal failure, a condition termed obstructive uropathy.

Diagnosis

Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate, usually affecting the middle lobe.

Often, blood tests are performed to rule out prostatic malignancy: Elevated prostate specific antigen (PSA) levels needs further investigations such as reinterpretation of PSA results, in terms of PSA density and PSA free percentage, rectal examination and transrectal ultrasonography. These combined measures can provide early cancer detection.

Ultrasound examination of the testicles, prostate, and kidneys is often performed, again to rule out malignancy and hydronephrosis.

Screening and diagnostic procedures for BPH are similar to those used for prostate cancer. Some signs to look for include:

* Weak urinary stream
* Prolonged emptying of the bladder
* Abdominal straining
* Hesitancy
* Irregular need to urinate
* Incomplete bladder emptying
* Post-urination dribble
* Irritation during urination
* Frequent urination
* Nocturia (need to urinate during the night)
* Urgency
* Incontinence (involuntary leakage of urine)
* Bladder pain
* Dysuria (painful urination)
* Problems in ejaculation