Laser Treatment for Enlarged Prostate (BPH) - Prostate Surgery in India

Diagnosis for Enlarged Prostate (BPH)

Clinical symptoms and physical examination provide the basis for diagnosis of Enlarged Prostate or Benign Prostatic Hyperplasia. The physical examination includes a digital rectal examination (DRE).

Digital Rectal Examination (DRE) 

DRE typically takes less than a minute to perform. The doctor inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess its size, shape and consistency. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard and often asymmetrical or stony like the bridge of the nose. If the examination reveals the presence of unhealthy tissue, additional tests are performed to determine the nature of the abnormality.

PSA Test

Blood test to check the levels of prostate specific antigen (PSA) in a patient who may have BPH helps the doctor to eliminate the diagnosis of prostate cancer. 

Uroflowmetry Test 

This is a simple test which records the urine flow to determine how quickly and completely the bladder can be emptied. With a full bladder, the patient urinates into a device that measures the amount of urine, the time taken, and the rate of urine flow. Patients with stress or urge incontinence usually have a normal or increased urinary flow rate, unless there is an obstruction in the urinary tract. A reduced flow rate may indicate BPH. 

Post-Void Residual (PVR) 

This test measures the amount of urine that remains in the bladder even after urination. The patient is asked to urinate immediately prior to the test and the residual urine is determined by ultrasound. PVR less than 50 ml. generally indicates adequate bladder emptying and measurements of 100 to 200 ml or higher often indicates blockage.

Laser Treatment for Enlarged Prostate (BPH)

Holmium Laser Enucleation of the Prostate (HoLEP)

Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to the standard Transurethral Resection of the Prostate (TURP) procedure for bladder outflow obstruction due to BPH. It requires a short period of hospitalisation and an anaesthetic.  A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.

Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to the standard Transurethral Resection of the Prostate (TURP) procedure for bladder outflow obstruction due to BPH. It requires a short period of hospitalisation and an anaesthetic.  A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.

What are the advantages of HoLEP

• There is no upper size limit of prostate that can be dis-obstructed – traditionally men with prostates over 100ml in size needed major open surgery
• There is often less bleeding than after a TURP
• Discharge is often quicker than after TURP at 1-2 days
• The chance of recurrence requiring further surgery is very low
• Unlike greenlight laser operations, large quantities of prostate tissue are sent for pathological analysis
• The PSA generally drops to very low levels after HoLEP operations

Minimally Invasive Robotic Prostate Surgery in India

Robotic Prostate Surgery in India

Robotic Prostate Surgery - where a minimally invasive robot assisted radical prostatectomy technique eradicates prostate cancer with minimal post surgery complications

The mission of “Minimally Invasive Robotic Prostate Surgery Program” is to leverage latest technology to and treat prostate disease through small incision and great precision resulting in:

·  Shorter hospital stay, Faster recovery and return to normal activities

· Less pain and scarring , Reduced blood loss and need for blood transfusion

·  Reduction in the use of pain medicines, Decreased postoperative pain

Usually in conventional approach surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave some cancer behind.  Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence

Highly trained Indian surgeons who have worked for decades at some of the global centres of excellence now use Advanced Robotic technique gives surgeon a sophisticated master slave robot that seamlessly translates the surgeon's movements at the computer console into precise, real-time movements of the surgical instruments inside the patient. This ensures that the Prostate is removed excellent outcomes and minimal chances of cancer left behind after the surgery.

If you're young and in good health, the short-term risks of this surgery are low. The hospital stay is usually 2 to 3 days, with the catheter left in place for 2 to 3 weeks. You're usually able to go back to work in about 1 month. You shouldn't have severe pain with this surgery. Most men regain bladder control a few weeks to several months after the surgery.

The main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, you are probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.

 Surgery does have risks. The main risks of radical prostatectomy are incontinence (loss of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Most bladder and impotence problems improve with time.

Options for Prostate Cancer Treatment and Surgery in India

Prostate Cancer Treatment and Surgery in India

High Intensity Focused Ultrasound (HIFU) - It makes use of high frequency energy to heat and destroy cancer cells in the prostate gland.When these sound waves are concentrated on body tissues, the tissues heat up and die. Specialists target the area containing the cancer.It is an outpatient procedure generally performed under local or general anesthesia. As HIFU is non surgical, there is no incisions or blood loss and recovery is quick.

Robotic Surgery - Robotic surgery for prostate cancer removal is an advanced technique whereby the robotic arms hold the surgery tools. The advantages of this surgery type are very high precision in performing the surgery and reducing the risks associated with the surgery.

Cyber Knife Treatment - In this procedure, the patient lays still and breathes normally while the CyberKnife zeroes in on the prostate and irradiates it without harming surrounding areas. The procedure is more comfortable for patients, as radiation is given accurately and treatments are completed in four to five days.

Laser Surgery - This procedure has emerged as the top choice for most patients. It is minimally invasive as all work to open the prostate channel made through the penis, is done without an incision on the abdomen. This surgery helps patients urinate better and with a good stream. The patient is able to empty his bladder fully after the surgery.In Laser Surgery for Prostate cancer, the obstructive prostate tissue is vaporized by the directed laser beam.

Radical Prostatectomy - It is the surgery done to remove the entire prostate and any nearby tissues like seminal vesicles and some nearby lymph nodes. Radical prostatectomy can be done as either open or laparoscopic surgery. The surgeon removes the prostate through a cut in the abdomen, or makes a series of small cuts instead of one larger cut. Sometimes prostate is removed through a cut in the area between the testicles and the back passage.After the prostate gland is taken out through an incision, a catheter is placed in the bladder to pass urine out of the body until the area heals.

Laparoscopic Radical Prostatectomy - A thin tube with a tiny camera is deployed. Small cuts are made near the tumor site, and thin tools remove the tumor and surrounding tissue. Patients are usually given general anesthesia that blocks nerve routes from the spine and numbs the area.

External beam Radiotherapy - This treatment deploys high radiation dose just on the area of the prostate gland. The whole of your prostate gland is treated along with an area of 1 to 2 centimetres around it.

Brachytherapy - Brachytherapy makes use of high dose of radiation reducing the risk of damage to nearby healthy tissue while destroying the tumor. Doctors place Brachytherapy seeds inside a body cavity or insert seeds into body tissue using hollow needles. It may be used alone or with radiation given externally. Radioactive seeds may be left permanently in place or removed after some time.

Hormone Therapy - Hormones occur naturally in your body and control the growth and activity of normal cells. Prostate gland cancer depends on the male hormone testosterone to grow. Lowering the amount of testosterone in the body can reduce the chance of an early prostate cancer coming back after treatment.

Chemotherapy - Chemotherapy involves drugs to kill cancer cells. It is used to treat prostate cancer that has spread to other parts of the body and is used mainly if hormone therapy is not controlling the cancer.

Cryotherapy - Cryotherapy uses an instrument to freeze and destroy abnormal tissue. Cryosurgery can be used to treat men who have early-stage prostate cancer that is confined to the prostate gland. It is less well established than standard prostatectomy and various types of radiation therapy. Long-term outcomes are not known. Because it is effective only in small areas, cryosurgery is not used to treat prostate cancer that has spread outside the gland, or to distant parts of the body.