Laser Treatement for Safer and Faster Management of Benign Prosate

Case highlights
• 81 year old gentleman diagnosed of acute urinary tract infection
• Patient was hypertensive, diabetic and had undergone coronary artery stenting
• Was on blood thinners which makes the conventional prostate resection difficult
• Delay of management of prostate could have allowed bacterial colonization of the coronary artery stent
• Brought to Fortis Hospitals with complications
• Laser TURP was performed to manage the enlarged prostate and urine infection

Bangalore, 19th July, 2010: Fortis Hospitals Bangalore performs a complicated Prostate Surgery on an 81 year old man with latest DIODE laser called Laser TURP wherein laser energy is used for vaporization of prostate tissue without any blood loss. This procedure is ideal for high risk patients who are on blood thinning agents and have the difficulty of undergoing resection of enlarged prostate with the conventional method using electrical energy.

Mr. Venkataswamy Reddy an 81 year old gentleman who had developed acute retention of urine following coronary angiography procedure done 2 weeks prior. He was a known diabetic and hypertensive and had undergone coronary artery stenting about two years ago and was on blood thinning agents – aspirin and clopidogrel. He was advised to undergo conventional TURP (Transurethral resection of the prostate) at a city hospital. Since Mr. Reddy was on blood thinning agents the urologist in the hospital wanted the blood thinners to be stopped a week prior to the procedure. “Stopping of the blood thinners increases the risk of getting a myocardial infarction, commonly known as heart attack and the patient’s hospital stay is longer including the need to stay in coronary care unit postoperatively” said Dr. Mohan Keshavamurthy, Consultant Urologist Fortis Hospitals.

The cardiologist was unwilling to stop the blood thinners because of the obvious cardiac risk but at the same time the doctors were not willing to defer his procedure since the ongoing urinary tract infection could colonise the coronary stent. With these complications Mr. Reddy was referred to Fortis Hospitals Bannerghatta road.

“After a complete workup it was diagnosed that Mr. Reddy had benign enlargement of the prostate with acute urinary tract infection. He was also hypertensive & diabetic. Understanding the cardiac risk Mr. Reddy had along with the acute retention of urine which could lead to further complications, we decided to perform the laser TURP procedure. For laser TURP we don’t need to stop the blood thinning agents and the prostate resection can be done without any blood loss. We performed the procedure without any complication and his post operative recovery has been excellent” said Dr. Mohan.

Benefits of Laser TURP
• No Blood Loss
• Shorter Hospital Stay
• Cardiac patients who are on blood thinning agents
• Patients with renal dysfunction who have a tendency to bleed profusely
• Prostate gland size of more than 60 gm
• Patients with Diabetes, Hypertension & high risk for anesthesia
• Patients who have undergone joint replacement surgery

How Laser TURP is superior to conventional TURP:

In conventional TURP, blood thinning agents have to be stopped a week to 10 days before the procedure. This puts the heart at risk for a second attack. The patient’s hospital stay is longer including the need to stay in coronary care unit postoperatively. In Laser TURP, procedure is done with the blood thinning agents on board which is a revolutionary change in clinical practice guidelines. Conventional TURP surgery is not traditionally performed beyond 60 min because of the risk of irrigant fluid (GLYCINE or DISTILLED WATER) absorption…TURP Syndrome with significant morbidity & mortality. Conventional TURP allows tissue removal at 1gram/min. Hence gland size more than 60 gm is converted from an endoscopic to open procedure. DIODE laser (which Fortis Hospital uses) can vaporize 3-4 grams/min. Here normal saline is used as an irrigant which on absorption does not cause TURP syndrome. Hence prostate gland beyond 100 grams can also be managed endoscopically using laser energy.

Advantages of Laser TURP:

Laser TURP in general is safer and faster than conventional TURP which utilizes electrical energy. Laser TURP is specifically indicated in patients who are on blood thinning agents such as heparin, aspirin, clopidogrel, patients with renal dysfunction, patients whose prostate gland size is more than 60 gm, patients who are at poor risk for anesthesia, are diabetic, have cardiac complications and those who have undergone joint replacement surgery. The benefits of this procedure are that there is no blood loss, involves shorter hospital stay and is ideal for large protate glands.

Laser TURP procedure is ideal for:

Patients with renal dysfunction have increased tendency to bleed because of platelet dysfunction making conventional TURP risky. This problem is obviated using laser energy. Conventional TURP can only be done through large caliber rigid scopes. Laser TURP can be done through small caliber flexible scopes. Hence standard lithotomy position which is not possible after joint replacement is not mandatory for laser TURP. Laser TURP can be done under short lasting general anesthesia which is ideal in patients who are high risk for anesthesia. Most patients can expect a rapid improvement in their urinary flow rate, and a quick return to normal activities following the procedure.

Fortis Hospitals’ expertise on Laser TURP:
Fortis Hospitals uses DIODE laser which is the fastest & safest laser available in the world. The hospital has the complete laser urology armamentarium under one roof and the Urology team has the largest & most comprehensive experience in performing laser urology procedures.
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Tags: Dr Mohan Keshavmurthy, laser TURP, prostrate enlargement, Turp Procedures, urinary tract infection, Urology procedure

This entry was posted on Wednesday, July 21st, 2010 at 7:51 am and is filed under Diagnosis Treatements, Emerging Surgery Trends, Fortis Press Release, Industry News, Media Coverage, Uncategorized, Urology. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.