TURIS – Button Vaporization

Endoscopic vaporization of a benign enlarged prostate, using laser. This allows patients on anti-coagulation therapy to continue their medication with minimal risk of hemorrhage. It also allows a shorter stay in hospital.

Indications:  

• Patients on anticoagulation or anti-platelet therapy
• Smaller prostate
• Where conservative management has failed.
• Patient choice
• This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
• Symptoms include:
  • a weak stream,
  • nightly urination frequency,
  • frequent urination,
  • inability to urinate,
  • kidney failure due to the weak urination (obstruction),
  • bladder stones,
  • recurrent bladder infections.
• Medication such as Flomaxtra, Urorec, Minipress etc. should always be given as a first resort.
• Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar
• Prostate cancer first needs to be ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
• A TUVP can also be performed to dis-obstruct a severe prostate cancer, to allow a normal urination process

How is it done?

• You will receive a general anaesthesia, unless contra-indicated.
• A cystoscopy is performed by placing a camera in the urethra with the help of lignocaine gel
• The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
• A vaporization of the prostate is then started and should take 60-120 minutes depending on the size of the prostate.
• Prophylactic antibiotics will be given to prevent any infections.
• Post– operative antibiotics will be continued for 10 days.

No specimen will be obtained due to vaporization, unless PSA was suspicious and an MRI with view to prostate biopsy has excluded a prostate cancer

What can go wrong?

• Any anesthesia has its risks, and the anesthetist will explain this to you.
• No blood loss is expected.
• You will wake up with a catheter in your urethra and bladder. This will remain in the bladder overnight.
• Lower abdominal discomfort for a few days
• NB! Each person is unique and for this reason symptoms vary!

What next?

• You will spend 1 –2 nights in hospital.
• You will a trial without catheter the next day
• You will be discharged as soon as you can completely empty your bladder.
• You may initially suffer from urge incontinence and dysuria (irritable voiding) and will improve within the next 6 weeks.
• Allow for 6 weeks for stabilization of symptoms.
• There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy
• A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
• Don’t hesitate to ask Jo if you have any queries

DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE

Side–effects

• Retrograde ejaculation in more than 90% of patients. Therefore, if you have not completed your family, this procedure is not for you unless absolutely necessary.
• Infertility as a result of the retrograde ejaculation.
• Stress incontinence initially for the first 6 weeks, especially in the elderly and the diabetic patients
• Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
• Urethral stricturing in 2-3% of patients, requiring intermittent self-dilatation.
• Regrowth of prostate lobes within 3-5 years requiring a second procedure.
• NB! Each person is unique and for this reason symptoms vary!

Wes TURIS