Compare Treatment Options for Enlarged Prostate
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TUNA vs Microwave vs TURP vs Greenlight Laser: Compare Treatment Options for BPH and Enlarged Prostate
by Dr. Alex Shteynshlyuger MD – Board Certified Urologist
Many patients come to New York Urology Specialists for second opinion with a question what is a better treatment for enlarged prostate: Greenlight laser or Holmium Laser, TUNA or Microwave; Greenlight laser or TURP of the prostate. We will address these questions below.
In general, TURP and Laser procedures (Greenlight Laser, Holmium Laser, KTP, etc) are done in hospital or outpatient operating rooms such as Ambulatory Surgery Center. Some laser procedures can be done in office settings. Based on very good studies, TURP and laser procedures have similar good long-term outcomes with significant improvement in the urinary stream and AUA symptom score (less frequent urination, less urgency, less night-time urination). Laser procedures have fewer short-term side effects than TURP. TURP provides tissue for pathology whereas Laser procedures typically do not.
TUNA (Transurethral Needle Ablation of the Prostate) and Transurethral Microwave Treatments (TUMT)
Transurethral Microwave Thermotherapy abbreviated TUMT is known commercially as Targis™ and Prolieve™.
Transurethral Needle Ablation of the Prostate called TUNA is known commercially as Prostiva™.
In general TUNA and microwave are similar in terms of outcomes and treatment efficacy. They are minimally invasive. They are performed in under an hour in office settings with minimal sedation. The patient does not go to sleep or can get mild anesthesia/sedation. Many patients go home without a catheter after the procedure and are able to urinate at home on the same day. Some men may need a catheter for a short period of time a few days to a few weeks.
Microwave and TUNA treatment has fewer side effects than TURP or Greenlight laser, in particular, the risk of retrograde ejaculation is much lower with Prostiva than with TURP; it is also lower with TUMT than with TURP.
In terms of success, TUNA and microwave work well for 70% of men. About 30% of men will need another treatment within 5 years; in comparison, fewer than 5-10% of men need retreatment within 5 years after Laser or TURP procedures.
Office or Operating-Room Procedure for BPH
The first decision you need to make in consultation with your treating Urologist is whether you want an office-based procedure or a hospital-based procedure. The choice depends on your particular circumstances as well as on your preferences. There is always some unavoidable trade-off between efficacy and side effects.
Most men are able to stop medications such as Flomax and Proscar after treatment with TUNA or microwave. TUNA and Microwave are effective for moderate symptoms of BPH and for prostate glands that are not too large. The effectiveness of TUNA or microwave are typically decreased over 2-3 years and after 5 years about 30% of men require additional treatment which could be another treatment such as microwave or TUNA or transition to Greenlight laser of the prostate or TURP.
For men with mild-to-moderate symptoms of BPH who do not wish to take medications, TUNA or microwave provides an effective office-based safe treatment option. Urolift procedure is also effective for improving symptoms of BPH.
For men with more severe symptoms of BPH such as blood in urine, very large friable prostate, renal insufficiency I would recommend definitive treatment such as Greenlight or Holmium laser of the prostate or TURP.”
There are about a dozen different lasers available on the market for treatment for BPH. Are there any differences between them? There are differences in terms of technology, how fast they are and how they interact with prostate tissue. My perspective on this is that an experienced urologist can use any of the 10 different lasers and produce an equivalent outcome with any given laser in a given patient. I like to compare the differences between different lasers as the difference between cola (Coke/Pepsi) and ginger ale. They taste differently but both satisfy the thirst at the end of the day.
Greenlight Laser vs TURP
Studies have shown that Greenlight laser is equivalent to TURP with slightly less blood loss after the procedure. When it comes to treatment selection between Greenlight, any other laser or TURP I would suggest going with the surgeon’s recommendation. Whatever the surgeon is most comfortable doing will probably be the best option for you because at the end of the day the long-term outcomes do not differ significantly between Greenlight laser, TURP or other lasers.
Many men after Greenlight laser or any other lasers can go home the same day or next day. After TURP men will typically stay for 1-2 days but some may go home the same day.
If you have any other questions, I would be happy to answer them.
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