Prostate - The British way with PVP.

Author

The British way with PVP.

Derek F.

2004-10-24, 4:07 am

This is the procedure at one British NHS Hospital.
Derek.

Directorate of Urology and Renal Services
Undergoing photoselective vaporisation of the
prostate gland
This leaflet has been written to answer questions you may have about your
operation. If you have any further questions it is very important that you
speak to
one of the urology team before your operation.
Why is photoselective vaporisation of the prostate recommended
Photoselective vaporisation of the prostate (PVP), also known as laser
prostatectomy, is used to treat benign prostatic enlargement. A high powered
laser
is used to core out the prostate by vaporising the centre of the gland,
leaving a wide
channel and so relieving urinary symptoms caused by the enlargement of the
prostate gland.
What to expect during your pre operative consultation?
As this is a new procedure within the department, a specific appointment
will be
arranged in order to provide you with information, to try to answer
questions that you
may have and to check that we have sufficient information about you. A lot
of the
necessary examinations may have already been carried out and therefore not
require repeating. You may however be asked to:
- complete a standardised questionnaire to grade your symptoms
- undergo an examination of the prostate. This would entail both an
examination
with a gloved finger and possibly with an ultrasound probe to give the best
estimate of the prostate size.
- repeat a urine flow test
- have a blood test (PSA) to check for prostate cancer. PSA (Prostate
Specific
Antigen) is a substance made by the prostate gland. Small amounts of PSA
pass
into the blood stream where its level can be measured. If this has been
checked
during the previous 12 months it may not need to be repeated.
- you may choose not to undergo the PSA blood test and the ultrasound
examination of the prostate and still undergo the PVP procedure so long as
you
are aware of the reasons behind our asking to carry out these tests.
What preparation is needed?
Prior to your admission to hospital you will be asked to attend the pre
assessment
clinic. Pre anaesthetic checks which may be carried out include blood tests,
urine
tests, heart tracing (ECG) and possibly a chest x-ray. A nurse will complete
the
relevant documentation giving you further opportunity to ask any questions
you may
have.

As this is a new procedure you may be asked to fill in additional
questionnaires or
take place in research projects. This is entirely voluntary and will not in
any way
affect your planned surgery. Any information collected will form part of our
ongoing
audit and enable us to assess the effectiveness of this treatment over time.
At the pre assessment clinic you will be asked about your current
medication.
We particularly need the details of medication that may affect bleeding.
Aspirin may be continued, however if you take clopidogrel (Plavix) or
warfarin
the dose may need to be modified or the drug stopped for a period of time
prior to your admission.
You will come into hospital either the day before or the day of your
operation and be
seen by the nursing and medical staff on the ward.
You will also be seen by the anaesthetist who will discuss with you the type
of
anaesthetic you will have.
On the day of the operation you will be advised to have nothing to eat or
drink for
several hours prior to surgery, this is to enable safe anaesthesia.
You will be asked to change into a hospital gown and be taken to the
operating
department on your ward bed or on a trolley.
At several points, details (name, date of birth, etc) will be checked.
How is the operation carried out?
The operation itself takes approximately 45 minutes
There is some additional preparation required and the time spent in the
operating
theatre suite is likely to be several hours.
The first part of the operation is to give you an anaesthetic so that you
won't be
aware of anything whilst the operation is being performed. You may be
completely
asleep (general anaesthetic), or just the area involved made numb, and then
a
sedative may be given to help the time pass comfortably.
Then you are taken into the theatre itself, moved onto the operating table
and
preparations are made to enable the operation to proceed.
The bladder and prostate gland are accessed via the penis along the urethra
(urinary passageway), and the operating instrument, the cystoscope,
(sometimes
referred to as a 'telescope'), is passed accompanied by sterile salt-water.
The salt-
water allows the urethra to dilate and provides a clear view. First an
inspection is
performed and then the size and shape of the prostate is rechecked by
inserting a
gloved finger into your anus (bottom). If there are no new or unexpected
findings,
then the laser fibre is introduced through the cystoscope and the procedure
started.
As the laser light is shone onto the prostate surface the prostate tissue
can be seen
to gradually disappear.
When the surgeon is happy with the appearances, the need for a catheter
(urinary
drainage tube) to be passed via the urethra is considered.

You will then be transferred from the operating table back onto your bed and
the
process of bringing you round from the anaesthetic begins. Time is spent in
the
recovery ward within the operating department before you return to the ward.
What will happen after the operation is completed?
You will wake up in the recovery area in your bed and when the nurses are
happy
with your condition a nurse from the ward will come to take you back to the
ward.
You will have a drip running into your arm or hand, this is to prevent
dehydration
until you are drinking. You will be given a drink when the nurse feels you
are ready
and able to tolerate it. You should be given a light meal soon after.
You are likely to have a catheter to allow free drainage from the bladder.
The
catheter will be removed a few hours after surgery or the following day. The
timing
of the catheter removal will depend upon several factors, including the type
of
anaesthetic you have had, how well you recover from the anaesthetic and how
much blood there is in the urine.
You may go home once you are passing urine and emptying your bladder
satisfactorily.
What problems can occur?
Before your planned surgery it is important that you understand what the
surgery
entails and the possible side effects.
Effects on your sex life - Approximately 25% of men may experience
retrograde
ejaculation (semen going into the bladder) resulting in a 'dry orgasm'. If
this occurs it
may affect your ability to father children, but you cannot rely on this as a
method of
contraception. Some men report a change in sensation of orgasm.
Urinary control- 7% of men experience mild discomfort of the urethra
immediately
after the operation. This usually lasts a few hours and painkillers can be
given which
will help ease these symptoms.
5% of men may have difficulty passing urine after the operation, this may
result in a
catheter being re inserted for a short period of time. Some of these men may
then
go home with the catheter in place and return as an outpatient to have the
catheter
removed
Impaired erection- There have been no reported cases in men undergoing this
procedure to date.
As with any operation, other surgical complications can occur. These include
infections, heart problems or deep vein thrombosis (blood clots in the
legs). The
risks of these will be discussed in the pre admission clinic and where
necessary
specific preventative measures will be taken.

Are there any alternatives to this surgery?
At the present time the standard operation performed for relieving symptoms
caused
by enlargement of the prostate gland is called transurethral resection of
the prostate
gland (TURP), when the enlarged prostate tissue is shaved away from the
inside
surface, again using cystoscopic instruments.
Please refer to the leaflet 'Having a Prostatectomy'.
As the PVP procedure is relatively new, it is not possible to predict the
long-term
outcome of this operation. However based on the currently available
information it
appears favourable and equivalent to TURP.
What are the benefits?
... A shorter hospital stay.
... If a catheter is required following the surgery it can be removed within
24
hours.
... the risk of bleeding both during and after the operation is reduced.
... the risk of requiring a blood transfusion is minimised
... the surgery itself is less physically traumatic
What can I do when I get home?
Strenuous activity (e.g. digging, carrying heavy items) should be avoided
for two
weeks following your operation. Driving can be resumed after one week (some
car
insurance is not valid during the recovery period after an operation, it
would be
advisable to check with your insurance company). Sports such as golf or
cycling
may be resumed after two weeks.
Avoid becoming constipated as straining may lead to bleeding from your
prostate
cavity. If necessary you can be given a mild laxative to take home after
your
procedure.
Sexual activity may be resumed as soon as you feel ready. If you do not
ejaculate,
there may be some discolouration of the semen for some weeks. This is normal
and
soon settles.
You may return to work when you feel fit which is usually between 2-7 days.
Follow up
You will be sent home with a letter for your GP and with any medication you
need.
A follow up appointment will be made for you 2-3 months after your
operation. At
this appointment you will be asked to provide a urinary flow rate test, so
come with a
full bladder if possible. You will also be asked to repeat the questionnaire
you had
completed prior to your surgery.

Contact points
If you have any problems following your discharge from hospital you may
contact
the ward you were on for advice.
Alternatively you may contact your GP
If the matter is urgent and you are unable to contact the hospital please
contact the
emergency medical services in the usual way

max bridgewater

2004-10-26, 2:08 am

It sounds like there are more complications than with TUNA.
Doesn't the TUNA work? A urologist told me to get the TUNA
done. I am first trying to releive my symptoms with Saw
Palmetto and other herbs for six weeks now with no results
yet.

>This is the procedure at one British NHS Hospital.
>Derek.
>
>Directorate of Urology and Renal Services
>Undergoing photoselective vaporisation of the
>prostate gland
>This leaflet has been written to answer questions you may
>have about your
>operation. If you have any further questions it is very
>important that you
>speak to
>one of the urology team before your operation.
>Why is photoselective vaporisation of the prostate
>recommended
>Photoselective vaporisation of the prostate (PVP), also
>known as laser
>prostatectomy, is used to treat benign prostatic
>enlargement. A high powered
>laser
>is used to core out the prostate by vaporising the centre
>of the gland,
>leaving a wide
>channel and so relieving urinary symptoms caused by the
>enlargement of the
>prostate gland.
>What to expect during your pre operative consultation?
>As this is a new procedure within the department, a
>specific appointment
>will be
>arranged in order to provide you with information, to try
>to answer
>questions that you
>may have and to check that we have sufficient information
>about you. A lot
>of the
>necessary examinations may have already been carried out
>and therefore not
>require repeating. You may however be asked to:
>- complete a standardised questionnaire to grade your
>symptoms
>- undergo an examination of the prostate. This would
>entail both an
>examination
>with a gloved finger and possibly with an ultrasound probe
>to give the best
>estimate of the prostate size.
>- repeat a urine flow test
>- have a blood test (PSA) to check for prostate cancer.
>PSA (Prostate
>Specific
>Antigen) is a substance made by the prostate gland. Small
>amounts of PSA
>pass
>into the blood stream where its level can be measured. If
>this has been
>checked
>during the previous 12 months it may not need to be
>repeated.
>- you may choose not to undergo the PSA blood test and the
>ultrasound
>examination of the prostate and still undergo the PVP
>procedure so long as
>you
>are aware of the reasons behind our asking to carry out
>these tests.
>What preparation is needed?
>Prior to your admission to hospital you will be asked to
>attend the pre
>assessment
>clinic. Pre anaesthetic checks which may be carried out
>include blood tests,
>urine
>tests, heart tracing (ECG) and possibly a chest x-ray. A
>nurse will complete
>the
>relevant documentation giving you further opportunity to
>ask any questions
>you may
>have.
>
>As this is a new procedure you may be asked to fill in
>additional
>questionnaires or
>take place in research projects. This is entirely
>voluntary and will not in
>any way
>affect your planned surgery. Any information collected
>will form part of our
>ongoing
>audit and enable us to assess the effectiveness of this
>treatment over time.
>At the pre assessment clinic you will be asked about your
>current
>medication.
>We particularly need the details of medication that may
>affect bleeding.
>Aspirin may be continued, however if you take clopidogrel
>(Plavix) or
>warfarin
>the dose may need to be modified or the drug stopped for a
>period of time
>prior to your admission.
>You will come into hospital either the day before or the
>day of your
>operation and be
>seen by the nursing and medical staff on the ward.
>You will also be seen by the anaesthetist who will discuss
>with you the type
>of
>anaesthetic you will have.
>On the day of the operation you will be advised to have
>nothing to eat or
>drink for
>several hours prior to surgery, this is to enable safe
>anaesthesia.
>You will be asked to change into a hospital gown and be
>taken to the
>operating
>department on your ward bed or on a trolley.
>At several points, details (name, date of birth, etc) will
>be checked.
>How is the operation carried out?
>The operation itself takes approximately 45 minutes
>There is some additional preparation required and the time
>spent in the
>operating
>theatre suite is likely to be several hours.
>The first part of the operation is to give you an
>anaesthetic so that you
>won't be
>aware of anything whilst the operation is being performed.
>You may be
>completely
>asleep (general anaesthetic), or just the area involved
>made numb, and then
>a
>sedative may be given to help the time pass comfortably.
>Then you are taken into the theatre itself, moved onto the
>operating table
>and
>preparations are made to enable the operation to proceed.
>The bladder and prostate gland are accessed via the penis
>along the urethra
>(urinary passageway), and the operating instrument, the
>cystoscope,
>(sometimes
>referred to as a 'telescope'), is passed accompanied by
>sterile salt-water.
>The salt-
>water allows the urethra to dilate and provides a clear
>view. First an
>inspection is
>performed and then the size and shape of the prostate is
>rechecked by
>inserting a
>gloved finger into your anus (bottom). If there are no new
>or unexpected
>findings,
>then the laser fibre is introduced through the cystoscope
>and the procedure
>started.
>As the laser light is shone onto the prostate surface the
>prostate tissue
>can be seen
>to gradually disappear.
>When the surgeon is happy with the appearances, the need
>for a catheter
>(urinary
>drainage tube) to be passed via the urethra is considered.
>
>You will then be transferred from the operating table back
>onto your bed and
>the
>process of bringing you round from the anaesthetic begins.
>Time is spent in
>the
>recovery ward within the operating department before you
>return to the ward.
>What will happen after the operation is completed?
>You will wake up in the recovery area in your bed and when
>the nurses are
>happy
>with your condition a nurse from the ward will come to
>take you back to the
>ward.
>You will have a drip running into your arm or hand, this
>is to prevent
>dehydration
>until you are drinking. You will be given a drink when the
>nurse feels you
>are ready
>and able to tolerate it. You should be given a light meal
>soon after.
>You are likely to have a catheter to allow free drainage
>from the bladder.
>The
>catheter will be removed a few hours after surgery or the
>following day. The
>timing
>of the catheter removal will depend upon several factors,
>including the type
>of
>anaesthetic you have had, how well you recover from the
>anaesthetic and how
>much blood there is in the urine.
>You may go home once you are passing urine and emptying
>your bladder
>satisfactorily.
>What problems can occur?
>Before your planned surgery it is important that you
>understand what the
>surgery
>entails and the possible side effects.
>Effects on your sex life - Approximately 25% of men may
>experience
>retrograde
>ejaculation (semen going into the bladder) resulting in a
>'dry orgasm'. If
>this occurs it
>may affect your ability to father children, but you cannot
>rely on this as a
>method of
>contraception. Some men report a change in sensation of
>orgasm.
>Urinary control- 7% of men experience mild discomfort of
>the urethra
>immediately
>after the operation. This usually lasts a few hours and
>painkillers can be
>given which
>will help ease these symptoms.
>5% of men may have difficulty passing urine after the
>operation, this may
>result in a
>catheter being re inserted for a short period of time.
>Some of these men may
>then
>go home with the catheter in place and return as an
>outpatient to have the
>catheter
>removed
>Impaired erection- There have been no reported cases in
>men undergoing this
>procedure to date.
>As with any operation, other surgical complications can
>occur. These include
>infections, heart problems or deep vein thrombosis (blood
>clots in the
>legs). The
>risks of these will be discussed in the pre admission
>clinic and where
>necessary
>specific preventative measures will be taken.
>
>Are there any alternatives to this surgery?
>At the present time the standard operation performed for
>relieving symptoms
>caused
>by enlargement of the prostate gland is called
>transurethral resection of
>the prostate
>gland (TURP), when the enlarged prostate tissue is shaved
>away from the
>inside
>surface, again using cystoscopic instruments.
>Please refer to the leaflet 'Having a Prostatectomy'.
>As the PVP procedure is relatively new, it is not possible
>to predict the
>long-term
>outcome of this operation. However based on the currently
>available
>information it
>appears favourable and equivalent to TURP.
>What are the benefits?

Derek F.

2004-10-26, 11:10 am

"jay1000" <jfschonREMoVE@yahoo.com> wrote in message
news:YZDdd.34725$bk1.11685@fed1read05...
>
> "Derek F." <Lordpilrig@NOXbtinternet.com> wrote in message
> news:cl3opd$90i$1@hercules.btinternet.com...
> "We particularly need the details of medication that may affect bleeding.
> Aspirin may be continued, however if you take clopidogrel (Plavix) or
> warfarin the dose may need to be modified or the drug stopped for a period
> of time prior to your admission."
>
> This is the first time I have seen aspirin allowed for any surgical
> procedure. Doctors in the US are pretty adamant about discontinuing
> aspirin one week prior to the procedure.
>
> Wonder why the difference.
>
>
Personally I have always stopped taking aspirin before prostate biopsies.
Derek.

Magna

2004-10-26, 7:27 pm

Derek,

Care to say which hospital?