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Erectile dysfunction is a well recognized complication of the standard treatment for Benign Prostatic Hyperplasia (BPH), or the enlarged prostate. Approximately 10 per cent of patients who have a TURP are left with erectile dysfunction as a result of the procedure.
This is a considerable risk for patients. Although the majority of patients I see with BPH are 65 and above, I do see a number of patients in their fifties. These patients often decide against surgery - even if it means they have to live with symptoms of BPH - because they do not want to risk a complication which would have a major impact on their lives.
Equally, for some patients in the older age group, erectile dysfunction is very important.
At The Prostate Laser Centre, we discuss risks and complications very thoroughly with patients before the procedure. In some cases, patients may be focused on dealing with the symptoms and less concerned about complications pre-operatively. But post-op, once the patient starts to recover, complications can become a major source of anxiety.
This is one reason why Green Light Laser treatment is such an important development. The Green Light Laser provides a high powered, safe and precise means of destroying surplus tissue by vaporising selected areas. By contrast, during TURP, surplus prostate tissue is burnt by electrical currents.
The nerves which control erections are located just at the side of the prostate. During TURP, erection problem can possibly happen due to these nerves being damaged from the heat of the electrical current. The current can be fairly indiscriminating in terms of the areas it targets.
The Green Light Laser is far more targeted. Even though it is so powerful that surplus tissue is immediately vaporised, it does not penetrate deep into the tissue. Hence it is believed that it minimizes the risks of erectile dysfunction. In my experience, I have not yet seen erection problems developing after green light laser therapy.
Although Green Light Laser treatment is a relatively new development in the UK, it is well established in America and parts of Europe. A total of 200,000 procedures have been undertaken worldwide. A major study* showed there is a 1 per cent rate of erectile dysfunction following Green Light Laser treatment, compared with 10 per cent for TURP.
A very common side effect after TURP is known as retrograde ejaculation. This means during orgasm, semen passes into the bladder rather than out through the penis. The semen is then voided the next time urine is passed. Retrograde ejaculation is not harmful and for many men it is not problematic, although it does result in less sexual satisfaction and infertility. The risk of retrograde ejaculation following TURP is high, up to 90 per cent. The figures for retrograde ejaculation following Green Light Laser are much lower, at between 29 and 41 per cent.
In conclusion, Green Light Laser offers patients the same result as TURP - rapid relief from the symptoms of BPH. However, with Green Light Laser, this is achieved with much reduced side-effects and complications. These benefits for the patient must be recognised.
* Yakupoglu YK, Donmezer S, Mestci B, Saglam R, Simsek US. Successful treatment of BPH over 100 ml with KTP laser. J Urol 2006 May;175(4 suppl.):463 abstract 1522.
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