THULIUM LASER PROSTATECTOMY : A NEW EMERGING PLATINUM STANDARD

Ramayya Pramila hospital doctors recently did prostatectomy for 220 gm prostate successfully using Thulium LASER technology. This remarkable feat was achieved in a single session and the patient was discharged within 48 hours of the surgery. Conventional method of doing prostatectomy (Trans Urethral Resection of Prostate –TURP) has limitations if the size of the prostate increase. As the size increases the complications like bleeding and fluid overload also increase. So many urologists prefer to do open surgery in big prostates. There are a few who do TURP in two sessions in such cases.

Currently Ramayya Pramila is the only centre with Thulium LASER facility in whole Andhra Pradesh. This centre can boast of treating many such cases again testimony to the fact that the size of the prostate is of no consequence with this wonderful technology.

Thulium LASER prostatectomy with morcellation provides significant reduction in bleeding, morbidity and hospital stay. We usually keep the catheter for 24-48 hours (a tube that drain the bladder) and discharge the patient within 48 hours. This is in total contrast to routine TURP where catheter and stay is prolonged (3-5 days) notwithstanding the complications like bleeding.

Slowly this technology is gaining widespread acceptance amongst urologist all over the world as it gives an upper hand in treating big prostates and patients with cardiac ailments. It suits well for patients with anti-platelet drugs (blood thinners) and anticoagulants. We use smaller diameter endoscope for the surgery and therefore the incidence of post-operative stricture (narrowing and hence recurrence of urinary problems) is low. It also safely preserves the continence and erectile function of the patients.

With the evolution of LASER technology; many LASERs like Holmium, KTP have also been used. Thulium LASER delivers the energy precisely and can vaporise the prostate also (unlike Holmium LASER).It can enucleate any size of the prostate (unlike KTP) and thus appears to be superior to contemporary LASERs. The Thulium LASER is surgeon friendly LASER and easy to learn and master the art of removing the prostate in toto.While the Holmium LASER needs a significant learning curve. It is not uncommon to see Holmium LASER machine being used only for stone fragmentation and not for prostate surgery   in many hospitals as the urologists are still struggling to master the art of using the Holmium LASER.

We have done a total of 1250 cases till now since we started using Thulium LASER since 2008.Many of the cases were referred to us by cardiologists because of their cardiac comorbdities.Some patients were on drug eluting stents so blood thinners could not be discontinued. These patients were considered high risk for routine TURP.A few were also referred by our fellow urologists; the reason being a large size of the gland. The complications like bleeding, blood transfusing was almost nil. We also did 2 patients in sedoanalgesia and pudental block as they were unfit for any major anaesthesia.

We feel the Thulium LASER is the new emerging platinum standard for prostate surgery and should be adopted by health care professionals for its versatile and superior technology.