How a burst of green light could banish night-time trips to the loo
ME & MY OPERATION LASER FOR ENLARGED PROSTATE
AN ENLARGED prostate is very common as men age, but a simple procedure can help. Stephen Lee, 71, a retired deputy headteacher from Sevenoaks, in Kent, had the operation, as he tells CAROL DAVIS.
THE PATIENT
SINCE retiring ten years ago I’ve been very active, cycling 70 miles a day and playing golf. But for some years I’d often had to get up in the night to empty my bladder. I assumed that was normal at my age. But last November, when I was in hospital for a knee replacement, suddenly I couldn’t go at all — I couldn’t wee for three days, and I was horribly aware of my bladder getting very full and uncomfortable.
Doctors thought the problem might have been an after-effect of the anaesthetic for the knee surgery. They fitted me with a catheter and sent me home because my operation had gone well, referring me for a urology appointment two months later.
In the meantime, I had to have the catheter in place constantly, with a bag strapped to my knee that I had to empty regularly — it was very annoying and I couldn’t wait to get rid of it.
When I had my urology appointment at King’s College Hospital in London, they told me the problem with my bladder wasn’t to do with the surgery but was caused by an enlarged prostate — it was pressing on my urethra, blocking the flow of urine from my bladder.
I was quite reassured to know the cause of the problem as I’d been imagining the worst.
They told me they could treat it using a laser — via a tube inserted through the urethra — which would dissolve part of the enlarged prostate from the inside.
I was over the moon that finally something could help. They could also do it as a day case, so I’d be going home the same afternoon.
I had the hour-long op under general anaesthetic in February.
WHEN I woke, I felt fine. I still had a catheter in place to keep me comfortable while I healed. Three days later, I returned to hospital to have it removed and found that I could urinate again, but it was only a dribble.
And now I had the opposite problem — I had no control.
The consultant I saw thought that the long period with a catheter and the overgrown prostate had irritated my bladder so it had become overactive, and would take time to settle down.
I was prescribed antibiotics in case there was an infection.
Then, at the end of May, I was prescribed the drug mirabegron to relax the bladder so it wouldn’t keep contracting and expelling urine. Three weeks later, I’d recovered control.
I saw Christian Brown — the consultant urologist who had carried out my procedure — again in June, and he said I could stop taking mirabegron.
Now I have full control again, which I’m very pleased about, and I don’t need to get up in the middle of the night to go the loo. I’ve had no side-effects whatsoever. We’ve just been on holiday to Portugal, and I had a lovely time without having to worry about issues with my bladder.
THE SURGEON
CHRISTIAN BROWN is a consultant urologist at King’s College Hospital and Guy’s and St Thomas’ NHS Foundation Trusts. AN ENLARGED prostate — or benign prostate enlargement — is very common, affecting around 60 per cent of men aged over 60.
The prostate is a doughnutshaped gland that lies under the bladder and surrounds the urethra, the tube that carries urine out of the body. The prostate grows naturally as men age in response to hormones, and can sometimes press on the urethra.
This can mean that men need to empty their bladder frequently, but feel that it never empties properly. It can also lead to urinary tract infections — when urine is stagnating in the bladder rather than being emptied — or even to complete blockage.
Lifestyle changes may help, such as drinking less water and having less caffeine, which can irritate the bladder.
Doctors may also prescribe alpha blockers to relax the prostate, 5-alpha-reductase inhibitors to shrink it and anti-muscarinics, which help to control symptoms such as frequency and urgency at night. When all else fails, we can offer surgery. This has traditionally meant transurethral resection of the prostate (TURP). Here we use electricity to chip away a section of the prostate to widen the channel the urethra passes through.
But this can cause bleeding, so men typically need to stay in hospital for two to five days afterwards.
More recently, we have been able to treat an overgrown prostate using lasers, which are continually evolving. They work by vaporising prostate tissue.
One effective laser is called GreenLight — it was developed in the late Nineties in the U.S. and has been available in the UK since 2002.
The latest version of this, called GreenLight XPS, has just been approved by the National Institute for Health and Care Excellence (NICE), which should make it more widely available.
It’s more powerful, more accurate and causes less bleeding than earlier versions, making operating times shorter.
It uses green wavelength light, which is absorbed by haemoglobin (a protein) in the blood vessels in the prostate. It penetrates only 0.8mm deep so is unlikely to damage healthy tissue.
And studies have shown that it is just as effective as TURP but, because there is less bleeding, men do not need a hospital stay — 98 per cent of our patients can go home the same day.
And a randomised controlled trial, published in the journal European Urology, has shown that GreenLight causes fewer sideeffects, such as erectile dysfunction, than TURP, because the laser does not go very far into the tissue.
The whole operation takes around 60 minutes under general or spinal anaesthetic.
First we feed the rigid laserscope — a tube with a laser fibre running through it and a camera at the tip — into the urethra.
This allows us to have a good look around the urethra, prostate and bladder.
BY PRESSING a foot pedal, I can vaporise sections of the prostate when the scope reaches them so they effectively disappear. The vaporised cells are flushed out of the body with saline, which we pump throughout the procedure.
At the same time as vaporising the tissue, I use the laser to seal small blood vessels close by to stop them bleeding.
Once we have widened the channel successfully, we put in a catheter to keep the patient comfortable — we take it out at the next appointment, within three days.
The patient then goes home, taking ibuprofen or paracetamol.
It can take time, sometimes months, for their bladder to go back to normal as it can be affected by the original prostate growth and wearing a catheter. Some 30-40 per cent of men will need a second operation in ten years’ time as the prostate grows again, but most patients will have many years of normal function with no further bladder problems.
NICE has now recommended that the NHS offers this treatment to patients who have an enlarged prostate but are not at high risk of complications — this means around 13,600 men could benefit.
Because patients should be able to leave hospital on the same day as the operation, it could save the NHS millions, as normally those undergoing TURP have to stay in for at least a couple of days.
THE operation costs £4,500 privately and £2,250 to the NHS.