San José, Costa Rica, since 1956

Doctors Promote New Laser Prostate Surgery

Doctors at the private CIMAHospital, in Escazú, west of San José, are touting a new procedure using state-of-the-art technology to treat enlarged prostates, a potentially painful condition they say affects a majority of older men.

The procedure, called Photoselective Vaporization of the Prostate (PVP), is significantly more efficient, less painful and has fewer side effects than the traditional operation to treat the condition, doctors recently told The Tico Times.

The prostate gland, located in men’s lower reproductive system, is wrapped around the urine-carrying urethra. Benign Prostatic Hyperplasia (BPH) is the term for the condition in which the prostate gland grows painfully large, obstructing the ability to urinate, causing bladder problems and, in extreme cases, irreparable kidney damage.

According to Dr. Carlos Calvosa and Dr. Arieh Grunhaus, urologists at CIMAHospital who are trained in the PVP procedure, as many as 50-60% of men over age 50 have an enlarged prostate. In the United States, Grunhaus said, an estimated 6.3 million men suffer from the symptoms and BPH leads to 400,000 annual hospital visits.

For these patients, the two urologists say, the PVP system represents a quick, easy and relatively painless option for the treatment of enlarged prostates, with impressive benefits compared to what has been the standard treatment.

According to Grunhaus, besides PVP, the next-best treatment has been to basically cut out the extra prostate tissue with an electric powered hot poker in a treatment called Trensurethral Resection of the Prostate (TURP). Side effects of the operation include bleeding and backwards ejaculation (into the bladder). Recovery from the operation, he continued, often takes months and involves wearing a catheter.

“It is a hot wire loop that cuts the tissue, taking pieces out of the prostate,” said Calvosa, making a scooping motion with his hand. “This whole traditional procedure – TURP – the results are good. But it is different with the laser treatment.”

CIMAHospital uses the GreenLight laser system, developed by the U.S. company Laserscope in 1998. Surgeons insert the laser, which includes a video camera, into the penis, following the urethra to the prostate.

Watching the small, missile-shaped insert magnified on a TV screen in the operating room, surgeons wield a potassium-based, green laser to literally vaporize the prostate tissue.

“The good part about the laser is the difference in the technology. In this new procedure, when we vaporize the tissue, we are vaporizing the blood vessels as well, so there is no bleeding at all. Those patients can go home the same day, and probably that is the most important thing,”

Grunhaus said. “With TURP, most patients will bleed after the procedure and there is a percentage who will need a transfusion. We needed to keep patients for two days and three nights in the hospital, and they had to have a catheter in place for a long time.” This difference in recovery time also translates into less time out of work, they added.

“These patients, with the traditional technology, have to wait a month before going back to work,” Calvosa said. “With the laser, practically in four or five days they are returning to their normal activities. That is a huge change.”

Grunhaus added that some patients, such as those with a heart condition or who are taking anti-coagulants (blood-thinner), are not eligible for the TURP surgery, but can get the PVP surgery.

The GreenLight procedure lasts about an hour, and recovery time in the hospital is about four hours. Both doctors insist that the side effects with this treatment are minimal to nonexistent. The surgery costs $3,850, compared to $16,000 in the United States, Grunhaus said, stressing that it is a procedure approved by the U.S. Food and Drug Administration (FDA). Since the GreenLight was introduced in 1998, he continued, more than 100,000 men have been treated with it worldwide.

The two doctors said they have treated 20 patients with the GreenLight procedure since July 11, when the machine was first introduced to the hospital. Both men took a three-month training course to be certified in the technology, and say they are the only doctors in Costa Rica who can perform the operation.


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