Laser Treatment

• Laser therapy is a newer approach with fewer side effects and a faster recovery time. The three approaches to using lasers to reduce prostatic tissue involve neodymium, holmium, or the potassium-titanyl phosphate (green light) lasers. For some years, the holmium laser has been the "gold standard" laser treatment. Studies and review articles now appearing in the literature suggest the green light laser offers more advantages with fewer unwanted side effects.
  
  

Laser Techniques

• The laser is inserted with a cystoscope (an instrument with a camera that is inserted into the urethra) and delivers laser heat to the prostate, selectively destroying tissue. The main difference between the holmium and green light laser is the former targets surface tissue, and the latter penetrates more deeply. Both types of laser are less likely to cause infection or irritation, with shorter periods needed for catheterization than earlier lasers, based on a study in "Current Urology Reports." Because laser therapy is an invasive technique, all types increase the potential of side effects, the main one being urinary tract infections. However, because lasers involve a shorter period of post-operative catheterization, this risk is less than with other methods. Bleeding is less with a laser because of coagulation effects. However, the same coagulation may cause swelling, leading to a temporary increase in the blockage. As of 2009, an important consideration in choice of treatments is the lack of longer than five years or so follow-up on the newer treatments.
  
  

Benefits Compared to Other Methods

• Multiple ways exist to treat the annoying symptoms of BPH, which include frequent urination both day and night. These include watchful waiting, that is, with mild symptoms simply living with the problem and having periodic evaluations to check for a worsening situation. Some men choose medication such as alpha-blocker drugs to relax muscles and ease urination. Other drugs like Finasteride may shrink the prostate to reduce the compression of the urethra. Surgery, with some possible unpleasant side effects, is another option. Transurethral resection (TURP) works through the urethra to scrape away extra prostate tissue. Transurethral incision (TUIP), also done through the urethra, makes several incisions in the prostate to relax the pressure. Widening the urethra through balloon dilation or stents is another approach. Various methods involving heat is a middle ground between surgery and medication. Heat sources to destroy part of the prostate using microwaves, radio waves or an electrical current are alternative approaches. These include transurethral evaporation (TUEP), visual laser ablation (VLAP), water thermotherapy, ultrasound and laser therapy.
  
  The problem with watchful waiting is that serious problems may develop without warning. Medication may have unwanted side effects. Alpha-blockers are actually hypertension drugs and as such, can have typical problems associated with this class of drugs such as dizziness. Finasteride can cause impotence. Surgical procedures involving incisions carry obvious risks of damage to the urethra. Dilations may not last. Stents can cause infection and fail as well, requiring removal. Other heat methods do not seem to have as long-lasting effects as laser therapy.