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BPH or enlarged prostate treatment with greenlight PVP Laser in New Delhi India

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BPH or enlarged prostate treatment with greenlight PVP Laser in New Delhi India

BPH or Enlarged Prostate

Prostate is a walnut shaped gland, located immediately below the neck of the urinary bladder, surrounding the urethra. Normal size of prostate is less than 20 gms. The prostate size increases with age. BPH is characterized by the benign (non-cancerous) overgrowth of prostate cells. Nearly half of men over the age of 65 have BPH or Enlarged Prostate. This enlargement causes bladder outlet obstruction and reduces the urinary flow and the man finds that his urine stream becomes weaker and it is more difficult to empty his bladder. These symptoms may significantly impair quality of life.

As the condition increases in severity, the symptoms begin to affect daily activities.


 

Treatment of enlarged prostrate can we by medicine or by surgery. The prostate is the walnut sized gland just below the Urinary bladder. When it enlarges it blocks the urinary passage and causes reduction in flow of urine.
There are medicines available to improve the urine flow. They work by opening the Urinary passage to improve the Urinary flow.
Medicines are always the first line of treatment for in large prostate and urinary problems. If Medicine is don’t work then the next best treatment is removal of the obstructing part of the prostate. This can be done by endoscopic surgery that is TURP or by Green Light Laser Prostatectomy .

The prostate is stimulated by the hormone testosterone. So any medicine which will decrease the testosterone level in the body will shrink the size of the prostate. There are some medicines which reduce the size of prostate by 20% and there are other medicines which reduce the size of prostate by almost 50%.

Hindi me Prostate Ko gadood kahte hain. Jub gadood Baddhta hai to peshaab me rukawat hoti hai. Gadood Ka ilaaj laser dwara kiya jata hai.

The treatment of enlarged prostrate in India is very cost-effective. All types of treatment or available including TURP and Green Light PVP Laser. Enlarged prostrate is a condition commonly affecting Indian man, so We are doing this procedure commonly in Indian men. In fact, patients from all over the world have come to us for this treatment. We have had patients from Thailand, USA, America, UK, Nigeria, Ghana, Uganda, Tanzania, Kenya, Afghanistan, Bangladesh.

Delhi is the capital city of India. It has an international airport. New Delhi is a very cosmopolitan city. Most of the people wear western clothes. All cuisines are available Indian, Chinese, African, Continental, French, Mexican, American and south East Asian.

Cost of treatment of enlarged prostate treatment in India is much lower than in USA or UK or even Nigeria. The cost is significantly lower in all aspects of treatment like Doctor consultation, cost of medicines and cost of surgery.

There are many medicines available for treatment of in large prostate. Some of the medicines reduce the inflammation of the prostate, some of them reduce pain of the prostate , some of them increase the urinary flow and reduce the urinary problems. There are also some medicines which shrink the prostate and reduce the size of the prostate.

There are six healthy habits which reduces the risk of prostate cancer:
Six Healthy Habits May Help Men Reduce Their Risk Of Dying From Prostate Cancer.
Bloomberg News (9/29, Bennett) reported that research presented at the European Cancer Congress indicated that “six healthy habits, including eating more tomatoes and less processed red meat,helped men reduce their risk of dying from prostate cancer.”
Investigators looked data from nearly “46,000 men...and found that those who adopted five or six of the habits had a 39 percent lower risk of developing lethal prostate cancer than those who adopted one or none of the habits.”
The data indicated that “each of the six habits, which also included not smoking, exercising, eating fatty fish and having a body-mass index of less than 30, has been linked with lowering prostate cancer risk."

Enlarge prostate can also cause erectile dysfunction. Many patients who suffer from Erectile dysfunction, their erections improve after prostate surgery. Treatment of enlargement of prostate does not cause Erectile dysfunction. Even if there is prostate cancer, we do nerve sparing robotic radical prostatectomy which prevents erectile dysfunction in prostate cancer treatment.

UTI, bleeding, retrograde ejaculation, erectile dysfunction. Most of these side effects are transient And will recover. Also the incidence of the side effects is much lower if the treatment is with laser.

Frequent urination or reduced urine flow can be treated by medicines initially. But at advanced stages when the medicines are not effective, the best treatment is Green Light Pvp laser prostatectomy.

The best treatment for in large prostate depends on the stage of the prostate. In the initial stages when the problem is not very severe, there are medicines available for treatment of the enlargement of prostate and the unary problems. In the later stages, when the symptoms become very severe and medicines are not benefiting, In that situation the best treatment is Green Light PVP Laser Prostatectomy.

Greenlight Pvp laser treatment is a new treatment for enlargement of Prostate which shrinks the prostrate by vaporisation of the prostate.

Laser treatment is the latest treatment for enlargement of the prostate gland. In this we vapourise the prostate and reduce the size and improve the urine flow. There is minimal bleeding and very little pain. Patient is discharged from the hospital in 24 hours.

Greenlight Pvp laser is the latest treatment of enlarged prostate and Urinary problems

Enlarged prostate treatment saw palmetto is A herbal plant that has anti-inflammatory properties on the prostate. It is shown to improve the urinary flow and reduce the Urinary problems and does not have the common side-effects seen with other medicines of prostate like dizziness or retrograde ejaculation or erectile dysfunction

Treatment for enlarged prostate urinary retention: If there is any retention of urine and the urine is blocked, The patient will be having a lot of pain. The best way to relieve the pain and cause drainage of urine is to pass the unary catheter as soon as the catch is passed urine will come out and patient will become for table. Retention can be temporary or permanent. Temporary means it happened due to some other factors like anal surgery or severe constipation. In those cases after the primary problem is relieved patient will pass urine normally.

If their attention is due to obstruction by and large prostate, the patient will keep on having retention of urine unless the prostate is treated by endoscopic TURP or with by laser prostatectomy.

Lasers are of different wavelengths. The green light PVP LASER has a wavelength of 532 µm and it is in the visible range. That is why we see the green light of this laser when it is working.

The term LASER stands for :

L = Light
A = Amplification
S = Stimulated
E = Emission
R = Radiation

The laser light differs from the ordinary white light
The ordinary white light goes in different directions and totally unregulated for examples, a lightbulb, whose light goes in all the directions, totally unregulated.
The laser light is monochromatic, coherrant and collimated. It is goes in one direction only, so it’s effect is selective, predictable and controllable in direction and focus , thus it’s very safe and has good tissue effects.
The Greenlight Pvp laser energy is absorbed only by haemoglobin and it is not absorbed by water.
It has a tissue penetration of only 0.8 mm making it very safe because it does not go deep into the tissue.

Green Light Laser treatment of enlarged prostate has very few side-effects. There is minimal bleeding and minimal morbidity. Risk of urinary incontinence or sexual dysfunction is also very low.

The Greenlight Pvp Laser destroys the prostate issue by process of continuous vaporisation.

There is no cutting involved, so it causes very little bleeding and is very safe even for high risk patients like diabetes, heart patients, patients with other medical problems or advanced age, and patients on blood thinners.

It has excellent post-operative outcomes.

• Minimal bleeding
• Patients are discharged in 24 hours
• Most patients are catheter free after 24 hours and urinated comfortably with a good urinary flow.
• There is no Incontinence (urinary leak)
• There is no impotance or sexual dysfunction
• Incidence of retrograde ejaculation is less than 30%
• Complications Occur infrequently and are mild if they do

The cost of Green Light PVP Laser treatment in India is almost 1/3 or one fourth less than cost of this treatment in USA or England. Get low-cost treatment of enlarged prostate through green light PVP laser prostatectomy.

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Symptoms of BPH are:

  • Urinary Frequency, especially at night
  • Urgency - the need to urinate immediately
  • Hesitancy - flow doesn't start right away
  • Intermittency - flow stops and goes
  • Flow of urine is slow
  • Blood in the urine                           
  • A Feeling the bladder isn't empty
  • Dribbling after urination
  • Pain or burning during or after urination
  • Impotence
  • Painful orgasms

While symptoms of BPH and Prostate Cancer can be similar, BPH has never been shown to be a precursor to developing prostate cancer.

Once a diagnosis of BPH is confirmed, a treatment is recommended. There is no cure for this condition so finding relief from the symptoms is the goal of the treatment.


 

The spectrum of symptoms that are associated with BPH are known collectively as lower urinary tract symptoms (LUTS).

The severity of symptoms and the degree of Bother to the patient have to be assessed as per the AUA Symptom score.

 

                                               The AUA Symptom Score

 

The symptoms of BPH overlap with those of other conditions, so your initial examination should be thorough. Your doctor will question you about your general health and symptoms. You will be asked about other conditions, such as diabetes and hypertension, and what medications you are taking.

Physical examination and Digital Rectal examination

A digital rectal examination will be performed to give the doctor an idea of the size and consistency of your prostate. He will also feel your abdomen to check whether your bladder is distended so that it can be felt (if it can, this is a sign that you may be retaining urine). Your doctor may also make an assessment of your nervous system, such as testing the muscle tone and sensation in the area around and between the scrotum and anus, as some disorders of the nervous system, such as Parkinson’s disease or spinal cord problems, can give rise to urinary symptoms similar to those of BPH. Since high blood pressure (hypertension) is common, blood pressure may also be measured as part of a general health check.

Urine test

An urinary tract infection ( UTI ) can cause symptoms like increased urinary frequency or urgency, a urine sample will be checked for signs of bacterial infection or blood. The urine may also be tested routinely for the presence of sugar, which is a sign of diabetes. The urine may also be checked for malignant cells resulting from a bladder, ureteric or kidney cancer.

Blood tests

Few men have kidney problems due to their BPH. Kidneys are affected by back pressure of urine due to urinary retention in the bladder. This will result in deranged Kidney function tests. This can be assessed by Kidney Function Tests. Your blood sugar level may also be tested to check that you do not have diabetes, as this can be a cause of frequent urination.

The amount of PSA may also be measured. (mentioned in detail in the prostate Cancer section. ) PSA is a marker of prostate cancer, but sometimes as a result of BPH. In fact, the larger your prostate, the higher your PSA tends to be.

 If your PSA level is raised, it may be recommended that you have a prostate biopsy so that prostate cancer can be excluded.

Urine Flow test (or Uroflowmetry)

By measuring the speed of your urine output over time, your urologist can get some useful information about your urine flow. For this test you will have to urinate (privately) into a machine that measures the speed of urination and more information.

Ultrasound to measure the residual urine left in the bladder

Ultrasound can give your doctor an idea of how severe the obstruction is and how well you might respond to certain types of treatment. 

TURP - Transurethral Resection of the Prostate

Historically, BPH was surgically treated by an operation called Open Prostatectomy which is a major abdominal surgery. Performed in a hospital under general anesthesia, the surgeon opens the patient's abdomen and either removes the gland or cuts off the overgrowth. The patient leaves the operating room with two catheters which stay in for up to a week. This procedure requires a long-term rehabilitation period.

Less invasive than Open Prostatectomy is the more commonly performed Trans urethral Resection of Prostate (TURP).

This procedure is done in as short hospital stay using Spinal Anaesthesia. Using a resectoscope, the surgeon enters the urethra through the natural passage in penis and cuts away pieces of the overgrown gland using electro-cautery. At the end of the procedure, a urinary catheter is put in the patient and is removed after 3-5 days. This procedure takes about 90 minutes and the patient may be discharged on the day after surgery. The patient can return to daily activities in about 1 week, and can start strenuous activity after 1 month of surgery. The benefit of this procedure is its safety and effectiveness in opening the bladder outlet and improving the urinary flow.

Possible side-effects directly after the procedure include some burning in urination and blood in the urine. There is a possibility of long-term recovery issues, including retrograde ejaculation.

TURP is considered to be the optimum treatment for BPH today.

What is Transurethral Resection of the Prostate (TURP)?

Transurethral Resection of the Prostate (TURP) is a procedure to remove excessive growth of the prostate gland, resulting from Benign Prostatic Hyperplasia (BPH).

TURP Procedure

TURP is a minimally invasive procedure to remove the overgrowth of prostate tissue. TURP is still considered the "gold standard" of prostate surgery options and the preferred treatment for BPH. It is performed by a urologist in a hospital under spinal anaesthesia. A resectoscope (an instrument much like a cystoscope with the advantages of a microscope, light, irrigation capability, and a wire loop) or a spring-action cutting tool, is inserted into the urethra to access the enlarged prostate gland. The electric current generated through the cutting tool removes small pieces of tissue until the bladder outlet is opened up. To control bleeding, the vessels are cauterized by the wire loop and the bladder and urethra are irrigated with a saline solution. A urinary catheter is put in for the purpose of resting the bladder, keeping the urethra open if swelling develops, and to wash the blood clots from the bladder. The procedure takes about 90 minutes.

Benefits of TURP

TURP has several advantages over the newer technologies. For men with other health problems that make the newer procedures inadvisable, TURP is the best option for treatment of BPH. If the prostate has grown too large, newer procedures they may not be effective, and some may feel more comfortable with surgery than an unfamiliar technology.

Additional Advantages include:

  • Visual, hands-on access to the prostate
  • Immediate removal of excess tissue
  • Can be coupled with other procedures, e.g., removing small bladder stones
  • Longevity of use with supportive data on overall efficiency, safety, and success rates
  • Traditionally taught in medical schools so doctors have extensive experience

Recovery after TURP

Commonly, there is a one-night hospital stay for observation and flushing of the catheter. Light bleeding will continue, presented in the urine and when the catheter is flushed out. The catheter will remain in for two to five days and must be flushed regularly by the patient after discharge; instructions on how to do this are given while in the hospital.

After discharge, precautions are recommended for the purpose of healing, comfort, and preventing damage to the treated area. Patients will require rest and should drink large quantities of water to flush out the bladder to prevent a urinary tract infection. No straining, lifting or pushing heavy items should occur. A significant improvement in recovery is seen after the catheter has been removed and, while some of the pre-operative symptoms may continue, they will slowly decrease over a period of two to four weeks. Complete reversal of all prior symptoms may take several months.

Sex after TURP Prostate Surgery

Sexual function returns for most men, but the doctor may advise against ejaculation for up to two months. While the ability to orgasm is unaffected by TURP, your ejaculate may no longer exit through the penis. This occurs if the valve to the bladder, which controls the direction of semen, is damaged during the procedure.

What is GreenLight PVP laser?

Lasers are of different wavelengths.
The GreenLight PVP LASER has a wavelength of 532 m and it is in the visible range.
That is why we see the green light of this laser when it is working.

The term LASER stands for:
L = Light
A = Amplification
S = Stimulated
E = Emission
R = Radiation

Is GreenLight PVP Laser safe?

The laser light differs from the ordinary white light.
The ordinary white light goes in different directions and totally unregulated for examples, a lightbulb, whose light goes in all the directions, totally unregulated.
The laser light is monochromatic, coherent and collimated. It goes in one direction only, so its effect is selective, predictable and controllable in direction and focus, thus its very safe and has good tissue effects.
The Greenlight PVP laser energy is absorbed only by haemoglobin and it is not absorbed by water.
It has a tissue penetration of only 0.8 mm and it does not go very deep in the tissue.
So, it is a very safe Laser.

Is GreenLight PVP Laser treatment right for me?

The Greenlight PVP Laser destroys the prostate issue by process of continuous vaporisation.
There is no cutting involved, so it causes very little bleeding and is very safe, even for high risk patients like diabetics, heart patients, patients with other medical problems or advanced age, and patients on blood thinners.

Benefits of GreenLight laser PVP:

It has excellent post-operative outcomes.

  • Minimal bleeding
  • Patients are discharged in 24 hours
  • Most patients are catheter free after 24 hours and urinated comfortably with a good urinary flow.
  • There is no Incontinence (urinary leak)
  • There is no impotence or sexual dysfunction
  • Incidence of retrograde ejaculation is less than 30%
  • Complications Occur infrequently and are mild if they do

GreenLight Laser PVP Procedure:

GreenLight Laser PVP requires only 1day admission. It is done under general, spinal, or nerve-block anaesthesia along with sedation. The surgeon inserts a cystoscope (a thin camera) into the urinary passage up to the prostate. The Laser fibre is run through the cystoscope and placed near the prostate. Laser energy is directed onto the prostate. The light is quickly absorbed by the hemoglobin in prostate which becomes heated to the point the prostate is vaporized. I continue to apply this laser light until the vaporization of prostate reduces the restriction on the urethra. GreenLight PVP Laser Vaporization of prostate results in less bleeding than in other treatment options. A catheter is inserted after the procedure. The procedure takes about one hour.


Recovery after Laser PVP

Patient is discharged next morning. The catheter removed two days after treatment. For some men, particularly those whose symptoms had been severe or had prior damage to their bladder, a more extended period of catheterization is required.
Mild discomfort such as slight burning while urinating and a small amount of blood in the urine during the first week is to be expected. Frequency and a sudden urge to urinate may occur for a short period of time as the urethra adjusts to changes. However, patients will notice a dramatic improvement in urine flow and relief of symptoms within a day or two of the procedure. Those with multiple health issues may not experience improvement quite as quickly.
Many men find they can return to normal activities about three days after GreenLight Laser PVP. It is recommended that patients refrain from strenuous exercise and heavy lifting or pushing, as well as working with equipment that vibrates for at least two weeks. Such activities put strain on the prostate and can cause bleeding.


Sex after GreenLight Laser PVP Prostate Surgery

Sexual activity should be avoided 1 month and resumed when the patient is comfortable doing so. Patients may experience retrograde ejaculation or diminished volume, neither of which affects orgasm or sexual pleasure. It is essential to take things slow and understand the fact that it will take a while for everything to come back to normal, including desire but overall it is important to try and regain normal behavior as soon as you are ready to do so.

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About Dr. Ashish Sabharwal

Name

Dr Ashish Sabharwal

Designation

Sr. Consultant Urologist, Andrologist and Robotic Prostate Surgeon

Speciality

Urology, Andrology, Robotic Surgery

Years of Experience

17 years

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Also Available at:

  • Indraprastha Apollo Hospital, New Delhi
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