SISK HEALTHCARE/TEKNO SURGICAL:BENIGN DISEASES of the prostate are common in middle aged and elderly men, and affect up to 80 per cent of men by age 80. They are not life-threatening, but for some men can cause symptoms such as poor urinary flow, high frequency of urination during the day and having to get up frequently at night to pass urine, some of which need treatment.
The usual treatment is the reduction in size of the prostate and the traditional procedure is known as trans-urethral resection of the prostate or TURP. “The urethra passes through the prostate and obstructive benign prostatic hyperplasia is an enlargement of the prostate which restricts and partly blocks the urethra”, explains Michael Connole, managing director of Sisk Healthcare company Tekno Surgical.
“TURP was the gold standard procedure for many years. It involves the diathermy of the prostate tissue. This cuts away tissue and enlarges the internal part of the gland to allow better flow through the urethra. But this has a number of downsides. There is quite a slow recovery period with the patient frequently having to spend three days in hospital and sometimes five. In addition, there is potential for blood loss.”
In the last number of years new treatments have been developed which have substantially reduced the risks and complications associated with the treatment of benign prostate diseases. Among these is photoselective vaporisation of the prostate (PVP) or laser therapy.
“This was developed by Dr Reza Malek and a team of surgeons in the Mayo Clinic some years ago”, says Connole. “It offers a much less invasive treatment for benign prostate disease than the traditional surgical procedure. This involves the vaporisation of the tissue in an enlarged prostate. It requires a very short stay in hospital, and is sometimes performed as a day case as opposed to the minimum three-day hospital stay required in relation to the traditional procedure. Recovery time is much faster, and there is a major reduction in the incidence of severe bleeding, impotence, incontinence and pain arising from the operation.”
American Medical Systems Holdings (AMS) is a worldwide pioneer of these treatment options for prostate disease and recently established a manufacturing operation in Athlone with the creation of 50 new jobs and plans for future expansion. The new operation involves an investment of €4.6 million, and is the first manufacturing operation AMS has established outside of the United States.
One AMS product, The GreenLight PV Laser System, is sold and supported in Ireland by Tekno Surgical, a Sisk Healthcare company, and the treatment is available in public and private hospitals around the country.
“Another big plus of PVP over the traditional treatment is that TURP is not really suitable for patients who have cardiac problems,” Connole points out. “Such patients may not be able to undergo a general anaesthetic and they may be on blood-thinning drugs which would exacerbate bleeding should it occur. They are suitable for laser vaporisation though.”
Given the similar age profiles for many cardiac patients and sufferers from benign prostate disease this is a major plus indeed. “The laser vaporisation treatment has been perfected over the years and many, many thousands of procedures take place worldwide every year,” says Connole. “We sold our first AMS GreenLight PV Laser System in Ireland about five years ago and we have seen their use increase quite rapidly over the past two to three years.”
David Boucher-Hayes is a consultant urologist at the Galway Clinic private hospital and is one of the pioneers of PVP. “I worked in Australia under Dr Tony Costello who was one of the first to put a laser on a prostate back in the 1980s,” he says. “I worked with him back in 2003 as principal investigator on a research product to validate PVP as a therapy for benign prostate disease. Since I came to work here in Galway in 2006 I’ve performed more than 950 PVP procedures.”
He explains the way the AMS GreenLight system works. “It produces a green laser light which gets absorbed by red. We don’t have to touch the fibre of the tissue we are trying to vaporise. The green laser energy gets absorbed by the red blood cells in the tissue. This vaporises the tissue and seals off the blood vessels to a depth of one to two millimetres. The advantage is that the energy is being concentrated on a very shallow depth and doesn’t go anywhere we don’t want it to.”
He has worked with three generations of the AMS GreenLight system and believes that the latest one is the best yet. “I used the latest XPS version for the first time in a procedure in St Francis Hospital in Mullingar recently. I left Galway at 6:30am, performed the procedure two hours later and the patient was able to go home at 12:30pm and come back the next day to have the catheter removed.”
Boucher-Hayes agrees with Connole’s point in relation to patients on blood-thinning medications. “An awful lot of people are on those drugs and this can make them unsuitable for the traditional TURP procedure”, he says. “In some cases it is necessary to take them off the drugs to operate and this can have its own complications. Because we are able to decrease the amount of bleeding so much with the laser therapy we are able to operate on people who we might not have been able to operate on before this.”
He is quick to point out that there is nothing wrong with the TURP procedure. “I’ve done 400-500 TURPs myself,” he notes. “You get the same result with both procedures but the laser therapy has so many advantages. When you compare the two procedures both offer improvements in the patient’s condition but the difference is that the patient spends two thirds less time in hospital with considerably less discomfort using the laser treatment. There are less complications and less blood loss. Also, the laser option costs 25 per cent less in Australia and the health system there is quite similar to here. That is a significant benefit.”
Michael Connole contends that the availability of the laser treatment should serve to reduce fear of prostate disease and should encourage more men to seek diagnosis and treatment. “The ability of this treatment to free up hospital beds could significantly reduce the number of patients waiting on trolleys in our hospitals. When you consider that there are many thousands of TURPs carried out each year and each laser treatment results in a saving of at least two days in hospital the potential is enormous.”
David Boucher-Hayes concludes by noting the continuing improvements to the technology and its cost. “This is a wonderful piece of technology and I am delighted to be involved with AMS and Tekno Surgical in bringing it to Ireland. Teckno Surgical is very focused on reducing the capital costs of the equipment in order to bring its benefits to the greatest possible number of people.”
