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New Laser Approach to Prostate Surgery

August 11, 1992|KATHLEEN DOHENY

A new laser technique could revolutionize a common prostate surgery now performed nearly half a million times a year to correct benign enlargement of the gland. The new approach, under study nationwide, gets men back to work in a fraction of the time usually needed after traditional surgery.

The laser-assisted procedure could replace routine prostatic surgery "if the long-term results are as good as we hope," says Dr. Gary Leach, chief of urology at Kaiser Permanente, Los Angeles, and the principal local investigator for the study, sponsored by the laser manufacturer.

Routine prostatic surgery, called transurethral resection of the prostate (TURP), is performed to remedy the benign enlargement of the prostate gland, a walnut-shaped organ that sits below the bladder and produces seminal fluid. Enlargement occurs about age 40, although few men notice symptoms until age 50-70. As the gland becomes larger, it can obstruct the flow of urine, resulting in a slow stream and the frequent need to urinate.

In the traditional surgery, an instrument is passed through the penis to trim away the part of the prostate that is causing obstruction. The surgery takes about an hour, says Leach, who is also a UCLA associate clinical professor of urology.

In the new laser-assisted technique, a small telescope-like device is passed through the penis and a laser fiber is inserted through the telescope. "We fire the laser for about 60 seconds at each of four sites," Leach says. "The surgery takes about 15 minutes. The irradiated tissue is sloughed off in the urine over a four- to six-week period."

So far, Leach has performed laser-assisted surgery on 15 men, ages 50-85, with good results. Nationwide, more than 100 men have undergone the surgery, he says.

Among the differences between laser and traditional surgery:

* Men who undergo the laser procedure return to work in about five days, Leach says; traditional takes three to six weeks.

* Laser-assisted surgery can be performed with local anesthesia; traditional requires a spinal or a general anesthesia.

* Laser surgery is done on an outpatient basis; traditional requires two or three days of hospitalization.

* With the laser surgery, no patients have had bleeding problems.

* Laser patients have not had incontinence or impotence, Leach says. Incontinence affects 1%-3% of traditional TURP patients and impotence affects about 5%.

* Overall costs of laser surgery will probably be lower, due to lack of hospitalization.

Still, the surgery is not for everyone and Leach cautions his patients not to view the new procedure as a miracle worker. "After surgery, don't expect a night-and-day difference." Men with extremely large prostate glands are not good candidates for the technique, nor are those with suspected prostate cancer.

"We need a longer follow-up time to determine the exact role of the laser surgery," Leach adds.

The laser surgery is FDA approved, but physicians must obtain special training before performing the surgery.

In an unrelated study, published in this month's American Journal of Public Health, prostate cancer patients treated by health maintenance organizations (HMOs) had more favorable outcomes than those in traditional, or fee-for-service, plans.

Researchers Howard P. Greenwald of USC and Curtis J. Henke of UC San Francisco followed about 1,000 patients, some in HMOs and some in fee-for-service plans, for a maximum of nearly seven years. The study was funded by the American Cancer Society and the National Cancer Institute.

The authors, who compared the quality of care between HMOs and traditional health care, found that HMO patients were less likely to die (from any cause) than the fee-for-service patients.

They also found that HMO patients were less likely to receive surgery and more likely to receive radiation therapy.

The objective of the study was to compare only treatment and death risk.

Researchers say the study refutes previous studies which suggest HMOs under-treat.

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