As men age, many experience an enlarged prostate, a condition known as Benign Prostatic Hyperplasia (BPH). This non-cancerous growth of the prostate gland surrounds the urethra and can interfere with the normal flow of urine from the bladder. The resulting symptoms include a frequent urge to urinate, a weak stream, and difficulty starting and stopping urination.
While medications are often the first line of treatment, they may not provide adequate relief for everyone. For those seeking a different solution, Photoselective Vaporization of the Prostate (PVP) is a minimally invasive surgical option. This procedure alleviates the urinary obstruction caused by BPH by removing excess prostate tissue. The goal of PVP is to restore normal urinary function and relieve the symptoms associated with an enlarged prostate.
The PVP Procedure Explained
The Photoselective Vaporization of the prostate procedure uses a high-powered laser that emits a specific wavelength of light (532 nm), which appears green. This wavelength is readily absorbed by hemoglobin, the protein in red blood cells abundant in prostate tissue. This selective absorption of energy causes the targeted tissue to be rapidly heated to the point of vaporization, removing the obstructing tissue. The process also coagulates blood vessels simultaneously, which contributes to minimal bleeding during and after the procedure.
The procedure is performed under general or spinal anesthesia and lasts between 20 and 50 minutes, though very large prostates may require more time. A surgeon inserts a thin, tube-like instrument called a cystoscope through the tip of the penis into the urethra. A laser fiber is then passed through the cystoscope to the enlarged prostate tissue.
The surgeon guides the laser fiber, delivering energy to vaporize the excess tissue and create an open channel for urine to flow through. The surgeon views the area on a monitor to ensure accuracy during the removal of the blockage. The result is a clear passage from the bladder, which typically leads to a rapid improvement in urinary symptoms.
Candidate Selection for PVP
A urologist will determine if a patient is a suitable candidate for PVP. The ideal candidate is a man experiencing moderate to severe urinary symptoms from BPH who has not achieved satisfactory results with medications or wishes to avoid their side effects. Symptoms can range from a weak urine stream to more severe issues like the inability to urinate or recurrent urinary tract infections. A formal assessment using the International Prostate Symptom Score (IPSS) helps quantify symptom severity.
Prostate size is an important consideration, as PVP is effective for a wide range of prostate volumes. For extremely large prostates, a surgeon might consider other surgical options more appropriate. One advantage of PVP is its suitability for patients taking anticoagulant medications, or blood thinners, as the procedure’s ability to seal blood vessels results in a low risk of bleeding.
Certain conditions may make an individual a poor candidate for the procedure. Men with an active urinary tract infection or acute prostatitis must have these conditions treated before undergoing PVP. The procedure is intended for benign enlargement, so confirmed prostate cancer would necessitate a different treatment approach. The final decision depends on the patient’s symptoms, overall health, and prostate anatomy.
Recovery and Potential Side Effects
The recovery period following PVP is shorter and more comfortable compared to traditional surgical options. PVP is an outpatient procedure, meaning most patients can return home the same day. A urinary catheter is placed in the bladder after the procedure to allow urine to drain while swelling subsides and is usually removed within 24 to 48 hours.
In the weeks following the procedure, it is common to experience temporary urinary side effects. These can include irritative symptoms such as increased urinary frequency, urgency, and a burning sensation during urination. Some patients may also notice a small amount of blood in their urine (hematuria), but these effects resolve as the treated area heals. Mild pain medication can be used to manage any discomfort.
While most side effects are temporary, there are potential long-term risks. One of the more common is retrograde ejaculation, where semen enters the bladder during orgasm instead of being expelled from the penis. This is referred to as a “dry orgasm” and does not affect the sensation of orgasm or erectile function. The risks of long-term erectile dysfunction or urinary incontinence are very low, and most patients return to non-strenuous activities within a few days and more strenuous activities within a couple of weeks.
Comparing PVP with Other BPH Treatments
The historical standard for surgical BPH treatment is Transurethral Resection of the Prostate (TURP). In a TURP procedure, an electrical instrument is used to cut away and remove excess prostate tissue. While effective, TURP is associated with a higher risk of significant bleeding and requires a hospital stay of one to three days. PVP, in contrast, offers a lower bleeding risk and is an outpatient procedure, allowing for a quicker return to normal activities.
The duration a catheter is needed after surgery is often shorter with PVP compared to TURP. Both procedures are highly effective in relieving urinary symptoms, though for very large prostates, some surgeons may still prefer TURP. The choice between PVP and TURP involves balancing prostate size, patient health, and the desire for a faster recovery.
Other minimally invasive procedures, such as UroLift and Rezum, offer alternatives to tissue removal. UroLift involves placing small implants to lift and hold enlarged prostate tissue out of the way, while Rezum uses steam to ablate tissue. PVP is an ablative procedure that removes tissue to create a wider channel. Complication rates may be lower after UroLift, while some data suggests Rezum may have a higher rate of needing a follow-up procedure compared to PVP and TURP.