Caitlin Whyte (Host): If you've been dealing with benign prostatic hyperplasia, or BPH, and medication doesn't seem to be working anymore, you may be a good candidate for a procedure called green light laser vaporization. Joining us to discuss this treatment is Dr. Jaspreet Singh, a Board Certified Urologist.

 This is DocTalk, presented by Montefiore St. Luke's Cornwall, and I'm your host, Caitlin Whyte.

Well, again, Doctor, thank you for joining us on another episode of DocTalk. Before we get into this technology, I'd like to start off with who would be a good candidate for green light laser vaporization of the prostate? What conditions is this designed to treat?

Jaspreet Singh, DO: Yeah, so the green light laser phototherapy or green light laser prosthetic procedure has been out for years, close to two decades and it's indicated for the treatment of benign prosthetic hyperplasia or what we shortly term BPH. And BPH is the benign enlargement of the prostate not to be confused with some of the cancerous processes of the prostate.

I have many patients mistaking the two and when they start having urinary changes are worried that it's related to prostate cancer. But it's indicated and have been using for many years benign prostate hypertrophy.

Host: When would surgical interventions start to be talked about when it comes to this condition?

Jaspreet Singh, DO: So, BPH is fairly common, Caitlin. In fact, by the age of 70, 3 out of 4 men are going to have urinary changes that are associated with BPH. We don't quite know why men are experiencing these changes, like what causes the prostate to enlarge? We don't quite know that, but we do know that know, getting older, obviously being a man who has a prostate and genetics has a lot of play in who's going to be experiencing worse symptoms than other men.

And in general, Caucasian men tend to have the highest risk for benign prostate growth. And then you look at globally, East Asian tend to have lower incidence of that. And then Hispanic, Black population somewhere in the middle. And what happens is, I guess, before we delve into the surgical option is to understand, you know, why are these urinary changes occurring?

And as the prostate grows it can influence these changes. What's happening is the bladder empties through a tube called the urethra and the beginning part of that urethra kind of travels through the prostate and as the prostate enlarges, it can cause like a compression or pinching off of the urethra so that as you can imagine, you know, any garden hose that's getting pinched off, the nature of the stream coming out of the garden hose is going to be obstructed, it's going to be weaker, men are going to feel symptoms of difficulty starting, or they have to push or strain, and then subsequently a patient will complain of feelings of not being able to empty, having to go back to the bathroom a few minutes after thinking they're done, waking up more often, having some urgency and frequency because, you know, the bladder is not completely emptying, so it just fills up that much quicker.

And so, what, what we need to do in the operating room is to be able to then open this urinary channel that runs through the prostate. We need to be able to create a channel to restore that, that flow. And that's where the laser prostatectomy or green light laser procedure comes into play. It's a uh, what we consider a minimally invasive surgical procedure.

It's an outpatient procedure in most men. I would say probably about 98 percent of my patients go home the same day. And what we're doing in the operating room, we're using this laser technology, and heat is applied to the prostate through the laser, and that heat allows the vaporization or destruction or removal of this prostate tissue in a very effective manner.

Host: Gotcha. So let's dive in a bit more to the green light laser technology. You just touched on how it works, but what is the goal of it? What do we leave the operating room with?

Jaspreet Singh, DO: Yeah, that's great. So, you know, many, many men that are going to be listening to this podcast are going to say, well, you know, there are so many options for treating benign prostate hypertrophy. And yes it's a disease that affects millions of men and it's a big medical industry and trying to treat men surgically.

So, we have transitioned through what we used to do fairly commonly about three decades ago because we had very limited options and it was the transurethral resection of prostate or what we shortly termed TURP. And the TURP procedure used to be a procedure that similarly a camera that's inserted in through the urethra but we, we used an instrument to actually cut the prostate from the inside out, and that would often result in patients having to be admitted into the hospital for a few days. Physical recovery was prolonged. Men were stuck with a catheter for up to a week in allowing the prostate to heal. And so, we've been able to provide similar results in being able to open this urinary channel that runs through the prostate, remove the prostate tissue with various different surgical options.

The reason I really like the Green Light laser is that essentially you can treat 90 percent of different types of prostate growth. And what do I mean by that, Caitlin? I mean, prostate enlargement comes in all sorts of various shapes and sizes. We have men whose prostates are three, four times the normal size, and we have men who are just slightly enlarged but are having significant obstruction.

The laser procedure allows us to treat all sorts of different types sizes of prostate. So I don't have to necessarily worry about not being able to provide an effective treatment for patients of different prostates. So, that's one less thing that I have to worry about. Number two there are procedures that kind of push the prostate tissue out of the way.

There's other procedures that use steam therapy to try to shrink the prostate and cause the prostate to kind of regress, but we're leaving a lot on the table when we do those types of procedures. One, when, when we're pushing the prostate out of the way, there are some patients that are not good candidates.

We have prostate tissue that can grow or push into the bladder. You can't really sweep that out of the way, you can't lift that out of the way, so that becomes a challenge in men who have that. Then the size of the prostate is often limited. The normal size of a prostate is about 25 grams. Prostates that are upwards of 80-100 grams tend to require multiple procedures to help open the channel up; where the green light laser for most men, it's a one time trip into the operating room.

And the nice thing about the laser procedure, what we're really looking for at the end of the case, before we finish the case and, get the patient out of the operating room, is we are able to see that urinary channel in real time. We're able to see that prostate tissue being removed in real time, so that when we're done with the procedure, we can be rest assured that that urinary channel and that prostate tissue has been removed and we've restored that open channel again for our patients.

Host: Absolutely. And you mentioned that recovery for the green light laser therapy is not as rough as maybe some other options. Can you just give us a little bit more about what post op looks like?

Jaspreet Singh, DO: Sure. So, like I said, most men, it's same day procedure. What would require us to keep you overnight, would be other medical problems, obviously, as, as we all get older, men have heart disease, and, perhaps diabetes, and those kind of things. So, in a very selective few, we may, for medical reasons, not necessarily the surgical procedure, have to keep overnight.

Whereas, traditionally, a catheter would have, have to be left in for upwards of a week. I leave the catheter in for just two days, or even less than 48 hours. Patients come back to the office to have that removed. As with any procedure that we are working on the prostate, men can see some blood in the urine, that's to be expected, that can linger on, on and off for several weeks it's like food coloring, Caitlin, you put, put a little bit of red dye in, in the glass of water, the whole thing's gonna get discolored, it's very similar to that, you may have a couple of drops of blood and the urine may look discolored. When the catheter comes out, one can expect some urgency and frequency to urinate.

It's the healing process on the inside. After the laser surgery, some of the prostate tissue does swell up and it takes about a week to 10 days for that swelling to regress. And so that first week and a half patients can experience some urgency, frequency, more of an annoyance. The pain really isn't experienced.

It's mostly described as a sense of discomfort or burning on urination. And that obviously gets better over the course of the week and a half as well. And of course, there are medications to help alleviate these symptoms. Long term complications are fairly low, which is another reason I really like the procedure.

The biggest thing that I counsel patients is the loss of ability to ejaculate, and that can occur with medications as well, and anytime we open up the urinary channel can disturb the ability of a man to ejaculate. Doesn't affect erections, doesn't necessarily affect climax or orgasm, but it's a, um, what I call like a dry orgasm where you reach climax but the ejaculate volume is diminished.

So that's probably the side effect that men experience the most. It's about three out of four men will experience that for most of them it's a long term permanent side effect. Fortunately, most men that have this problem are well past their age of having kids, so it's something that we don't, they don't really have an issue with, and plus to be able to, the trade off of, waking up three, four times a night and spending minutes over the toilet to empty the bladder to be able to urinate again, you know, as you were when you were 30 years old, and that trade off to lose ejaculation, most men are are more than happy and, don't really find it an issue.

Host: Of course. Well, Doctor, as we close out this episode today, is there anything else we should keep in mind when it comes to considering this green light laser therapy?

Jaspreet Singh, DO: Well, again, you know, for most men that are out there struggling with urinary symptoms who are going to go through and realize there's various options. The things that lean towards the green light laser being an effective procedure is one, the long term data. It's a technology we've been using for close to 20 years.

You know, over a million men have had a green light laser procedure. It's very safe and in the right set of hands, very effective. And a really long term, good, viable option in being able to restore this quality of life that gets impacted as we age.

Host: Well, thank you again, Doctor, for joining us and for all the work that you do. Visit MontefioreSLC.org for more information about our urology services.

And thanks for listening to DocTalk. Please remember to subscribe, rate, and review this podcast, and all the other Montefiore St. Luke's Cornwall podcasts. I'm your host, Caitlin Whyte.