12th August 02:16
The British way with PVP. (warfarin x-ray enlarged prostate urinary bladder)
This is the procedure at one British NHS Hospital.
Directorate of Urology and Renal Services
Undergoing photoselective vaporisation of the
one of the urology team before your operation.
Why is photoselective vaporisation of the prostate recommended
Photoselective vaporisation of the prostate (PVP), also known as laser
prostatectomy, is used to treat benign prostatic enlargement. A high powered
is used to core out the prostate by vaporising the centre of the gland,
leaving a wide
channel and so relieving urinary symptoms caused by the enlargement of the
What to expect during your pre operative consultation?
As this is a new procedure within the department, a specific appointment
arranged in order to provide you with information, to try to answer
questions that you
may have and to check that we have sufficient information about you. A lot
necessary examinations may have already been carried out and therefore not
require repeating. You may however be asked to:
- complete a standardised questionnaire to grade your symptoms
- undergo an examination of the prostate. This would entail both an
with a gloved finger and possibly with an ultrasound probe to give the best
estimate of the prostate size.
- repeat a urine flow test
- have a blood test (PSA) to check for prostate cancer. PSA (Prostate
Antigen) is a substance made by the prostate gland. Small amounts of PSA
into the blood stream where its level can be measured. If this has been
during the previous 12 months it may not need to be repeated.
- you may choose not to undergo the PSA blood test and the ultrasound
examination of the prostate and still undergo the PVP procedure so long as
are aware of the reasons behind our asking to carry out these tests.
What preparation is needed?
Prior to your admission to hospital you will be asked to attend the pre
clinic. Pre anaesthetic checks which may be carried out include blood tests,
tests, heart tracing (ECG) and possibly a chest x-ray. A nurse will complete
relevant do***entation giving you further opportunity to ask any questions
As this is a new procedure you may be asked to fill in additional
take place in research projects. This is entirely voluntary and will not in
affect your planned surgery. Any information collected will form part of our
audit and enable us to assess the effectiveness of this treatment over time.
At the pre assessment clinic you will be asked about your current
We particularly need the details of medication that may affect bleeding.
Aspirin may be continued, however if you take clopidogrel (Plavix) or
the dose may need to be modified or the drug stopped for a period of time
prior to your admission.
You will come into hospital either the day before or the day of your
operation and be
seen by the nursing and medical staff on the ward.
You will also be seen by the anaesthetist who will discuss with you the type
anaesthetic you will have.
On the day of the operation you will be advised to have nothing to eat or
several hours prior to surgery, this is to enable safe anaesthesia.
You will be asked to change into a hospital gown and be taken to the
department on your ward bed or on a trolley.
At several points, details (name, date of birth, etc) will be checked.
How is the operation carried out?
The operation itself takes approximately 45 minutes
There is some additional preparation required and the time spent in the
theatre suite is likely to be several hours.
The first part of the operation is to give you an anaesthetic so that you
aware of anything whilst the operation is being performed. You may be
asleep (general anaesthetic), or just the area involved made numb, and then
sedative may be given to help the time pass comfortably.
Then you are taken into the theatre itself, moved onto the operating table
preparations are made to enable the operation to proceed.
The bladder and prostate gland are accessed via the penis along the urethra
(urinary passageway), and the operating instrument, the cystoscope,
referred to as a 'telescope'), is passed accompanied by sterile salt-water.
water allows the urethra to dilate and provides a clear view. First an
performed and then the size and shape of the prostate is rechecked by
gloved finger into your anus (bottom). If there are no new or unexpected
then the laser fibre is introduced through the cystoscope and the procedure
As the laser light is shone onto the prostate surface the prostate tissue
can be seen
to gradually disappear.
When the surgeon is happy with the appearances, the need for a catheter
drainage tube) to be passed via the urethra is considered.
You will then be transferred from the operating table back onto your bed and
process of bringing you round from the anaesthetic begins. Time is spent in
recovery ward within the operating department before you return to the ward.
What will happen after the operation is completed?
You will wake up in the recovery area in your bed and when the nurses are
with your condition a nurse from the ward will come to take you back to the
You will have a drip running into your arm or hand, this is to prevent
until you are drinking. You will be given a drink when the nurse feels you
and able to tolerate it. You should be given a light meal soon after.
You are likely to have a catheter to allow free drainage from the bladder.
catheter will be removed a few hours after surgery or the following day. The
of the catheter removal will depend upon several factors, including the type
anaesthetic you have had, how well you recover from the anaesthetic and how
much blood there is in the urine.
You may go home once you are passing urine and emptying your bladder
What problems can occur?
Before your planned surgery it is important that you understand what the
entails and the possible side effects.
Effects on your *** life - Approximately 25% of men may experience
ejaculation (***** going into the bladder) resulting in a 'dry ******'. If
this occurs it
may affect your ability to father children, but you cannot rely on this as a
contraception. Some men report a change in sensation of ******.
Urinary control- 7% of men experience mild discomfort of the urethra
after the operation. This usually lasts a few hours and painkillers can be
will help ease these symptoms.
5% of men may have difficulty passing urine after the operation, this may
result in a
catheter being re inserted for a short period of time. Some of these men may
go home with the catheter in place and return as an outpatient to have the
Impaired erection- There have been no reported cases in men undergoing this
procedure to date.
As with any operation, other surgical complications can occur. These include
infections, heart problems or deep vein thrombosis (blood clots in the
risks of these will be discussed in the pre admission clinic and where
specific preventative measures will be taken.
Are there any alternatives to this surgery?
At the present time the standard operation performed for relieving symptoms
by enlargement of the prostate gland is called transurethral resection of
gland (TURP), when the enlarged prostate tissue is shaved away from the
surface, again using cystoscopic instruments.
Please refer to the leaflet 'Having a Prostatectomy'.
As the PVP procedure is relatively new, it is not possible to predict the
outcome of this operation. However based on the currently available
appears favourable and equivalent to TURP.
What are the benefits?
... A shorter hospital stay.
... If a catheter is required following the surgery it can be removed within
... the risk of bleeding both during and after the operation is reduced.
... the risk of requiring a blood transfusion is minimised
... the surgery itself is less physically traumatic
What can I do when I get home?
Strenuous activity (e.g. digging, carrying heavy items) should be avoided
weeks following your operation. Driving can be resumed after one week (some
insurance is not valid during the recovery period after an operation, it
advisable to check with your insurance company). Sports such as golf or
may be resumed after two weeks.
Avoid becoming constipated as straining may lead to bleeding from your
cavity. If necessary you can be given a mild laxative to take home after
***ual activity may be resumed as soon as you feel ready. If you do not
there may be some discolouration of the ***** for some weeks. This is normal
You may return to work when you feel fit which is usually between 2-7 days.
You will be sent home with a letter for your GP and with any medication you
A follow up appointment will be made for you 2-3 months after your
this appointment you will be asked to provide a urinary flow rate test, so
come with a
full bladder if possible. You will also be asked to repeat the questionnaire
completed prior to your surgery.
If you have any problems following your discharge from hospital you may
the ward you were on for advice.
Alternatively you may contact your GP
If the matter is urgent and you are unable to contact the hospital please
emergency medical services in the usual way
12th August 02:16
The British way with PVP. (aspirin warfarin)
"We particularly need the details of medication that may affect bleeding.
Aspirin may be continued, however if you take clopidogrel (Plavix) or
warfarin the dose may need to be modified or the drug stopped for a period
of time prior to your admission."
This is the first time I have seen aspirin allowed for any surgical
procedure. Doctors in the US are pretty adamant about discontinuing aspirin
one week prior to the procedure.
Wonder why the difference.
14th August 14:38
The British way with PVP.
It sounds like there are more complications than with TUNA.
Doesn't the TUNA work? A urologist told me to get the TUNA
done. I am first trying to releive my symptoms with Saw
Palmetto and other herbs for six weeks now with no results