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| |  New Minimally Invasive Alternative to BPH Surgery SAN FRANCISCO—Nov. 19, 1996 -- A San Francisco urologist is utilizing a unique laser therapy to provide a "patient friendly" out-patient alternative to the most common in-hospital surgery in the United States for men -- correction of benign prostatic hyperplasia (BPH). Dr. Ray Fay, M.D., said the procedure, called "interstitial laser coagulation" (ILC) offers patients a number of benefits over the conventional BPH surgery, called "transurethral resection of the prostate" (TURP), which is performed several hundred thousand times a year in the United States, making it the most prevalent in-patient surgery. "Conventional TURP requires general or regional anesthesia, several days in the hospital and a recovery period of up to six weeks," Dr. Fay said, "and it carries with it severe discomfort and risks of incontinence, sexual dysfunction and death." He said ILC has been performed for several years in Europe and in selected sites in the United States. "It is well tolerated by patients," he said, "without those complications and with a relatively quick, comfortable recovery period. And international clinical studies show it to be as effective as conventional therapy." Dr. Fay estimated more than 900,000 American men are diagnosed annually with BPH. He said it is a natural consequence of aging and ultimately affects most men. "It begins when the walnut-sized prostate enlarges with age, and then the urinary passage, or urethra, which runs through the prostate from the bladder to the penis, becomes obstructed as the prostate enlarges," he explained. He said symptoms range from frequency of urination to acute urinary retention, severe discomfort, and kidney and bladder infections associated with incomplete emptying. Dr. Fay said early-diagnosed cases have historically been left to what he called "watchful waiting," given the lack of risk-free, cost-effective therapies. "But by age 74, three out of four men require either medication, which brings some relief, or surgery," he said. In the conventional TURP, a portion of both the urethra and the prostate surrounding it is removed with an electrocautery wire loop introduced through a tubular instrument (cystoscope), which is inserted into the urethra through the penis. "It can cost about $10,000 per treatment, said Dr. Fay. He said the new laser procedure uses a smaller standard cystoscope in the urethra to introduce a special fiberoptic probe, directly into the prostate. There the probe delivers low-power laser energy for a few minutes to heat and destroy a controlled volume of tissue. The process is repeated as needed to treat the specific-size prostate. "The whole procedure only takes about 30 to 60 minutes," he said. The treated tissue is then absorbed gradually and naturally by the body over time, resulting in prostate shrinkage and alleviation of symptoms. "Since the new laser therapy can be done on an out-patient basis, the costs of several days in the hospital are completely eliminated," he said. Fay, chairman of the Department of Urology at California Pacific Medical Center, conducts a private practice with Pan Pacific Urology in San Francisco.
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