Irreversible tide of technological advancement?

doi:10.1136/bmj.a903

Published 22 July 2008, doi:10.1136/bmj.a903
Cite this as: BMJ 2008;337:a903

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Endoscopic ablation

Irreversible tide of technological advancement?

The first 150 words of the full text of this article appear below.

Commenting on the systematic review by Lourenco et al,¹ we wishto make several specific and general points.

The contention that holmium laser enucleation holds most promisein challenging transurethral prostatic ablation (TURP) beliesthe fact that this technique has a steep learning curve andrequires careful morcellation of the prostate in the bladderonce enucleated.

Since the systematic review was carried out, photoselectivevaporisation (PVP—so called greenlight PVP laser of theprostate) has been used in many urology units. The short learningcurve, day case nature with minimal to no bleeding, and abilityto carry out ablation while patients are receiving anticoagulantshave made this development in prostate management an extremelyattractive option.² Two randomised controlled trials have comparedPVP against TURP, one with 6 months’ follow-up³ and onewith 12 months’ follow-up.⁴ The latter showed equivalentflow rate and symptom score outcomes, alongside shorter lengthof stay, shorter . . . [Full text of this article]

Hashim U Ahmed, MRC clinical research fellow, Manit Arya, specialist registrar urology, Mark Emberton, reader in interventional oncology

¹ University College London, London W1P 7PN

hashim.ahmed@ucl.ac.uk

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