The original article can be found in: BVI News By Dr. Heskith Vanterpool
On Friday, January 25, 2013 the BVI’s first ever laser prostatectomy operation, was successfully performed by Dr. Dwayne Thwaites, American Board Certified Urologist, at the Bougainvillea Clinic.
The patient was a middle age male who had for sometime struggled with symptoms of an enlarged prostate which was obstructing the free passage of urine. Medical therapy with drugs had failed and an operation to shave the obstructing prostate was necessary.
The three forms of prostatectomy for BPH were explained to the patient and his preference was for the most advanced operation with Green Light Laser which vaporizes the obstruction, clearing the urinary passage with the least side effects and with little or no bleeding.
Benign Prostatic Hypertrophy or enlargement (BPH) causes slowing of the urinary stream, and frequent waking at night to urinate, as well as inability to hold urine when the need to go is perceived. Other symptoms are straining to get the stream started, interruption of the stream and post void dribbling, with wetting of clothing.
Eventually BPH will cause urine to back up from the bladder into the kidney, with resulting kidney failure. BPH could cause complete obstruction of ability to urinate , usually very painful and distressing if it occurs relatively suddenly but slow onset of obstruction could be painless but yet quite dangerous.
Stagnation of urine in the bladder could also cause bladder stones and urinary infections.
The first form of treatment for BPH is medication with alpha blockers such as Hytrin or Flomax, that relax the muscles of the bladder and prostate. Eventually however, these tend to lose their effectiveness and anti-testosterone drugs such as Proscar or Avadart may be added to slowly reduce the size for the prostate.
Then there is the transurethral resection of prostate(TURP) with electrical cautery- a nice operation but still bloody and with potential complications that while few , are more frequent seen than with laser. After TURP a catheter is left in the bladder for 5-7 days to keep the urinary passage open and the patient will usually need hospitalization for 1-2 nights. Finally, the new kid on the block and most advanced – Green Light Laser Prostatectomy (GLLP) in which the laser light essentially vaporizes a thin layer of tissue with each contact of the laser, with virtually no bleeding.
The heat effect does not penetrate as deep into the underlying as does electrocautery, and as a result GLLP causes less disturbance of sexual function such as retrograde ejaculation and possible erectile dysfunction. After GLLP the patient needs a urethral catheter for 24 hrs only and on occasion the doctor may not even leave a catheter in the bladder at all. Overnight hospitalization is rarely necessary with this new form of prostatectomy.
Lithotrypsy for Bladder and Kidney Stones.
In another first for the BVI, Dr. Thwaites performed- Lithotripsy of Bladder Stones one month ago. That patient had 15 bladder stones that could not pass and these were causing intermittent obstruction of urination. With the Lithotripter machine Dr. Thwaites inserted a small probe through the penis into the bladder and pulverized the stoned into powder and tiny fragments. These were then washed out/passed in the urine without the need for a trans-abdominal open bladder operation as would otherwise be necessary.
The patient was discharged from hospital ( Bougainvillea Clinic) within a couple of hours after the procedure. Bladder stones are usually caused by chronic stagnation of urine in which stones crystallize out of the urine , much like salt from a salt pond. Occasionally as small stone form the kidney passes into the bladder and there grows until too large to pass via the urethra. These patients are usually men with BPH and chronic urinary obstruction.
With the newly acquired Lithotripter machine patients with stones obstructing the kidney or bladder stones can now be treated at Bougainvillea Clinic.
The public may also be interested to know that at Bougainvillea Clinic Dr. Thwaites can now also do Radical Prostatectomy for Early Cancer of the Prostate and pelvic floor reconstruction for female bladder/pelvic floor issues.
Thanks to Dr. Dwayne Thwaites and a now well equipped Bougainvillea Clinic patients in the BVI now have access to a wide range of procedures for Prostate , bladder and kidneys conditions , which before could only be done off-island.
