New Worlds: Laser surgery to remove enlarged prostate

Every year, hundreds of Israeli men undergo complex surgery and long-term hospitalization because they are not suitable for endoscopic surgery.

(photo credit: JPOST STAFF)
A benign enlargement of the prostate gland is a common occurrence in men over 60 years of age. Men with significant urinary incontinence will be referred to surgery to treat the problem. In about a quarter of the cases the prostate is large, thus indicating conventional endoscopic surgery in the lower abdominal area.Every year, hundreds of Israeli men undergo complex surgery and long-term hospitalization because they are not suitable for endoscopic surgery.
The surgical approach is determined by the size of the gland. Endoscopic resection through the urethra (closed surgery) is technically limited and can be performed for up to 60 minutes. This restricts the surgeon from cutting down a certain amount of prostate tissue that blocks the urinary system.
In addition, the patient may suffer significant side effects. Therefore, when there is a large amount of prostate tissue, open surgery is usually recommended.
Dr. Yaron Erlich, director of the urological service at the Sharon Medical Center in Petah Tikva, said that his is the only hospital in Israel where these men can undergo laser prostatectomy using the HOLEP method without an incision. This is an appropriate alternative to open surgery for large prostates, he said. This is an endoscopic operation but requires advanced skills and equipment. The surgery has been around for many years, but has only recently arrived in Israel.
Erlich said that the patient is hospitalized for only 24 hours instead of the five or six days that it takes for conventional open surgery. In addition, he loses only a minimal amount of blood and regains his normal functioning very fast.
The risk of developing gestational diabetes mellitus (GDM) increases with increased weight gain between pregnancies, according to a new study published in PLOS Medicine led by Linn Sorbye of the University of Bergen, Norway.
GDM is defined as glucose intolerance of various degrees that is first detected during pregnancy. Both pre-pregnant body mass index (BMI) and gestational weight gain are known risk factors for GDM, which can cause health problems for both mothers and babies. In the new study, researchers used data from the Medical Birth Registry of Norway on 24,198 mothers with a first and second pregnancy between 2006 and 2014. The overall absolute risk of GDM in second pregnancy was 18.1 per 1000 pregnancies. 35.6 % of women in the study gained more than 1 BMI unit (kg/m2) of weight between the start of their first pregnancy and the start of their second pregnancy. These women had an increased risk of developing GDM in their second pregnancy compared to women whose weight was stable. Women who gained between one and two BMI units had a doubled risk, while those gaining between two and four units had a 2.6 times increased risk. Women gaining more than four BMI units had a five-fold increased risk.
“Antenatal guidelines for monitoring GDM in pregnancy should add inter-pregnancy weight change as an independent risk factor for GDM with a routine stress test of glucose tolerance during pregnancy in women with weight gain more than one BMI unit,” the authors wrote.
Yariv Schwartz, a 44-year-old lifeguard, suffered for five years from severe side effects, including obesity, pain and dizziness, due to a rare pancreatic tumor that was not identified at several hospitals due to its problematic location. But the problem was resolved when he came to Jerusalem’s Shaare Zedek Medical Center for endoscopic ultrasound that identified the growth and removed it by radio-frequency ablation.Schwartz was saved from having to undergo major surgery, including the removal of the duodenum and the top of the pancreas. The painless treatment by Dr. Alain Dankaur, head of the hospital’s endoscopic ultrasound unit, performed the successful procedure, and the lifeguard was discharged after 24 hours; he soon returned to full function at the Jerusalem Beach in Tel Aviv.
His was the first such case in Israel and one of the few cases in the world of using the technique. Only 16 patients in the world have been treated for this problem using radio-frequency using a standard endoscopic device with an ultrasound transducer through which a needle is inserted that is heated to burn away the tumor.
Men with gambling addictions are more likely to have suffered childhood traumas including physical abuse or witnessing violence in the home, according to new British research published in Addictive Behaviors.
Psychologists examined survey responses of more than 3,000 men on a variety of life factors and found that more than a quarter who had probable pathological gambling problems had witnessed violence in the home as a child. A tenth reported being physically abused in childhood, and a further 7% said they had suffered a life-threatening injury.
Problem gamblers – those who have not yet escalated to a pathological problem but are deemed to have a more serious addiction than non-problem gamblers – also reported higher rates of childhood trauma, with almost 23% saying they had witnessed violence at home, and 9% experiencing physical abuse. In comparison, just 8% of non-problem gamblers witnessed domestic violence when they were children, and less than 4% had suffered abuse.
The study, led by the University of Lincoln, also found that 35% of pathological gamblers had suffered serious money problems as adults, 29% had been convicted of a criminal offence and almost 20% had experienced relationship breakdowns. In comparison, for non-problem gamblers, the figures came in at just 12, 9% and 10% respectively.
The researchers said the findings highlight a need for gambling treatment services to include routine screening for traumatic life events or substance abuse, so that treatments can be better tailored.
“Probable pathological gamblers and problem gamblers reported injuries, marital difficulties, homelessness, money problems and criminality more often than non/ non-problem gamblers. Taken as a whole, this suggests that disordered gambling does not occur on its own, but that it is perhaps symptomatic of other social, behavioral and psychological problems of some individuals,” they said.