MRI Upload
What to Expect:
Laser Focal Therapy for BPH
Your Focal Laser Therapy for BPH Appointment
Overview
The day before
We perform a non-invasive physical, give a shot of antibiotics to decrease the risk of infection, review the MRI images, discuss the risks, benefits, and alternatives of the procedure, answer your questions, review instructions, and finalize paperwork.
The day of
Early the next morning, we perform the procedure, and you’ll go back to your home or hotel room shortly afterwards.
The day after
We see each patient again to see how they are doing, give another shot of antibiotics (again, decreasing the risk of infection), review the MRI images from the procedure, answer questions, and provide more instructions.
Travel note
For individuals traveling from outside the Houston area, we can recommend hotels as well as transportation options to help ease your travel planning.
1 The day before the procedure
Our doctors and nurses provide our personal cell phone numbers to every laser focal therapy patient we treat. This way, our patients can always reach us. We’ll also meet with you the day before, the day of, and the day after the procedure.
- Perform a non-invasive physical
- Give a shot of antibiotics to decrease the risk of infection
- Review the MRI images
- Discuss the risks, benefits, and alternatives of the procedure
- Answer your questions, review instructions
- Finalize paperwork
2 The day of the procedure
The Procedure
- On the day of the procedure, you will have an intravenous catheter (IV) inserted in your arm so that we can provide you with IV antibiotics, pain medications and fluids to maintain hydration.
- After providing IV versed (similar to valium) and placing lidocaine jelly to help decrease sensation, you will have a urinary catheter placed to provide cooled urethral saline protection (CUSP).
- You will be positioned prone (on your stomach) on the MRI table for the procedure.
- IV-conscious sedation medications (fentanyl and versed) are administered.
- A small rectal probe (the diameter of an index finger in width) covered in numbing lidocaine jelly will be inserted in the rectum. By using this machine, the doctor can move the laser precisely.
During the procedure, the doctor can accurately use real-time 3T MRI to visualize the target, guide placement of the laser fiber, and ablate (destroy) cancer cells and/or excess tissue putting pressure on the urethra. This helps monitor sensitive structures to decrease risk of damage to urinary and sexual function.
The doctor reviews the pre-procedure MRI together with the newly acquired images to confirm the location and boundaries of the target(s).
- The DynaTRIM device is calibrated to the images, and the parameters (knobs) are adjusted to an appropriate three-dimensional approach.
- The thin, 1.85mm cooling cannula and FDA-cleared laser fiber is then placed into the target through the inner channel of the rectal probe under MRI guidance.
- Cooled urethral saline (CUSP) is performed through the placed Foley catheter. The laser is then activated at a low power to confirm appropriate location with the heat from the laser being monitored with real-time MRI thermometry in two separate planes. Only after this final confirmation will the doctor increase the laser to treatment level power, monitor the tissue being ablated and make appropriate adjustments to contour the ablation zone.
- Next, the laser fiber is usually repositioned to provide multiple ablations which will cover a significant portion of the transitional zone (which surrounds the urethra).
Duration
The entire procedure is usually finished within about 2-4 hours.
Results
Results are confirmed with contrast-enhanced MR images.
3 The day after the procedure
We see each patient again to see how they are doing and:
- give another shot of antibiotics (again, decreasing the risk of infection)
- review the MRI images from the procedure
- answer questions
- provide more instructions
The Foley catheter is usually removed seven-to-ten days after the procedure (often by the patient after flying home—written instructions are provided).
Due to swelling in the prostate from the procedure, urinary symptoms get worse before they improve. Most men get back to their baseline function approximately three weeks after the procedure and see noticeable improvement around three months after the procedure (plus or minus a month).
