From the March 2014 issue of HealthCare Business News magazine


With TURP, the technology has been around for a long time, meaning it was available in a competitive market and the loops can be sterilized and used for multiple procedures, while the holmium laser uses a fiber that burns away as it’s used, eventually requiring replacement. And the fiber can cost hundreds of dollars. Urologists, especially those well-versed in the use of TURP, would point out the lower costs of using that technology over laser surgery. However, once people started looking at the overall costs, a clearer picture developed.

Patients who are treated using lasers usually go home the same day of surgery, more than half without a catheter and even those with catheterization usually have it removed the next day as opposed to a typical two days or longer. With limited bleeding, it also offers an option for those with conditions preventing them from having TURP.


For a busy hospital, providing a more effective treatment with faster recover time provides a return on investment by increasing patient throughput. Additionally, marketing departments realized that the technology could give them a leg-up on the competition, by touting the better patient outcomes and faster recovery.

Reimbursement between TURP and surgical laser treatment of BPH differs slightly according to James Laskaris, senior analyst at research firm, MD Buyline. According to Laskaris, for laser vaporization of prostate in an outpatient setting the Medicare reimbursement for the technical payment is $3,304 with a physician payment of $2,315. For TURP, physician payment is reimbursed at a different rate of $950 while reimbursement for the hospital is only slightly less at $2,905. The difference in the reimbursement for the professional payment is due to the fact that the laser procedure takes longer and also requires a greater level of expertise. There isn’t a difference in reimbursement between different types of lasers.

That point makes the greenlight a harder sell.

Getting the green light
Even though holmium lasers offered benefits over TURP, there was still room for improvement. That improvement came when greenlight lasers were introduced.

With the advent of the technology, the next step in the evolution of BPH was taken. Greenlight technology is easier to learn, making it more attractive to urologists. It also requires less steps during the surgery. Greenlight is delivered at a different wavelength and it is absorbed by hemoglobin rather than water. The hemoglobin gets heated and vaporizes the tissue. Since the tissue is vaporized rather than enucleated, there’s no need to use a morcellator.

March 2014 Magazine

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