A normal prostate gland is the size of a golf ball, a 100-gram prostate is the size of an orange, and a 400-gram prostate is the size of a large grapefruit.

“yeah but the smaller prostates typically can be well managed with medications and Only We will we be moving to surgical treatment when the prostates get larger so you've got sort of a selection bias going on there you so front line gold standard historical is ter it's now a bipolar turp so it can be done safely and the reason you go from 100 if you're starting there down to 15 as opposed to 30 or 40 is you want to be one and done you never want to be back again yes a good a a good surgical procedure is effective for life now they're not all like that and so the ones that the less tissue remove if you don't remove any tissue for example you're more likely to have a secondary treatment okay my partner Amy cranbeck is really one of the Pioneers in mod in whole LEP surgery so this is different so again if you think about the orange analogy a turp or any of those other procedures is basically trying to scrape out the pulp one one little chunk at a time Amy will go in and she'll get in the plane between the peel or the Rind of the orange and she'll take out take it all out in one piece she pushes it into the bladder and then there's a mors lator that then Chomps it into little tiny pieces that you then remove through the urethra so there the be the benefit of whole so just let's make sure people understand that because I love that I think that I think your orange analogy makes this so much easier to understand yeah if you're doing a turp you're sticking a p you got a pencil hole going through the orange you got to put that you got to put a hollow pencil into that pencil hole and literally one tiny tiny thimble at a time pull out little sacks of Pulp one by one by one by one by one by one by one yes additionally remember that when you're doing that you're disrupting the kind of architecture of the orange and there's lots of blood vessels that exist within the transition zone itself yeah and so it's now it's bleeding like a Civ bleeds a lot when when Dr cranbeck when Amy does her procedures she gets in that natural tisue into that natural plane and it's not bleeding as much and she somehow manages to take that whole pulp minus the peel shove it into the bladder and when it's in the bladder now isolated you can break it apart Yes she'll morate it apart so she'll she is spectacular so um was a procedure developed originally described in New Zealand I Believe by a New Zealand neurologist and it was limited for a long time based on the technology that existed within the lasers but um the Laser Technology and Amy really helped develop the latest versions of these lasers that are just higher energy more precise take that and then you can then you know couple that with an experienced surgeon and the outcomes for it are spectacular so what are the what are the um patients who would not be considered candidates for that procedure is there a is there a contraindication to that no if you're talented enough you you can do it in anybody which she can now the smaller the prostate the less distinct there the the differentiation is between the peripheral Zone the the skin of the orange the peel of the orange and the pulp and so it actually requires more skill to do a hoap in a smaller gland than in a bigger gland when the prostate really really big the adoma is very well formed and it's easier to get into that plane so a large prostate would be something over 80 gram that's where You' really say in let's say a general urologist practice the threshold for doing a TPL like procedure goes down it's really long to do a turp it takes a long long time to do it yeah if you're a talented holp surgeon you know Amy can do a 200 g prostate in about 20 minutes I mean it's just spectacular tell me about what that patient goes through uh post procedure they go home that day obious it's procedure they they have a catheter in place no no catheter yeah that's the other thing I remember Ted from when we were little spring chickens is how many the the catheter Management on that patient with a blood bag full of bloody water and urine coming out for days and days and days and again it's a relatively small price to pay I think for the ultimate relief you're going to get but H how is it that this patient just literally leaves the office without a catheter yeah so it has to just do with you know what you do at the end of the procedure so how well you're controlling the bleeding and I think the big difference in hold up as I mentioned is when you're in that distinctive plane ABA and peripheral Zone you it's just the vessels are much more discreete whereas in a turp there's these sinuses and so forth so so the analogy again to the”