Laser Photoselective Vaporization

About

Illustration comparing enlarged prostate before and after surgery

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Mayo Clinic surgeons perform photoselective vaporization of the prostate (PVP) to relieve prostate obstruction. Prostate obstruction is usually due to benign prostatic hyperplasia (BPH), but can occur because of more uncommon conditions, such as prostate cancer or prostatitis. Your physician will conduct a thorough evaluation to confirm benign prostatic obstruction as the principal cause of your urinary condition and will suggest treatment options, including PVP.

Laser PVP has emerged as a safe, less invasive and effective alternative to transurethral resection of the prostate (TURP), the long-standing BPH treatment of choice. When conducting laser PVP, your surgeon uses high-powered laser generators to emit energy pulses through a surgical cystoscope (an instrument consisting of a tube and an optical system) which is introduced through the urethra. A variety of ablative lasers are available that use varying wavelengths to treat the prostate in slightly different ways; some lasers penetrate prostate tissue deeper than others, for example. Energy pulses create a laser beam of varying intensity at the end of the instrument. Ablative lasers use a wavelength that's readily absorbed by hemoglobin (resulting in less bleeding) and are well suited to precise tissue vaporization.

Surgeons perform tissue vaporization by systematically rotating (also referred to as "arcing") the laser instrument, beginning at the bladder neck and evenly shaving back the prostatic lobe successively towards the prostate apex, stopping short of the urinary sphincter.

Studies, such as those routinely outlined at the annual meeting of the American Urological Society, consistently show laser PVP to be a low-impact procedure that offers rapid recovery and routinely results in excellent long-term outcomes. Patients generally report minimal postoperative discomfort. In most cases, any associated dysuria (pain or burning with urination) is limited and short lasting.. Because laser PVP vaporizes tissue rather than cutting or scraping as in TURP, the procedure is particularly advantageous for high-risk patients with blood clotting disorders or patients taking blood thinners.

What to Expect

Mayo Clinic doctors use several diagnostic procedures to determine whether laser ablative techniques are the preferred BPH treatment option. Learn more about laser PVP candidates candidates.html. Mayo Clinic pioneered the research and practice of KTP laser PVP and has extensive experience performing procedures using a variety of laser alternatives.

Before Surgery

• Follow your physician's specific instructions regarding any medications, fasting periods, and pre-surgery bowel preparations. Different patient scenarios may call for different pre-surgery recommendations.
• Communicate with your physician and the hospital staff regarding time of arrival at the hospital and any other questions you may have about surgery.

On the Day of Surgery

• Ask about and resolve any remaining questions regarding your procedure.
• Local, spinal, or general anesthesia is used during laser PVP, depending on each patient's condition.
• During surgery, family members can remain in a hospital or outpatient waiting area where a member of the health care team can update them periodically on the progress of surgery. Family who need to leave the waiting area should inform the desk attendant how to reach them.

After Surgery

• It is not uncommon for patients to require a catheter for up to 24 hours following laser PVP.
• Laser PVP is generally an outpatient procedure, and patients are typically discharged a few hours after surgery. Some patients may be required to remain in the hospital for a day or two to monitor any complications.
• Some patients may experience pain, which can be managed with medications, as needed. Discomfort can include burning when you urinate (dysuria) or pressure in your rectum.
• Your doctor will typically place temporary restrictions on activity. For example, you may be allowed to walk and do light household tasks while recuperating at home, but you may be required to avoid heavy lifting, vigorous activities, or operating heavy machinery for several weeks. Rely on your doctor's specific guidance.
• Laser PVP may, in some cases, weaken the muscles controlling urination. However, bladder control improves over time as muscles heal and any swelling subsides. In most cases, bladder control occurs rapidly after surgery.
• You can return to normal activities and your work environment within seven to 10 days following laser PVP, depending on the nature of your work. Your physician may suggest that you avoid sexual activities for several weeks to prevent delayed bleeding.