Prostate laser surgery

Overview

Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by an enlarged prostate — a condition known as benign prostatic hyperplasia (BPH).

During prostate laser surgery, your doctor inserts a scope through the tip of your penis into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra, and if the prostate is enlarged, it restricts urine flow from the bladder. A laser passed through the scope delivers energy that shrinks or removes excess tissue from the prostate that is preventing urine flow.

Lasers use concentrated light to generate precise and intense heat. There are several different types of prostate laser surgery, including:

• Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel. This procedure is generally used to treat prostates that are mild to moderately enlarged.
• Holmium laser ablation of the prostate (HoLAP). This procedure is similar to PVP but uses a different type of laser.
• Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess prostate tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate.

The type of laser surgery your doctor recommends will depend on several factors, including:

• The size of your prostate
• Your health
• The type of laser equipment available
• Your doctor's training

Why it's done

Prostate laser surgery helps reduce urinary symptoms caused by BPH, including:

• Frequent, urgent need to urinate
• Difficulty starting urination
• Slow (prolonged) urination
• Increased frequency of urination at night
• Stopping and starting again while urinating
• The feeling you can't completely empty your bladder
• Urinary tract infections

Laser surgery might also be done to treat or prevent complications due to blocked urine flow, such as:

• Recurring urinary tract infections
• Kidney or bladder damage
• Inability to control urination or an inability to urinate at all
• Bladder stones
• Blood in your urine

Laser surgery can offer several advantages over other methods of treating BPH. It can take several weeks to months to see noticeable improvement with medications. Improvements in urinary symptoms from laser surgery are noticeable right away. The advantages over traditional surgery, such as transurethral resection of the prostate (TURP) and open prostatectomy, can include:

• Lower risk of bleeding. Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn't allow their blood to clot normally.
• Shorter or no hospital stay. Laser surgery can be done on an outpatient basis or with just an overnight hospital stay.
• Quicker recovery. Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.
• Less need for a catheter. Procedures to treat an enlarged prostate generally require use of a tube (catheter) to drain urine from the bladder after surgery. With laser surgery, a catheter is generally needed for less than 24 hours.

Risks

Risks of laser surgery can include:

• Temporary difficulty urinating. You might have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.
• Urinary tract infection. This type of infection is a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place. You will likely need antibiotics to treat the infection.
• Narrowing (stricture) of the urethra. Scars after prostate surgery can block urine flow, leading to additional treatment.
• Dry orgasm. A common and long-term effect of any type of prostate surgery is the release of semen during ejaculation into the bladder rather than out of the penis. Also known as retrograde ejaculation, dry orgasm isn't harmful and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child.
• Erectile dysfunction. The risk of erectile dysfunction after prostate treatments is small and generally lower with laser surgery than with traditional surgery.
• Need for retreatment. Some men require follow-up treatment after laser vaporization surgery because not all of the tissue is removed or it might grow back over time. Men who have laser enucleation don't usually require re-treatment because the entire part of the prostate that can block urine flow is removed.

Serious long-term complications are less likely with prostate laser surgery than with traditional surgery.

How you prepare

Food and medications

Several days before surgery, your doctor might recommend that you stop taking medications that increase your risk of bleeding, such as:

• Blood thinners such as warfarin (Jantoven) or clopidogrel (Plavix)
• Nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others)

You are likely to be prescribed an antibiotic to prevent urinary tract infection.

Other precautions

Arrange transportation because you won't be able to drive yourself home after the procedure that day, and you may have a catheter in the bladder.

What you can expect

Before surgery you will be given either general anesthesia or spinal anesthesia. With general anesthesia, you'll be unconscious during the procedure. With spinal anesthesia, you'll remain conscious, but pain will be blocked from the surgical area. Exactly what you can expect during and after prostate laser surgery varies depending on the particular type of laser and technique used.

During the procedure

A narrow fiber-optic scope is inserted through the tip of your penis into the urethra. The laser inserted through the scope is used to vaporize or cut out the prostate tissue blocking urine flow. Depending on the procedure, your doctor might also use instruments to remove cut pieces of prostate tissue from the bladder.

After the procedure

You'll likely have a urinary catheter in place because of swelling that blocks urine flow. If you're unable to urinate after the tube is removed, your doctor might reinsert the catheter to allow you to heal or give you catheters that you can insert on your own a few times a day until swelling goes down and you can urinate normally.

You might also notice:

• Blood in your urine. It's normal to see blood for a few days to weeks after the procedure. Call your doctor if the blood in your urine is thick like ketchup, bleeding appears to be worsening or blood clots block your urine flow.
• Irritating urinary symptoms. You might feel an urgent or frequent need to urinate, or you might have to get up more often during the night to urinate. Most men experience burning, especially at the tip of the penis and near the end of urination. With some types of laser surgery, these symptoms can last for weeks or even months depending on how you heal and the size of your prostate.
• Difficulty holding urine. Incontinence can occur because your bladder is used to having to push urine through a urethra narrowed by enlarged prostate tissue. For most men, this issue improves with time.

Depending on the type of prostate laser surgery you have, you might go home afterward or need to stay in the hospital overnight.

Your doctor is likely to recommend that you:

• Take it easy. Avoid strenuous activity, such as heavy lifting, until your doctor approves it. You might need to wait up to two weeks after HoLEP, but as little as a few days with procedures such as PVP.
• Hold off on sex. Your doctor might recommend waiting a week or two after the procedure. Ejaculating too soon can cause pain and bleeding.
• Take medication as prescribed. If your doctor prescribes antibiotics, take the full course.

Results

Prostate laser surgery improves urinary flow for most men. Results are often long lasting.

Sometimes, the laser surgery doesn't remove all of the prostate tissue blocking urine flow or the tissue grows back, and further treatment is needed. See your doctor if you notice any worsening urinary symptoms.