What is a prostate laser surgery?
Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by an enlarged prostate, condition such as benign prostatic hyperplasia (BPH). It can also be used to treat all sizes of prostate as well as all types of urinary tract stones anywhere within the urinary tract, bladder tumours, strictures and post radiotherapy bleeding. Lasers use concentrated light to generate precise and intense heat. During prostate laser surgery, your doctor inserts a scope (camera) through the tip of your penis into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. A laser passed through the scope delivers energy that shrinks or removes excess tissue that is preventing urine flow.
Why this procedure
It is an option for men who have a severely enlarged prostate, so avoiding major surgery. There is an immediate improvement in the urinary flow, with only mild discomfort. The procedure is very safe with reduced risk of significant bleeding; the need for blood transfusions is very low, fluid absorption (a problem in TURP) is rare and a short catheter time combined with a reduced length of inpatient stay make this procedure the modern alternative to the standard Transurethral Resection of the Prostate (TURP)
What is the procedure
Holmium laser enucleation of the prostate (HoLEP) uses a laser to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. The procedure is carried out under a general anaesthetic and usually takes 2 to 3 hours of operating time.
Risks and possible side effects
Apart from the risk of infection that accompanies any operation or invasive procedure, the only significant side-effect is the near certainty that normal ejaculation will cease. This is because the contraction that occurs during orgasm may not completely block the entrance to the bladder once some tissue has been removed, and the semen will flow back into the bladder (“retrograde” or “dry” ejaculation) rather than out through the penis. This is not harmful, but it does mean that future fertility is greatly reduced. The procedure does not generally affect erectile function or continence, although the urinary symptoms may take a few weeks to settle down afterwards.
Before, during and after the procedure
An MRI scan is a very useful imaging tool to evaluate the anatomy of the prostate in the planning of surgery. It is important to exclude significant prostate cancer before carrying out a HoLEP procedure, particularly in men under the age of 70, because more definitive surgery or treatment to the whole gland may be necessary. In general, catheters are removed early the next morning and most patients discharged within 24 hours of surgery. Patients with larger prostates, the elderly and those on anti-coagulants tend to stay a little longer. There is an immediate improvement in the urinary flow, with only mild discomfort. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.