Prostate Laser Surgery Procedure: Purpose, Risks, Treatment and Results | Fortis Healthcare

Prostate laser surgery

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 urethra is surrounded by the prostate. A laser is passed through the scope. The laser delivers energy that is used to shrink or to remove the excess tissue that is blocking the urethra and preventing urine flow.

All lasers use concentrated light to generate precise and intense heat. Laser surgery removes excess prostate tissue by:

  • Ablation. The laser melts away excess tissue.
  • Enucleation. The laser cuts away excess prostate tissue.

There are different types of prostate laser surgery, such as:

  • Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue to enlarge the urinary channel.
  • Holmium laser ablation of the prostate (HoLAP). This is a similar procedure to PVP, except that a different type of laser is used to melt away (vaporize) the excess prostate tissue.
  • Holmium laser enucleation of the prostate (HoLEP). The laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument, called a morcellator, is then used to chop the prostate tissue into small pieces that are easily removed.

The type of laser surgery your doctor will perform depends on several factors, including the size of your prostate, your health, the type of laser equipment available and your doctor's training.


Why it's done Risks How you prepare What you can expect Results

Prostate laser surgery is performed to reduce urinary symptoms which are caused by BPH. The urinary symptoms are as mentioned.

  • Difficulty in starting urination
  • Frequent Urination
  • Prolonged urination
  • Increased frequency of urination especially during
  • The feeling of filled bladder after every urination
  • Urinary hesitancy

Prostate laser surgery can also be done for the treatment of few complications, which may arise due to enlarged prostate, as mentioned below.

  • Urinary tract infection
  • Kidney or bladder damage
  • Urinary Incontinence and urinary retention
  • Bladder stones
  • Blood in urine

Other procedures are also available to treat BPH, however, prostate laser surgery has many advantages over other procedures (open prostatectomy and transurethral resection of the prostate). The advantages are as listed down:

  • Lower risk of Bleeding: Prostrate Laser Surgery is the best option for the patients, who have a bleeding disorder
  • Minimal hospital stay: In Prostate Laser surgery the patients may stay in the hospital for only one day, however, other procedures might require a prolonged hospital stay
  • Faster Recovery: As the Prostrate laser surgery does not require any cuts outside the patient’s body, the patients can recover quickly
  • Immediate results: The improvements in the patient’s condition can be immediately seen after the laser surgery procedure
  • Safe from cardiac side-effects.

Prostate laser surgery shows fewer serious long-term complications, as compared to the other traditional surgeries. Some side-effects and complications, arising out of prostrate laser surgery, are highlighted below.

  • Temporary difficulty in urinating: The patient might have difficulty in urinating right after the procedure as a tube is inserted into the penis to carry urine out from the bladder
  • Urinary tract infection: Urinary tract infection is common in any prostate procedure as a catheter is placed. The patients may require antibiotics to treat the infections.
  • Narrowing of the urethra: Patients may get scars on the inside, after prostate surgery and these scars can block urine flow (Stricture Urethra), requiring additional treatment
  • Retrograde ejaculation or dry orgasm: Prostate surgery can cause dry orgasm or retrograde ejaculation, which means that the semen enters in the bladder rather than penis during sexual climax. This is not harmful for the patient, however this would prevent a patient to become a father.
  • Erectile dysfunction: After prostate laser surgery, there is a small risk of erectile dysfunction as compared to the other traditional surgeries
  • Follow-up treatment: Some patients require follow-up treatment, after the prostrate laser surgery because sometimes, all tissues are not destroyed or the prostate gland might grow again, after the surgery.
  • Incontinence of urine: No control over urine leakage.

The patients would have to follow certain guidelines, before the surgery and the doctor will explain what preparations are required to be done, before the surgery. Some of the pointers highlighted by the doctors are as mentioned.

  • Food and the medication: The patient should inform the doctor about any earlier prescriptions, over-the-counter medicines or supplements that the patient is taking. This is very important because if patient is taking any blood-thinning medications, such as clopidogrel (Plavix), warfarin (Coumadin) etc. or any OTC pain killer medications such as aspirin, ibuprofen (Advil, Motrin IB) or naproxen sodium, the doctors might ask the patients to stop the medications before the procedure.
  • Fasting before the procedure: The doctor will ask the patients not to eat or drink anything, the night before the procedure.
  • Arrangements after the procedure: The doctor will inform the patient about the time of stay in the hospital after the procedure. Patients have to arrange for the vehicle and a companion as they would not be able to drive back home themselves after the procedure.
  • Activity Restrictions: Patients might not be able to return to work for about two weeks after the procedure. However, the time of restraint would depend upon the type of laser surgery the patient has undergone.

During the Procedure:

  • Prostate laser surgery can take around 30 minutes to 2 hours to complete, depending on the size of the enlarged prostate. Doctors will explain the procedure to the patients in detail.
  • Before the surgery begins, the patients will be given spinal anesthesia or general anesthesia depending upon the patient’s condition
  • During the procedure, a narrow fiber-optic scope is inserted through the tip of the penis into the urethra. The procedure is performed through the natural body openings and hence, no cuts are required on the outside of the body.
  • The laser is inserted through the scope and the laser can destroy, vaporize or cut the part of the prostate that blocks the urine flow.
  • The doctors will remove the cut out pieces of the prostate tissue from the bladder by using instruments.

 

After the procedure:

  • The patients may have the urinary catheter attached to the bladder, as the urine path is blocked by swelling, right after the procedure.
  • The catheter will remain attached to the bladder for a 1-2 days until the patients can urinate naturally.
  • The patients might see blood in the urine for a few days to one week after the surgery. However, if the blood is thick then the blood may clot and block the urine flow. Patients should inform the doctor in such a situation.
  • Some patients may experience a burning sensation at the tip of the penis while urinating or increased frequency of urination, especially at night. These symptoms will arise depending on the types of laser treatment and the size of the enlarged prostate.
  • Patients may also feel difficulties to hold urine, however these symptoms improve with time.
  • Patients should not do strenuous activity such as weight lifting, for some days, after the procedure. In the case of HoLEP procedure, doctors might ask the patient to take rest for two weeks, however in PVP procedure, one week rest is sufficient for patients.
  • After the surgery, patients are asked to avoid sexual intercourse, as having an orgasm (ejaculating) within a few days may cause pain and bleeding.
  • Doctors may prescribed antibiotics or other medications after the procedure and the patients are advised to take the full course of medicine.

 

Prostate laser surgery is a well-excepted procedure, which improves urinary flow for most men. Generally, the results are often endured for a long period of time. However sometimes, this procedure would not destroy all the prostate tissues, which blocks the urine flow, and hence the remaining tissues might grow again after some time, requiring further treatment. Patients should consult the doctor if they notice any worsening of urinary symptoms.

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