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Green Light Laser Prostatectomy



Benign Prostatic Hypertropy (BPH)

Definition: A walnut sized gland that surrounds the urethera near the bladder. As a man ages, the gland can grow causing constriction of the urethera, interfering with the normal flow of urine through the urinary tract.
Why have treatment for an enlargement of the prostate?

Most men seek treatment from their urologist when they begin to have symptoms that interfere with their lifestyle. Your urologist can help you select a treatment that relieves the obstruction and improves your voiding.

GreenLight™ photoselective vaporisation of the prostate (PVP)

PVP uses a high-energy laser to vaporize prostate tissue and seal the treated area. The laser light is produced by a Neodymium-Aluminium-Garnet Laser (Nd YAG).The frequency of the light is then doubled by firing it through a potassium titanyl phosphate (KTP) crystal. It is this that gives it its unique and very special properties that make it perfect for work in the prostate. The green colour of the laser is rapidly absorbed by haemoglobin. The Prostate has an excellent blood supply and very rich in heamoglobin. The Prostate tissue is vaporised with little bleeding as vessels are sealed at the time of vaporisation.

Its advantages over TURP are less bleeding and a much shorter catheterisation time and hospital stay. The procedure is performed via a telescope inserted into the urethra under spinal or general anaesthetic and usually lasts 30-60 minutes. For more information please visit the AMS Greenlight laser website.
GreenLight laser vaporisation of the prostate

Why have GreenLight laser vaporisation of the prostate?

The reasons are the same as Indications for TURP

What are the advantages of GreenLight laser prostatectomy?
  • Operation can be performed as a day case
  • Catheter to drain urine is removed within 24hours post operatively.
  • Quick relief of your BPH symptoms with shorter recovery time compared to alternative treatments
  • Return to normal activities within a short period
  • Immediate increase in urine flow
  • Saline is used as irrigation which is safer than the Glycine irrigation used to TURP in most centres in London. This Glycine can cause a rare but dangerous problem known as TUR syndrome.
  • Instruments are smaller than for TURP, so, in theory, there should be a reduced risk of a urethral stricture.
  • Treatment can be performed in patients who have abnormal clotting or are on drug thinners (e.g. aspirin, clopidogrel and warfarin ) in certain cases.
  • To date, long term results appear to be favourable and comparable to routine TURP
  • What are the disadvantages of GreenLight laser prostatectomy?
  • Reduced efficacy for very large prostate gland
  • No tissue available for histological analysis as the prostate is vaporised
  • Discomfort or pain on passing urine is more common than after a TURP. This may last a week or sometimes go on for several months. This is sometimes accompanied by needing to visit the toilet more often and urgently during the day and the night.
  • Sometimes, slough, which is dead prostatic tissue, may be passed after the laser prostatectomy. This may temporarily interrupt the flow of urine; TURP can also be affected by blood clots that have similar problems.
  • Complications can occur although these are rare and can follow inappropriate firing of the laser into the bladder and damaging the tissue in that area.

    What are the alternatives to GreenLight laser prostatectomy?

    There are several procedures of which the most common are listed below.
  • TURP: This is the gold standard treatment for BPH by which other treatments are judged. Compared to laser prostatectomy, There is more blood loss and a greater chance of needing a blood transfusion, a longer hospital stay and more post operative complication. There is less discomfort felt in the bladder and penis after this compared to laser prostatectomy and usually there is no slough to pass.

  • Open Prostatectomy: For this, an incision is made in the lower abdomen under general anaesthetic or when the skin is made numb from the waist down, and the prostate removed. Urinary symptoms are improved possibly slightly better than laser prostatectomy. A prolonged hospital stay is required and bleeding can occur sometimes requiring a blood transfusion. This option is reserved for very large prostates that are usually too large to be treated by one of the other options.
  • Are any special tests required before GreenLight laser prostatectomy?

    To ascertain whether you require prostate surgery and to be able to advice you on the best treatment options, you will need to have a prostate assessment.

    What do I need to do before a GreenLight laser prostatectomy?

    You should take your normal medication as before the procedure. Ask your doctor if you should stop aspirin or clopidogrel (Plavix) 10 days before the operation or if you need to stop warfarin. You may need a blood test before surgery to determine if all is well. In some cases, you may be allowed to continue with warfarin.

    It is important to exclude a urinary tract infection before your procedure. The urine should be checked by a health professional.

    No food should be eaten 6 hours before but clear water only can be consumed 3 hours before the planned time of laser prostatectomy.

    Most patients can go home a few hours after the procedure. Sometimes, you may need to spend the night in hospital and go home the following morning. This is more likely if your procedure is done late in the day, or if you travelled a long distance to reach the hospital.

    What happens during a GreenLight laser prostatectomy?

    Under general anaesthesia (i.e. asleep) or spinal anaesthesia (i.e. numb from the waist down), a telescope examination is made of the prostate and bladder using a camera mounted on the end of a tube passed through the water pipe (urethra). The laser is introduced and the prostate vaporised.

    An irrigating catheter is placed in the urethra and then the patient returns to the ward.

    What happens immediately after a GreenLight laser prostatectomy?

    You will return back to the ward. An irrigating catheter will be in place draining the bladder. This may have a slightly red colour. Usually, this will stay in either 6 hours or overnight. There may be a little discomfort, but it is unusual to have pain. Drinking plenty of fluids (8 cups a day or 3 litres/day) will ensure a good flow of urine. The catheter may cause you to have bladder spasms or to feel the need to urinate. These symptoms can be improved by medication if necessary.

    You will be given antibiotics while you are in the hospital to prevent infection and a drug to reduce inflammation (e.g. diclofenac). These will probably continue for 1 week after the procedure. You should be able to get out of bed and walk around soon after returning from the operating theatre.

    The catheter is held in place by a balloon inflated with water. When the balloon is deflated, the catheter slips out. You may feel pain when you urinate because the prostatic urethra will still be healing. After removal of the catheter, the desire to pass water may be very urgent and it may sting. This improves gradually, but may take as long as a few months. If you have difficulties, it may be helpful for you to try to hold on for 10 minutes each time you wish to pass water. Medication can also help. Another exercise is to stop passing urine in midstream and count to three. This helps improve your control. Do not worry if you experience some dribbling of urine at this stage. Providing your bladder is emptying completely, you will be able to go home. Sometimes, an ultrasound scan of the bladder will be performed to check the bladder is empty.

    What is life like after GreenLight laser prostatectomy?

    Many patients obtain immediate relief of symptoms and dramatic improvement in urine flow usually within 24 hours of the procedure. In some patients, it may take up to 8 weeks for the urinary flow to improve and there may actually be a deterioration in the flow with increased need to visit the toilet during the day and night. This occurs because some prostate ('slough' i.e. lasered prostate) may need to be passed in the urine before the flow can be improved.

    You will probably be taking an antibiotic, anti-inflammatory and possibly a drug to calm the bladder for the first week or so.

    In general, you should:
  • Continue drinking a lot of water to flush the bladder.
  • Avoid straining when moving your bowel.
  • Eat a balanced diet to prevent constipation. If constipation occurs, ask your doctor if you can take a laxative.
  • Avoid caffeine and alcohol
  • Don't do any heavy lifting for 2 weeks
  • Don't drive or operate machinery until you feel ready and for at least 1 to 2 weeks
  • Contact your doctor if
  • your urine is so red that it is difficult to see through it,
  • if it contains clots or bits of tissue (slough)
  • if you feel significant or increasing discomfort
  • By six to eight weeks after the operation, urination should be easier and less frequent, although you may have to get up at night to urinate. Months may go by before you feel completely normal. Generally, the longer you had the problem before you were treated, the longer your recovery time will be.

    How soon can I return to normal activities?

    Most patients can resume normal activities within the week. This would include a desk job and driving a car, which you should be able to resume within a couple of days. You will have to avoid more strenuous activities, as well as lifting more than 30 pounds or riding a lawnmower for example, for about 2 weeks following the GreenLight PVP Laser procedure.

    Will I still be able to have sex following the GreenLight laser prostatectomy?

    The GreenLight PVP Procedure should not affect your ability to have an erection or an orgasm. Some men have reported retrograde ejaculation, or "dry climax" following the procedure. If you are sexually active now, you can look forward to remaining sexually active.

    Can I have GreenLight laser prostatectomy if I had a TURP in the past?

    Since TURP leaves behind a small part of the gland, it is still possible for prostate problems, including BPH, to develop again. However, surgery usually offers relief from BPH for at least 15 years. Only 10 percent of the men who have had TURP eventually need a second operation for enlargement. So Green light laser can be performed.

    For more information go to http://www.prostatelasercentre.com/la.html

    Greenlight HPS Laser Therapy (http://www.greenlightbph.co.uk/)

    www.nice.org.uk.