Laser prostate surgery – Facts and myths a patient should know

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

During laser prostate 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 get rid of the excess tissue that's block the urethra and preventing urine flow.

All lasers use targeted light to generate precise and intense heat. Laser surgery removes excess prostate tissue using two principles as mentioned below:

• 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:

• Photo selective vaporization of the prostate (PVP) - A laser is used to melt away (vaporize) excess prostate tissue to enlarge the urinary channel.
• Holmium/Thulium 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/Thulium 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 many factors, including the size of your prostate, your health, the type of laser equipment available and your doctor's training.

Why it's done

Prostate laser surgery helps to reduce urinary symptoms caused by BPH. Urinary symptoms caused by BPH can include:

·         Urgent need to urinate

·         Difficulty starting urination

·         Slow urination

·         Increased frequency of urination at night(nocturia)

·         Stopping and starting again while urinating

·         The feeling you can't completely empty your bladder

·         Urinary tract infections

A number of procedures are available for treating BPH, but laser surgery has several potential advantages over other methods. The advantages generally include:

• Lower risk of bleeding - Because there is a low risk of bleeding with laser surgery, it can be a good choice for men who take medication to thin their blood or who have a bleeding disorder that does not allow their blood to clot normally.
• Shorter hospital stay - Laser surgery can be done with just an overnight hospital stay.
• Quicker recovery - Recovery from laser surgery generally takes less time than conventional treatments.
• More-immediate results - Improvements in urinary symptoms from laser surgery are noticeable quickly, whereas it will take more time to see some noticeable improvement with medications.

·         Risks

Serious long-term complications are less likely with prostate laser surgery than with traditional surgery. Risks of laser surgery can include:

• Temporary difficulty urinating - You may 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 - Urinary tract infections are a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place, and may require antibiotics or other treatment.
• Narrowing (stricture) of the urethra - Just as you can form scars on the outside of your body, you can form scars on the inside after prostate surgery. These scars can block urine flow, requiring additional treatment.
• Dry orgasm (retrograde ejaculation) - Any prostate surgery can cause retrograde ejaculation, which means semen released during sexual climax (ejaculation) enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful, and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child. This is a common long-term side effect of procedures to treat an enlarged prostate.

How you prepare

Here are some issues to discuss with your doctor:

• Your medications - Tell your doctor about any prescription, over-the-counter or supplements you take. This is especially important if you take blood-thinning medications, such as war far in or clopidogrel and non prescription pain relievers such as aspirin, ibuprofen. Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days prior to the surgery.
• Fasting before your procedure - Your doctor will likely tell you not to eat or drink anything after midnight the night before the procedure. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
• Arrangements after the procedure. Ask your doctor how long to expect to be in the hospital. You won't be able to drive yourself home after the procedure that day or generally if you have a catheter in the bladder.
• Activity restrictions. You may not be able to work or do strenuous activity for about one to two weeks after surgery, but depending on the type of laser procedure you have, you may need more or less recovery time. Ask your doctor how much time you may need.

What you can expect

Laser surgery for an enlarged prostate can take from half-hour to one or two of hours depending on the size and anatomy of the prostate being treated.

Before the surgery begins, you will be given either general anesthesia, which means you will be unconscious during the procedure, or spinal anesthesia, which means you, will stay conscious during the procedure.

During the procedure

A narrow fiber-optic scope is inserted through the tip of your penis into the urethra. By accessing the prostate through your penis, your doctor won't need to make any cuts (incisions) on the outside of your body. The doctor will use the laser to destroy, vaporize or cut out the prostate tissue blocking urine flow. Depending on the procedure, your doctor may also use instruments to remove cut pieces of prostate tissue from the bladder.

After the procedure

After the procedure, you may have a urinary catheter in place because urine flow is blocked by swelling. If you're unable to urinate after the tube is removed, your doctor may replace the catheter for some time to allow you to heal until swelling goes down and you can urinate again normally.

You may also notice:

• Blood in your urine - You may see blood for a few days to weeks after the procedure.
• Irritating urinary symptoms - You may feel an urgent or frequent need to urinate, or you may have to get up more often during the night to urinate.
• Take it easy - Don't do any strenuous activity, such as heavy lifting, until your doctor says it's OK.
• Take medication as prescribed - If your doctor prescribed antibiotics, make sure to take the full course of exactly as your doctor says.

Results

Prostate laser surgery improves urinary flow in most men. Often, results are long lasting.

If you are having any issues related to the above areas then a urologist can help by discussing the problem, examining you, investigating and reaching an accurate diagnosis. Dr. Rahul Yadav is one of the very few dedicated best Urologist in India today. Within the urology subspecialty, apart from treating prostate related problems, he is keenly interested and experienced in Uro-oncology, Female and Paeditric Urological diseases, sexual problems and its management and among very few dedicated Laparoscopic/Robotic Uro-oncology surgeon in India. He is closely involved in the diagnosis, treatment and follows up of patients undergoing urology treatment at the Apollomedics Super Specialty Hospital, Lucknow (UP) which is one of the specialized centers for urological treatment in India.