urology Prostate Laser Surgery

Prostate Laser Surgery is the technique applied when moderate to severe urinary symptoms of Benign Prostatic Hyperplasia (BPH) is to be treated. Gold standered treatment option for this is TURP , Trans Urethral Resection of prostate. The source of energy for this procedure is high frequency modulated electric current. Now a special energy LASER is available for this surgery. Several different types of prostate laser surgery are available which include Photoselective vaporization of the Prostate (PVP) - where the laser melts away the excess prostate tissue, Holmium Laser Ablation of the Prostate (HoLAP) - another similar process and the Holmium Laser Enucleation of the Prostate - where the laser is used to cut and remove the complete prostate tissue that blocks the urethra.Then with another instrument this enucleated prostate tissue is shred into small piece and then washed out. The type of laser surgery is dependent on the recommendations of the doctor and depends on factors like, the laser equipment available, the size of the prostate and the health status of the patient.

Why does prostate laser surgery become necessary?

Several reasons might surface that would require a prostate laser surgery. These include:

  • increased frequency of urination at night
  • difficulty in starting to urinate
  • stopping suddenly during urination and then starting again
  • the feeling that the bladder hasn't been emptied completely
  • slow urination
  • inability to control urination
  • urinary tract infections

Laser surgery might also be needed to prevent complications arising from a blockage in the flow of urine. The common problems include:

  • bladder stones
  • blood in urine
  • kidney or bladder damage
  • recurring urinary tract infections

Why should laser prostate surgery be preferred?

Lots of clinical advantages make laser prostatectomy a much better option than open prostatectomy and transurethral resection of the prostate. These are:

  • Lower blood loss: compared to regular TURP, LASER prostatectomy resultas in almost zero bleeding. Thus it is suited for those men who are on blood thinner medications , have a bleeding disorder and men with poor cardiac functions. LASER TURP is done with normal saline. Thus the fluid over load that can happen with normal TURP is completely avoided.Thus this LASER TURP is highly safe in cardiac patients
  • Quicker recovery: The recovery takes far less time considered to TURP or an open surgery. This means that there would be a shorter hospital stay.
  • Reduced need for a catheter: Prostate treatments usually require a catheter to drain the urine from the bladder for three to four days post surgery. The number of days on catheter decreases with laser surgery.
  • Immediate results: The improvements can be seen right away, while it might take several months to see any noticeable improvement with medications.

What are the preparations to be taken?

There are no special preparation for LASER surgery. If any urine infection is there that needs to be treated.. An antibioticis be prescribed to avoid infections in the urinary tract.

What is to be expected before, during and after the laser prostatectomy?

General anaesthesia (you would be unconscious) or spinal anaesthesia (you would be conscious) is given to the patient. A narrow 21 french scope is passed scope is through the tip of the penis into the urethra nad then in to bladder. Prostate is examined for size and number of lobes and the effects on the bladder. Then LASER fiber is inserted through this scope. Depending upon the type of LASER prostate tissue is either enucaleated from the capsule or vaporized in a systematic way. In holmium enucleation of prostate, lobes of prostate is morselated using a special instrument, and pieces of prostate tissues is washed out from the bladder .

A urinary catheter would be passed in to bladder and kept for two days then removed.There might be some blood in the urine, but you would need to consult the doctor if it is too thick or blood clots result from it. There might be some burning sensations at the tip of the penis at the end of urination. Urination might become quite frequent. It might be difficult for you to hold back urine as the bladder has been accustomed to pushing urine through the urethra that was blocked by prostate tissues. All these symptoms would subside over a period of 2 days to a weeks time.

The prostate laser surgery results in an improved urinary flow and the results that last long, with least bleeding and completely cardiac safe.

Authored By : Dr. Mahendra Jain

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Dr. Mahendra Jain

MBBS.MS.MCh.DNB Consultant Urologist

Dr Mahendra Jain is an eminent and an extremely experienced Urologist ...

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