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By Mayo Clinic staffLaser surgery techniques for enlarged prostate are all done by inserting viewing scopes and instruments through the tip of the penis into the urethra. This makes surgery possible without making any cuts (incisions) on the outside of your body. Exactly what you can expect during and after the procedure can vary somewhat depending on your surgeon and the particular type of laser and technique used.
Holmium laser enucleation of the prostate (HoLEP)
During HoLEP, a laser is used to cut prostate tissue into small pieces. An instrument called a morcellator is used to grind tissue into easily removable fragments. HoLEP cuts out the entire portion of the prostate gland that can block urine flow. Because the entire prostate is removed, you won't need re-treatment, as you might with some other BPH procedures.
HoLEP results are similar to those achieved with the most effective nonlaser prostate removal surgeries and open prostatectomy. HoLEP generally has a lower risk of complications than open surgery or TURP.
One advantage of HoLEP over other laser treatments is that removed prostate tissue can be examined for signs of prostate cancer.
The HoLEP technique is difficult for surgeons to learn and is only done at a few advanced medical centers.
Photosensitive vaporization of the prostate (PVP)
This type of surgery heats and melts away (vaporizes) enlarged prostate with extremely hot laser energy. It's done with a potassium titanyl phosphate (KTP) laser or a lithium triborate (LBO) laser. The newer, higher powered LBO system allows for a shorter operation time than older KTP lasers.
PVP is also called green light laser therapy, because the wavelength that the laser emits appears as green light.
More research is needed to better understand the safety and long-term results of PVP, particularly in men who need to continue taking blood-thinning medications during the procedure and in men who have large prostates. The depth of tissue penetration by the green light or KTP laser is much deeper than that with the holmium laser.
Holmium laser ablation of the prostate (HoLAP)
HoLAP is similar to PVP except that the laser energy source is different. The laser energy used is absorbed by water, making it precise and keeping it from penetrating deep into tissues. The same type of laser is also used to treat bladder or kidney tumors, open up scars that can block the urinary system, and break apart kidney or ureteral stones. HoLAP and other laser ablation procedures are generally well suited for smaller prostates that still cause significant urinary symptoms.
Prior to surgery
Before laser surgery, your doctor will give you one of two kinds of anesthesia:
- General anesthesia, which means you'll be unconscious during the procedure.
- Spinal anesthesia, which means you'll have an anesthetic injected into your spine to prevent pain. With spinal anesthesia, you'll remain conscious during the procedure.
During the procedure
During laser surgery, a narrow fiber-optic scope is inserted through the tip of your penis into the urethra. The instrument is used to focus a high-energy laser beam into prostate tissue blocking urine flow. Depending on the procedure, the laser will come out of the fiber at an angle (side-firing laser fiber) for ablative procedures or the end (end-firing laser fiber) for enucleative procedures. Depending on the procedure, your doctor will also use instruments to remove pieces of prostate tissue from the prostate area and your bladder.
Laser procedures for enlarged prostate generally take from 30 minutes to an hour.
After the procedure
Ask your doctor about any specific restrictions or steps you need to take after the procedure.
- Don't take blood-thinning medications until your doctor says it's OK.
- Don't do any strenuous activity, such as heavy lifting, until your doctor says it's OK. This can be up to two weeks after HoLEP, but as short as a few days with other procedures such as PVP.
- Don't have sex until your doctor says it's OK. For most men, this is a week or two after the procedure. Having an orgasm (ejaculating) too soon may cause pain and bleeding.
- Pay attention to blood in your urine. Drink plenty of fluids and avoid strenuous activity unless your urine is clear (and not pink), and the suggested time has passed.
- Take antibiotics as prescribed. If your doctor prescribed antibiotics, make sure to take the full course of antibiotics exactly as your doctor says.
You may need to have a urinary catheter in place after the procedure because urine flow is blocked by swelling. If you're unable to urinate after the tube is removed, your doctor may give you catheters that you can insert on your own a few times a day until swelling goes down and you can urinate again normally.
- AUA guideline on the management of benign prostatic hyperplasia: Diagnosis and treatment recommendations. Baltimore, Md.: American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/bph-management/chapt_1_appendix.pdf. Accessed March 12, 2009.
- Humphreys, MR (expert opinion). Mayo Clinic, Rochester, Minn. March 22, 2011.
- Fitzpatrick JM, et al. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/125743340-3/0/1445/91.html?tocnode=54305416&fromURL=91.html. Accessed April 14, 2011.
- Lee J, et al. Advances in laser technology in urology. Urology Clinics of North America. 2009;36:189.
- Rieken M, et al. Complications of laser prostatectomy: A review of recent data. World Journal of Urology. 2010;28:53.
- Ahyai SA, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. European Urology. 2010;58:384.
- Gnessin E, et al. An update on holmium laser enucleation of the prostate and why it has stood the test of time. Current Opinion in Urology. 2011;21:31.
- Prostate enlargement: Benign prostatic hyperplasia. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement. Accessed May 23, 2011.
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