Laser Prostatectomy - Treating Benign Prostate Hypertrophy

What is laser prostatectomy?

Benign prostate hypertrophy, also known as benign prostatic hyperplasia (BPH) and prostatic hypertrophy, is the enlargement of prostate gland in men. A common condition that occurs in men with age, BPH causes problems with urinating. In some cases, an untreated condition can lead to blockage of the bladder, stones, bladder infection or kidney damage.

The exact cause of prostate enlargement is unknown but is postulated to be caused by hormone imbalances and cell growth changes.

Treatment in form of home remedies and medicines is recommended if your symptoms cause you moderate discomfort. If your symptoms are severe, your doctor may suggest surgery to remove a part of your prostate.

Prostate laser surgery helps to relieve urinary symptoms that range from moderate to severe. With the help of a scope inserted through the penis into the tube that carries urine from the bladder, your doctor will pass laser to shrink (ablation) or remove (enucleation) tissue that is causing the blockage of urethra and interrupting urine flow.

Different types of prostate laser surgery are:

1. Photoselective vapourisation of prostate (PVP) - Excess prostate tissue is vapourised to clear the urinary passage.
2. Holmium laser ablation of prostate (HoLAP) - Similar to PVP in procedure, this process differs only in the type of laser used to melt the excess tissue.
3. Holmium laser enucleation of the prostate (HoLEP) - The laser, along with another instrument called the morcellator, cut excess prostate tissue causing urinary blockage.

Why do you need laser prostatectomy?

The prostate gland surrounds the urethra, which carries urine from the bladder to outside the body. Enlargement of prostate squeezes or blocks the urethra, causing host of urinary inconvenience such as weak flow of urine, inability to urinate or empty the bladder fully, frequent urination, strain during passing of urine, and urinary tract infections.

Laser surgery of prostate gland can provide relief from these urinary symptoms and also reduce or prevent further complications that may arise from blocked urine flow.

These include:

• Kidney or bladder damage
• Recurrent urinary tract infections
• Incontinence
• Bladder stones

Prostate laser surgery offers some advantages over other modes of treatment for the condition. These include a lower risk of bleeding, a short hospital stay or a day treatment as an outpatient, reduced catheter usage post surgery, immediate improvement, and quicker recovery. Laser surgery is also a preferred option if your health does not permit a traditional surgery or if your prostate enlargement is not severe.

Which specialist should you consult if you have any of the signs and symptoms?

Consult your general practitioner if you are experiencing urinary problems. Your doctor will refer you to an urologist if s/he suspects your symptoms to be caused by an enlarged prostate.

What are the screening tests and investigations before the surgery?

Your doctor will ask you questions about your symptoms and conduct a physical examination. Tests for diagnosis and screening prior to surgery include urinalysis (urine test to rule out other urinary conditions), blood test to check serum creatinine, and a digital rectal exam (doctor will insert a finger into your rectum to check the size of your prostate and look for signs of prostate cancer).

Your doctor may also conduct a prostate-specific antigen (PSA) test to rule out prostate cancer. Though the two conditions are not related, they display similar symptoms.

What is the procedure for laser prostatectomy surgery?

The surgery is performed under general anaesthesia or a spinal anaesthesia, and may take 30 minutes to few hours, depending on the extent of prostate enlargement. Your doctor will insert a fibre-optic scope through the tip of your penis, without making any incisions on your body. The scope is directed to reach the urethra where high-intensity beams from laser vapourise or remove the extra prostate tissue. Additional instruments may be employed to cut prostate tissue pieces.

A urinary catheter will be placed immediately after the surgery as the urine flow will remain blocked due to swelling and some time is needed for healing.

What are the known complications of the surgery?

There are lesser risks involved with prostate laser surgery as compared to traditional surgery. Known complications include difficulty urinating for sometime after the procedure, urinary tract infections because of catheter, formation of internal scars in the area operated upon causing narrowing of urethra, erectile dysfunction, retrograde ejaculation (semen entering the urinary bladder instead of exiting through penis), and a need to repeat the surgery due to regrowth of some tissue.

What precautions or steps are necessary to stay healthy and happy before and after laser prostatectomy?

Your doctor will guide you through with permissible and restricted medications prior to the surgery. Blood-thinning medicines and painkillers must be stopped several days prior to the surgery to reduce your risk to bleeding.  You will be required to remain in fasting condition a night before the surgery. Consult with your doctor about your need for hospital stay after the surgery. You will require help from someone to drive you home after the surgery.

What are the dietary and physical activity requirements before and after laser prostatectomy?

Do not undertake strenuous physical activity for two weeks after surgery, though the exact recovery period depends on the severity of your condition and the procedure used.

As a caregiver, how can you support and help the patient cope with the surgery?

The patient undergoing the surgery will require assistance in being transported back home, as driving will cause strain in the operated area, and generally too, the catheter fixed in the bladder will cause some restriction on movement.

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