Prostate laser surgery

Overview

Prostate laser surgery is a surgical procedure done with a laser to the prostate gland for benign prostate hyperplasia. Benign prostate hyperplasia is a condition where the prostate gland enlarges in males. This enlarged prostate gland causes difficulty in urination. Laser surgery is done to relieve symptoms caused by an enlarged prostate. The prostate gland belongs to the male reproductive organ. 

Laser technique

The prostate gland surrounds the urethra and contributes to semen production. As individuals age, the prostate gland surrounding the urethra enlarges. This enlargement is benign and hence called the benign prostate enlargement (BPH). Laser surgery for the prostate is done to shrink the excess tissue that causes BPH. 

Using a probe that is inserted through the penis, a beam of strong concentrated light is passed to the prostate. Light energy transmitted from the laser tip produces a vaporization bubble to ablate the prostate. This removes the excess tissue that is blocking the urethra from freely passing urine. This intense light removes the excess tissue that is pressurizing the urethra and causing narrowing. Another device can be used to chop the excess tissue and remove it. 

Types of Laser surgery

The laser light can be delivered in three different types. They are: 

• Photoselective vaporization of the prostate (PVP) is deployed in mild to moderate enlargement of the prostate. It is a process of vaporizing the prostate to remove the excess tissue that enlarges the urinary canal or urethra. As vaporization is caused in this procedure, no tissue is available for pathological examination. 
• Holmium laser ablation of the prostate (HoLAP) involves using a holmium laser to remove excess prostate tissue and enlarge the urinary canal. 
• Holmium laser enucleation of the prostate (HoLEP) is used in severe BPH. It uses a holmium laser to remove the excess prostate and enlarge the urinary canal. Another special instrument is used to remove the cut prostate tissue. 
• Thlium laser enucleation of the prostate is done by using a Thulium laser instead of a Holmium laser. 

Indications

Prostate laser surgery is indicated in BPH to reduce the symptoms caused by the enlargement. This procedure is indicated in individuals with the symptoms of:

• Difficulty to urinate
• Urination is slow, prolonged
• Increased frequency of urination with an urge to urinate
• Urination is not free and continuous but stops in the middle and begins again
• Incomplete emptying of the bladder 
• Urinary tract infections
• Damage to the kidneys or the urinary bladder 
• Stones in the bladder 
• Blood in the urine while urinating 

Advantages

There are various methods to treat BPH. They include medication, electrovaporization, laser vaporization, and surgery. Medication can take a long time to show its effects, electrovaporization is a slow process and no tissue is left for pathological examination, surgery for the prostate carries its own risk. Unlike all these, the laser has many advantages. 

• It is one of the safest procedures for removing excess tissue. 
• It has shorter catheterization times of < 24 hours unlike other procedures
• It has fewer bleeding complications and hence is even suitable for those on blood thinner medications
• It has reduced hospital stays as it can be done on an outpatient basis or just 1-2 days in a hospital
• It has less recovery time when compared to surgical procedures

Before the procedure

Before undergoing Laser therapy, an individual should understand the importance and necessity of the procedure by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. The HCP will prescribe medicines before undergoing laser therapy. Certain routine blood and urine investigations are carried out to rule out any infections or other conditions not known to the individual. 

A prostate examination will be done along with tests like PSA. Advanced imaging techniques like MRI, CT scan, or ultrasound may be done to study the extent of the enlargement, visualize the narrowing of the urethra, assess the extent of the damage, and decide on the type of laser therapy to be given. A cystoscopy test is done to look inside the prostate and the bladder for any abnormal signs. A Urodynamics test may be done to assess the functioning of the bladder. 

During the procedure

Prostate laser surgery is performed under anesthesia. General anesthesia will make an individual unconscious but spinal anesthesia will keep the individual conscious. An individual is laid on the back with legs raised. A special instrument called a resectoscope that has a viewing camera is inserted in the urethra to view the prostate. A narrow fiber of laser is sent through the resectoscope which sends pulses of light to vaporize the excess prostate or cut the tissue. Another special device called the morcellator is sent through the resectoscope after withdrawing the laser to remove the cut pieces of the prostate. A urinary catheter is put in the urethra once the resectoscope is removed. 

After the procedure

The entire procedure takes about 1-3 hours depending on the enlargement. An individual is monitored till the vitals are stabilized and discharged depending on the recovery. The catheter will be removed once an individual can pee on their own. Medications to reduce pain and ward off infections will be given. 

Side effects

The side effects of prostate laser include blood in the urine, pain and burning while urinating, difficulty holding the urine, and an increased urge to urinate. These will be for a few days after the procedure. 

Risks and complications

The risks associated with the procedure include Urinary tract infections, narrowing of the urethra making it difficult to pee, backward ejaculation of the semen into the bladder rather than out of the penis, inability to erect the penis for long enough during sexual intercourse, and need for retreatment if all the tissue is not removed. 

Conclusion

Prostate laser surgery is a surgical procedure for benign prostate enlargement done by using laser light. It has a quick recovery time and is a safe procedure. It can increase the quality of life of an individual by removing the enlarged prostate in BPH.