Laser Prostatectomy

What is laser prostatectomy?

In laser prostatectomy, laser energy is passed through a thin tube called a cystoscope to vaporise and remove excess prostate tissue in conditions such as benign prostatic hyperplasia (BPH).

This helps to alleviate constriction in the urethra and restore the normal flow of urine from the bladder.

Bipolar transurethral resection of the prostate (TURP) vs laser surgery

Although TURP and laser surgery are mostly similar, laser surgery:

• Does not yield any tissue samples for further examination
• Does not require the stoppage of blood thinners

Why do you need laser prostatectomy?

Laser prostatectomy is commonly used to treat the symptoms of benign prostatic hyperplasia (BPH), also known as enlargement of the prostate.

BPH is a non-cancerous condition where the prostate grows larger. As it enlarges, the gland presses against the urethra (urinary tube), restricting the flow of urine.

BPH symptoms include:

• Slow (prolonged) urination
• Difficulty starting urination
• Frequent, urgent need to urinate
• Increased frequency of urination at night
• Stopping and starting again while urinating
• The feeling of being unable to completely empty the bladder
• Urinary tract infections
• Bladder stones

Laser prostatectomy eases many of these urinary symptoms almost immediately and offers faster recovery outcomes compared to traditional surgery. It can be done as an outpatient procedure or may require a short overnight stay.

Laser prostatectomy can also be used to prevent or treat complications due to blocked urine flow, such as:

• Kidney or bladder damage
• Recurring urinary tract infections
• Inability to control urination or an inability to urinate at all
• Blood in the urine
• Bladder stones

What are the risks and complications of laser prostatectomy?

Laser prostatectomy is generally safe. Serious long-term complications are less likely with prostate laser surgery than with traditional surgery.

However, there are still some risks and complications to be aware of:

• Temporary difficulty urinating for a few days after the procedure. This means you may need a catheter to carry urine out of the bladder.
• Dry orgasm (retrograde ejaculation) is a common and long-term effect of any type of prostate surgery. This is the ejaculation of semen into the bladder rather than out of the penis. The condition is not harmful and generally does not affect sexual pleasure, but it can affect fertility.
• Urinary tract infection is a possible complication after any prostate procedure. This is more likely the longer the catheter is in place.
• Urinary incontinence is a rare but important complication that affects the ability to control the release of urine from the bladder.
• Narrowing (stricture) of the urethra is a rare complication that may occur due to scarring. Scars after prostate surgery can block urine flow and require additional treatment.
• Erectile dysfunction is a rare complication. Compared to traditional surgery, there is a lower risk of erectile dysfunction occurring due to laser surgery.
• Re-treatment may be needed if not all of the tissue is removed or if it grows back over time. Re-treatment may also be more commonly required for similar procedures such as transurethral resection of the prostate (TURP) and prostatic enucleation.

How do you prepare for laser prostatectomy?

Before the procedure, your doctor will review your medical history. You may also undergo some scans and tests.

Once your laser prostatectomy is scheduled, your doctor will advise you on how to prepare.

You may be asked to stop eating and drinking a few hours before the procedure, especially if you are undergoing general anaesthesia.

Note: If you are taking any medication or herbal supplements, you should inform your doctor. You may need to adjust or stop taking some medication before the procedure (e.g. aspirin, blood thinners).

What can you expect in laser prostatectomy?

Laser prostatectomy is usually done under general anaesthesia. It is typically performed as an inpatient procedure that requires an overnight stay.

Estimated duration

Depending on the size of the prostate treated, laser prostatectomy can take between 30 mins – 90 mins.

During the procedure

Your doctor will:

• Insert a narrow scope (thin, hollow tube) through the tip of your penis into the urethra.
• Guide a laser through the scope to heat up and vaporise the excess prostate tissue that is blocking urine flow.
• (If cancer is suspected) Remove small pieces of prostate tissue.
• Insert a temporary urinary catheter to help with urination post-procedure.

After the procedure

You may have to stay overnight in the hospital for observation.

For the first few days, you may have some swelling in your urethra. A urinary catheter will help to transport urine out of your body. Once your swelling goes down and you can urinate normally, your catheter will be removed. This usually takes a few days.

You may also experience some post-procedure symptoms, such as:

• Blood in the urine: This is normal for a few days to weeks after the procedure. However, if you notice thick blood in your urine, worsening bleeding, or if blood clots block your urine flow, inform your doctor.
• Discomfort during urination: For a few weeks following the procedure, you may experience an urgent or frequent need to urinate. There may also be a burning sensation at the tip of the penis and near the end of urination.
• Incontinence (difficulty holding urine): Incontinence may occur because your bladder is used to pushing urine through a narrowed urethra. The issue improves with time for most men.

Care and recovery after laser prostatectomy

Most people can go back to normal activity within a week and will achieve full recovery after 4 – 6 weeks.

In the initial recovery period, you should:

• Avoid strenuous activity, such as heavy lifting, until approved by your doctor.
• Wait a week or two before engaging in sexual intercourse. Ejaculating too soon can cause pain and bleeding.
• Take medication as prescribed.