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Laser Prostatectomy

What is a Laser Prostatectomy?

A laser prostatectomy is a minimally invasive operation that uses a laser to remove the obstructing part of the prostate gland that is causing your urinary symptoms. This allows a free flow of urine. The advantage of laser prostatectomy over conventional surgery (TURP) is reduced bleeding and a shorter hospital stay.

What is the Prostate?

The prostate is a walnut-sized gland that sits at the base of the bladder surrounding the urethra, the tube through which you urinate. As you get older, the prostate gland grows and can cause an obstruction to the flow of urine leaving the bladder, thus causing problems urinating.

Why do I need a Laser Prostatectomy?

You are having significant problems or bother passing water, and may have stopped passing water altogether (urinary retention).

How is a Laser Prostatectomy performed?

The operation is performed under general or spinal anaesthesia. It is performed through as specialised telescope called a laser resectoscope which is passed up the pipe of the penis (urethra), and therefore there are no external cuts or scars.

A laser beam is directed onto the prostate through a fibre optic cable passed up the resectoscope, and used to core out (enucleate) the central portion of the prostate gland, until there is a wide channel with no obstructing tissue. This usually takes about 60-90 minutes. The prostate tissue that is cored out is then chopped up into smaller pieces by a device called a morcellator and removed through the resectoscope.

When I have finished the operation, I pass a catheter into the bladder, which drains the urine and helps to wash away any blood. This catheter usually stays in overnight and will be removed before you go home, usually on the day after surgery.

What are the risks, consequences and alternatives associated with having a laser prostatectomy?

Most procedures are straightforward; however as with any surgical procedure there is a chance of side effects or complications.

Serious or frequently occurring risks

Common (greater than 1 in 10)

  • Temporary mild burning, bleeding or frequency of urination after the procedure - it can take a few weeks for the internal wound from the operation to heal.
  • No semen is produced during orgasm in 80% patients after the procedure (retrograde ejaculation).
  • The operation may not relieve some of your symptoms.

Occasional (between 1 in 10 and 1 in 50)

  • Temporary loss of urinary control (incontinence) which improves over time.
  • Urine infection requiring antibiotics.
  • Bleeding requiring return to theatre and / or blood transfusion.
  • Possible need to re-operate in future due to recurrent obstruction.
  • Failure to pass urine after surgery requiring another catheter.

Rare (less than 1 in 50)

  • Permanent loss of urinary control (incontinence) which may require additional corrective surgery 1%.
  • Impotence – difficulty in achieving a satisfactory erection.
  • The need to self-catheterise after the procedure to fully empty the bladder.
  • Injury to urethra causing delayed scar formation, which can obstruct urethra.
  • Very rarely perforation of the bladder requiring temporary insertion of a catheter or open surgical repair.

Alternatives to laser prostatectomy

  • Medication – medication is usually not as effective as surgery, can have side effects, and you will need to take it for the rest of your life.
  • Urolift procedure.
  • Transurethral Prostatectomy (TURP) is the standard operation for prostate enlargement. Laser Prostatectomy has similar effectiveness to TURP in published studies. TURP has a higher risk of bleeding compared to laser prostatectomy so you may need to stay in hospital a day or two longer with a catheter.
  • Transurethral Incision of Prostate (TUIP) - also sometimes called Bladder Neck Incision. May be recommended for small prostates.
  • Open prostate operation – higher risk of complications and longer recovery so only recommended in really large glands, that are too big to manage with minimally invasive surgery.
  • Long-term catheter – can cause significant discomfort and complications, so only recommended if you are not fit for an operation.
  • Observation of symptoms – is a good option if your symptoms are mild and don’t trouble you.

What type of anaesthetic will I have?

The anaesthetist will see you before your operation to discuss the alternatives. The anaesthetist will also check that you are fit enough for the anaesthetic.

Getting ready for your operation

If you smoke, try and cut down or preferably stop, as this reduces the risks of heart and chest complications during and after the operation. If you do not exercise regularly, try and do so for at least half an hour per day e.g. brisk walk or swimming.

You may be sent an appointment to visit the pre-assessment clinic a few days before your operation date. This is a general health check to ensure you are fit for surgery. The pre-assessment nurse will organise for you to have bloods taken and have an ECG (electrocardiogram - heart tracing), and answer any questions that you may have.

Please let Dr Nathan know well in advance of your surgery (at least 2 weeks) if you are taking any blood thinners such as aspirin, Assasantin, Plavix, Iscover, Brilinta, Warfarin, Pradaxa, Xarelto etc.

What should I expect after the operation?

After your operation you will normally go back to the surgical ward. You can start eating and drinking as soon as you recover from the anaesthetic.

Pain

Because there are no external cuts, this procedure is relatively pain free. You may experience some discomfort from the catheter, but this is usually easily treated with mild painkillers.

Catheter

A urinary catheter is a tube that runs from the bladder out through the tip of the penis and drains into a bag. It is important to drain the urine in this way until the urine is clear. Your catheter is usually removed on the day after your operation.

Before you are allowed home

  • You must be passing water without difficulty.
  • Mild painkillers such as Paracetamol and Voltaren must adequately control any pain.
  • Your temperature must be normal.

Discharge information and home advice

Bleeding

It is quite normal to see an occasional show of blood in your urine during the first month after surgery – this is due to the healing of the operation site. If you see blood, simply increase your fluid intake. If you have prolonged heavy bleeding (>24 hours), significant pain or increasing difficulty passing water, please contact my rooms or the nurse manager at the hospital.

Pain

Mild painkillers such as Paracetamol should be enough to deal with any post-operative discomfort

Bowels

It is important that you do not get constipated. There are no dietary restrictions but you should try and eat plenty of fruit and vegetables and wholemeal bread. If you feel that you may be constipated, see your GP. Try an drink 2-3 litres of fluid a day.

Exercise

You should take it easy for a month, although it is important to take some gentle exercise like walking, to reduce the risk of developing a blood clot in your legs.

During the first 2 weeks you should not:

  • Lift or move heavy objects.
  • Dig the garden.
  • Housework.
  • Carry shopping.

You can resume normal sexual activity 2 weeks after your operation.

Work

Recovery takes 4-6 weeks from your operation date; I will be able to advise you when it will be safe to return to work as this depends on your occupation – you may be able to resume a sedentary office job after only a week or two but may need to take a month off if you have a strenuous job. A sick note for your hospital stay and recovery period can be obtained from your family doctor or my rooms.

Driving

You may resume driving a motor vehicle after 1-2 weeks if you feel well and do not have significant pain or discomfort. You should initially commence this with short trips. You should avoid any long car trips for at least four weeks.

Disclaimer

This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.

Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.