Laser Prostatectomy

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KEY POINTS

• The prostate gets bigger as men age, which is called benign prostatic hyperplasia, or BPH. BPH can cause problems with urination. Laser prostatectomy means that part of the prostate gland is removed using a laser, usually to treat BPH.
• Tell your healthcare provider about all medicines and supplements that you take, and tell your provider if you have allergies to any food, medicine, or other things such as latex.
• Ask your healthcare provider how long it will take to recover, if there are activities you should avoid, including lifting, and when you can return to your normal activities.

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What is a laser prostatectomy?

Laser prostatectomy means that part of the prostate gland is removed using a laser. Lasers use heat to destroy the part of the prostate gland that is pushing on the urethra. The urethra is the tube that carries urine from the bladder out through the penis.

The prostate gland is part of a man's reproductive system. It is about the size of a walnut and located between the bladder and the penis. The prostate gland surrounds the upper part of the urethra. It makes fluid that nourishes sperm and helps carry it out of the body during sex.

The prostate gets bigger as men age (enlarges), which is called benign prostatic hyperplasia or BPH. BPH can put pressure on the urethra, irritate the bladder, and cause problems with urination. BPH is a common health problem for men over age 60.

Laser removal is one way that part of your prostate can be removed without a cuts made through your skin. Use of a laser is a type of minimally invasive surgery.

When is it used?

Laser prostatectomy is used to treat BPH. Removing just the part of the prostate that is blocking the urethra may help your problems with urination.

Your healthcare provider may recommend this surgery if:

• Your symptoms are not controlled with medicines
• You are having trouble starting to urinate
• You are urinating very slowly
• You feel the urge to urinate often especially at night
• You are having trouble emptying your bladder completely
• You have other medical problems that make other types of procedures too risky for your health

With laser prostatectomy, you will likely have less bleeding and fewer side effects, go home sooner, and heal faster than if you had a more invasive surgery.

Your healthcare provider may recommend a more invasive procedure to remove the whole prostate if:

• You have cancer of the prostate
• You have had medicine or other procedures in the past that have not worked well to treat BPH

Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Tell your healthcare provider if you have any food, medicine, or other allergies such as latex.
• Antibiotics may be prescribed for a few days before and after surgery to help prevent infection.
• You may go home with a catheter for a few days after the procedure. A catheter is a small tube used to drain urine from the bladder. It's best to learn about the catheter and urine collection bag before your procedure. Ask your healthcare provider about this.
• Your healthcare provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Follow any instructions your healthcare provider may give you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for tests or procedures.

What happens during the procedure?

The surgery may be done at a surgery center or at the hospital.

You will be given medicine to help you to relax. You will be given medicine called anesthesia to keep you from feeling pain during the surgery.

• Local anesthesia numbs the part of your body where you will have the surgery.
• Regional anesthesia numbs part of your body while you stay awake. If you have regional anesthesia, you may also be given medicine to help you relax. The medicine can make you drowsy or you may fall asleep before the procedure.
• General anesthesia relaxes your muscles and puts you into a deep sleep. A breathing tube is usually put in your throat when you have general anesthesia.

Your healthcare provider will pass a cystoscope (a small, lighted tube) through the tip of your penis and into your bladder. With the scope your provider will be able to see the area where the enlarged prostate is causing problems. Your provider will use a laser to remove or to vaporize pieces of prostate tissue. No cuts are made with this procedure.

What happens after the procedure?

You may be able to go home or you may stay in the hospital overnight, depending on your condition.

You may have a catheter in your bladder to drain urine and flush out any blood clots after surgery. You may go home with the catheter. Your healthcare provider will remove the catheter usually in 2 to 3 days.

While recovering from surgery, you may have trouble controlling your bladder. You may notice blood in your urine or have trouble urinating. These symptoms usually go away as you heal.

Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid, including lifting, and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• You may have problems with anesthesia.
• You may have infection, blood clots, or bleeding.
• Your bladder could be damaged. This can cause discomfort with urination or you may not be able to pass urine.
• The muscle around your urethra may be permanently damaged. This could make it hard to control your urine.
• A scar may form around the urethra and make it narrow. In the future, you may need to have your urethra stretched to widen the passageway.
• It may be harder for you to have an erection. Also, when you have an orgasm, semen may not come out of your penis. Instead it may flow backward into your bladder.
• You may become sterile and unable to have children after the procedure.
• You may need another surgery on your prostate at a later time.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.