Benefits of Prostate Laser Surgery

Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by an enlarged prostate — a condition known as benign prostatic hyperplasia (BPH).

During prostate laser surgery, your urologist inserts a scope through the tip of your penis into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. A laser passed through the scope delivers energy that shrinks or removes excess tissue that is preventing urine flow.

Lasers use concentrated light to generate precise and intense heat. There are several different types of prostate laser surgery, including:

Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel.
Holmium laser ablation of the prostate (HoLAP). This procedure is similar to PVP but uses a different type of laser.
Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate.

The type of laser surgery your prostate specialist recommends will depend on several factors, including:

The size of your prostate
Your health
The type of laser equipment available
Your doctor’s training

Why it’s done

Prostate laser surgery helps reduce urinary symptoms caused by BPH, including:

Frequent, urgent need to urinate
Difficulty starting urination
Slow (prolonged) urination
Increased frequency of urination at night
Stopping and starting again while urinating
The feeling you can’t completely empty your bladder
Urinary tract infections

Laser surgery might also be done to treat or prevent complications due to blocked urine flow, such as:

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

Laser surgery can offer several advantages over other methods of treating BPH, such as transurethral resection of the prostate (TURP) and open prostatectomy. The advantages can include:

Lower risk of bleeding. Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn’t allow their blood to clot normally.
Shorter or no hospital stay. Laser surgery can be done on an outpatient basis or with just an overnight hospital stay.
Quicker recovery. Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.
Less need for a catheter. Procedures to treat an enlarged prostate generally require use of a tube (catheter) to drain urine from the bladder after surgery. With laser surgery, a catheter is generally needed for less than 24 hours.
More-immediate results. Improvements in urinary symptoms from laser surgery are noticeable right away. It can take several weeks to months to see noticeable improvement with medications.

Preparations

Food and medications

Several days before surgery, your urology doctor might recommend that you stop taking medications that increase your risk of bleeding, such as:

Blood thinners such as warfarin (Coumadin) or clopidogrel (Plavix)
Nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others)

You are likely to be prescribed an antibiotic to prevent urinary tract infection.

Other precautions

Arrange transportation because you won’t be able to drive yourself home after the procedure that day or generally if you have a catheter in the bladder.

What you can expect

Before surgery you will be given either general anesthesia — which means you’ll be unconscious during the procedure — or spinal anesthesia, which means you’ll remain conscious. Exactly what you can expect during and after prostate laser surgery varies depending on the particular type of laser and technique used.

During the procedure

A narrow fiber-optic scope is inserted through the tip of your penis into the urethra. The laser inserted through the scope is used to destroy, vaporize or cut out the prostate tissue blocking urine flow. Depending on the procedure, your doctor might also use instruments to remove cut pieces of prostate tissue from the bladder.

After the procedure

You’ll likely have a urinary catheter in place because of swelling that blocks urine flow. If you’re unable to urinate after the tube is removed, your doctor might reinsert the catheter to allow you to heal or give you catheters that you can insert on your own a few times a day until swelling goes down and you can urinate normally.

You might also notice:

Blood in your urine. It’s normal to see blood for a few days to weeks after the procedure. Call your urologist if the blood in your urine is thick like ketchup, bleeding appears to be worsening or blood clots block your urine flow.
Irritating urinary symptoms. You might feel an urgent or frequent need to urinate, or you might have to get up more often during the night to urinate. Most men experience burning, especially at the tip of their penis and near the end of urination. With some types of laser surgery, these symptoms can last for weeks or even months depending on how you heal and the size of your prostate.
Difficulty holding urine. Incontinence can occur because your bladder is used to having to push urine through a urethra narrowed by enlarged prostate tissue. For most men, this issue improves with time.

Depending on the type of prostate laser surgery you have, you might go home afterwards or need to stay in the hospital overnight.