Green Light Laser Prostatectomy
Last updated date: 14-May-2023
Originally Written in English
Green Light Laser Prostatectomy
TURP (also known as re-bore procedures) has been the usual treatment for men with lower urinary tract symptoms or water outflow problems caused by an enlarged prostate (BPH) for several decades. TURP surgery improves flow rates and subjective symptom scores in a long-term and consistent way. As a result, it has become one of the most commonly done urological procedures.
Despite its effectiveness, prostate surgery has a long list of side effects, including bleeding and the need for blood transfusions, infections, strictures, sexual issues, and incontinence. In other studies, the rate of impotence (i.e., erections that aren't as good as they were before surgery) has been as high as 18 percent. In addition to the risks associated with TURP, men who have the procedure require two to three days of catheterization and hospitalization after the procedure before undergoing a voiding trial (catheter removal) and discharge.
Green light Laser Prostatectomy (laser prostate surgery) was first introduced in 2003 with the goal of giving good results that were comparable to those of a standard TURP procedure but with much fewer adverse effects. Dr. Malek of the Mayo Clinic in the United States was the first to use laser prostate surgery, and he did so with first-generation, low-powered devices. The early models have now been utilized for several years with good results. These initial reports show excellent functional outcomes, including improvements in flow rates and symptoms that are comparable to those seen with a TURP surgery. The benefits of Green Light Laser prostatectomy, on the other hand, include a considerable reduction in the risk of bleeding, as well as shorter catheterization duration, hospital stay, and complication rates.
Green Light Laser Prostate Surgery
Green light laser prostatectomy is a method for the treatment of Benign Prostatic Hyperplasia (BPH), a condition in which the prostate gland enlarges and causes urethral obstruction, making urination difficult. By secreting fluid into the urethra during ejaculation, the prostate plays an important role in male reproduction.
The green light laser prostatectomy is a minimally invasive surgery that can be done in outpatient settings. The technique uses high-powered laser light paired with fiber optics to destroy prostate tissue overgrowth rapidly and precisely. The urologist, who has received specific training, focuses the laser on the prostate, the pulses of light emitted by the fiber are absorbed by the blood, and the tissue temperature rises to the point where the adjacent cells vaporize within minutes. The green light method can be used instead of transurethral resection of the prostate (TURP).
Green light provides patients with immediate symptom relief, improved urine flow, and no short-term adverse effects. Long-term studies on the treatment are not yet available, but after five years, it has proven to maintain its level of improvement in urine flow and comfort, as well as provide men with a better quality of life.
Green Light Laser Prostatectomy Advantages
Green light laser prostatectomy provides various advantages over conventional benign prostatic hyperplasia treatment options, including:
- Blood loss is kept to a minimum. Because the laser forms a 1-2 mm zone of coagulation necrosis around the vaporization site, there is essentially little bleeding. During surgery, the laser cauterizes the injured blood vessels, preventing any bleeding.
- After surgery, it provides instant symptom alleviation and a marked improvement in urine flow.
- It's a less risky process with fewer risks. It takes substantially less time to recover. It is performed as an outpatient procedure in otherwise healthy patients, and the patient is discharged on the same day. Only a few patients may be required to stay in the hospital overnight.
- Symptomatic alleviation that lasts for roughly five years.
- Patients on anticoagulant treatment can potentially benefit from the procedure because it is safe and effective.
Green Light Laser Prostatectomy Indications
The following are good candidates for the procedure:
- Those who have moderate to severe enlargement of prostate (BPH) symptoms such as a weak stream of urine, poor bladder emptying, stop and start urination, straining to start urination, an increased desire to urinate, disturbed sleep due to the need to urinate, and sequelae of enlarged prostate.
- Those who have symptoms of an enlarged prostate and have tried and failed minimally invasive treatments.
- Those whose prostate structure restricts the use of alternative treatments.
- Those who have failed medical treatment, refuse to take medication, or have had negative side effects.
- Those who want to regain their previous level of quality of life before the development of BPH symptoms.
Green Light Laser Prostatectomy Preparation
- Fasting. You will be required to fast before the procedure because it will be performed under a general anesthetic or a spinal anesthetic. Before the treatment, you must fast for 6 hours. Before a procedure, all food and fluids must be avoided. If you are diabetic, inform the doctor when scheduling your procedure so that he can take this into account.
- Bowel. You don't need to do anything special to prepare your bowels. No preparation is necessary if you move your bowels frequently each morning. If you have digestive problems or are constipated, you may need a bowel preparation enema, which you may get over the counter at a pharmacy and administer yourself the morning before the procedure. If you're having problems with your bowels, tell your doctor.
- Medications. Although you should be able to continue taking your prescribed medications, including blood thinners, before surgery, this is not always possible. It may be necessary to stop taking some medications in some cases, so make sure your doctor is aware of all drugs, tablets, and medications you are taking, whether on prescription or not. Your doctor and anesthesiologist will go over which of these medications you can take on the day of surgery and which you should avoid. Make sure you bring all of your current medications, including inhalers and sprays, to the hospital in their original containers. All natural therapy preparations should be avoided since they may interfere with the blood's capacity to clot.
Green Light Laser Surgery Prostate
This surgery is frequently performed under light general anesthesia. Doctors may offer a spinal (regional) anesthetic alternatively if you have additional long-term (chronic) medical conditions, such as cardiac or respiratory problems. This means that you are awake but not in discomfort from the waist down during the procedure. If this is the case for you, they will inform you during your outpatient visit.
They will leave a catheter in your bladder for a short time after the procedure if you have a spinal anesthetic since you will not be able to urinate on your own.
Doctors try to avoid using sedation and local anesthesia unless necessary because they are likely to cause you discomfort.
When you're in the operating room, the doctor does the following:
- To inspect your bladder, the doctor will insert a telescopic tool called a cystoscope into your urethra (the tube through which you urinate) and up into it. The cystoscope is about the size of a pencil and includes a small video camera on one end that allows the doctor to see images of your bladder on a television screen.
- Using a high-powered laser, surgeons will vaporize the prostate tissue through the cystoscope.
- If doctors have any worries about your bladder working normally for the first 24 hours after your treatment, they may implant a tiny catheter in your urethra to empty urine. In most cases, this isn't required for bleeding.
Recovery after Green Light Laser Prostatectomy
Following that, the patient is monitored in the recovery area before being discharged the same day or within hours of the treatment. Catheterization for an extended period may be necessary for patients with severe symptoms or previous bladder damage, and they may have to stay longer or perhaps overnight.
Mild discomfort, such as a mild burning sensation when urinating, frequency, or a sudden urge to urinate, can occur. It is normal to see a small amount of blood in the urine during the first week after the procedure, so don't be worried. Within a day or two after the procedure, patients will experience a significant improvement in urine flow and symptomatic relief. Men who have several health problems may not see as much improvement as those who are in reasonably good health.
Men should plan to resume normal exercise 3 days after the green light procedure. For around two weeks, patients should avoid intense exercise, heavy lifting, or pushing, as well as equipment that vibrates. These activities might irritate the urogenital area and result in bleeding.
Sexual activity should be avoided for two to three weeks before being resumed when the patient is ready. Retrograde ejaculation or decreased volume are possible side effects, although neither should influence sexual pleasure or satisfaction. It's also vital to try to get back to normal behavior as soon as the patient is ready.
Green Light Laser Prostatectomy Risks
As with most major surgeries, there are possible complications that arise including:
- Difficulty passing urine. This operation may necessitate the insertion of a catheter (a ﬂexible, thin plastic tube that empties urine from your bladder). Some men will be ready to return home without a catheter, but others may have difficulty urinating for a short period. If this occurs, your bladder may need to be controlled with a catheter for a day or two. There are no long-term consequences, and you won't have to stay in the hospital.
- Bleeding. Even though no cuts are made to your skin, this is still a major procedure. You may experience some bleeding during or after the surgery. Even if you're on blood-thinning medications, your chances of receiving a blood transfusion are fewer than one in a hundred.
- Dry orgasm. The most prevalent side effect is dry orgasm. It occurs when your sperm returns to your bladder rather than leaving through your penis. After green light laser prostatectomy, it affects up to 5 out of 10 men. Specialists have some options for lowering this risk, which they will discuss with you. The standard operation, Transurethral Resection of the Prostate (TURP), has a 9 in 10 chance of this developing. Although your orgasm may be less strong, you will usually learn to appreciate the pleasure once more. Although dry orgasms can cause sterility, they cannot be used as a method of contraception because some sperm may escape. If this is essential to you, scientists have found strategies to lessen this adverse effect.
- Erectile dysfunction. There have been a few cases of erectile dysfunction following this procedure. If the laser is used too close to the nerves in your penis, this could result. The probability is less than 1%.
- Prostate regrowth. Your prostate gland is not completely removed, allowing the tissue to regenerate. Over a decade, 1 in 47 TURP patients will require additional (revision) surgery due to prostate regrowth. After Green light laser surgery, about one out of every 100 cases need revision surgery each year.
- Scar tissue (stricture). Just like with TURP, scar tissue (a stricture) can form after the procedure. If this occurs, a simple operation will be required to correct the issue. With TURP, the chance of this happening in the first year is 1 in 25, but with green light laser prostatectomy, the risk is 1 in 50.
- Incontinence. Surgical incontinence is an uncommon complication. The likelihood is much below 1 in 500. While you are healing from your surgery, we may recommend that you practice pelvic floor exercises to help strengthen the muscles around your prostate and become continent more rapidly.
Green Light Laser Prostatectomy Alternatives
There are several procedures present to treat prostate diseases:
- No treatment at all (observation). For patients with mild symptoms, observation is a good choice. If you're considering surgery, your symptoms have likely progressed to the point where you need more drastic measures. Specialists will not force any patient to accept any procedures that they do not want to perform. Patients can, of course, choose to have no treatment at all. They do, however, want all patients to be aware of the hazards of delaying treatment and the potential consequences of allowing enlarged prostate problems to spin out of control.
- Medications. medications aren't always as successful as surgery, and they come with risks and side effects. Furthermore, you'll have to take them for the rest of your life.
- UroLift. UroLift is a technique that involves inserting a small hard camera into the penis and prostate and placing clips on either side of the prostate to compress the obstructing sections of the prostate and open up the urinary tract. It can be done in the surgery center or the office.
- Microwave of the Prostate. This is an office technique that includes inserting a tiny catheter tube containing a microwave antenna into the penis and heating the prostate for a brief length of time. The prostate will shrink and urinary problems will improve while the prostate is heated.
- Rezuum. Rezuum is a local anesthetic office technique in which steam is pumped into the prostate via a camera inserted into the penis and prostate, which heats the prostate and causes it to shrink.
- Transurethral Prostatectomy (TURP). The typical procedure for prostate enlargement is a transurethral prostatectomy (TURP). According to published studies, laser prostate surgery is equally effective as TURP. Because TURP has a higher risk of bleeding than green light laser prostatectomy, you may need to stay in the hospital for an additional day or two.
- Transurethral Incision of Prostate (TUIP). Transurethral Incision of Prostate (TUIP) is also known as Bladder Neck Incision. Small prostates that are a little too narrow may benefit from this treatment.
- Open or robotic suprapubic prostatectomy. Suprapubic Prostatectomy, either open or robotic, is advised when the glands are too large to be treated with minimally invasive surgery. This is a rare therapy that is only used when the prostate is highly enlarged. It entails removing the prostate through a cut in the belly and bladder and coring out the inner portion of the prostate using either open or robotic/laparoscopic techniques. This is not the same procedure that we use to treat prostate cancer, but the principle is similar.
- Long-term catheter. if you are not fit for surgery and are unable to pass urine at all or are retaining significant amounts of urine in your bladder, a long-term catheter is indicated. To drain the bladder, a catheter through the penis or a tube put below the belly button (umbilicus) may be used.
Green light laser prostatectomy is a safe and effective procedure. The tissue reduction is complete, and the functional outcomes are excellent. All of the patients were able to effectively void. There were no major difficulties discovered. Because the procedure is technically complex, the first interventions take a lengthy time.