Definition and Overview
Millions of men all over the world, across different ages and socio-economic classes, suffer from prostate problems. The prostate gland, which is an essential part of the male reproductive system, is located right on the neck of the urinary bladder. In a healthy human male, the prostate has a size comparable to a walnut and weighs around 7 to 16 grams. However, due to certain conditions and factors, it can become enlarged and make urinating very difficult.
One of the conditions that can make prostate gland to expand beyond its normal size is called benign prostatic hyperplasia, also known as BPH. This change in the size can constrict the urinary bladder and urethra, making the process of passing urine difficult, painful, and in some cases, impossible.
One of the more modern treatments for prostate conditions, particularly BPH is laser surgery, which effectively removes excess tissue that causes the symptoms. These procedures can address enlargement in the gland through enucleation (or the process of cutting away excess amounts of tissue in the prostate gland using laser light,) and ablation (or using the heat of the laser to melt away the excessive tissue that causes constriction in the urethra).
Below are the different types of laser procedures performed to treat prostate disorders:
- HoLAP or Holmium laser ablation of the prostate – This is an ablative procedure, which means that the heat of the laser is used to vaporize the excess tissue in the gland.
- HoLEP or Holmium laser enucleation of prostate –This is a procedure that cuts and removes excess prostate tissues that constrict the patient’s urethra that causes painful urination. In this procedure, the surgeon uses a tool called a morcellator to cut tissue into smaller pieces so they can be easily removed.
- PVP, or photoselective vaporization of the prostate – This is an ablative procedure that widens a constricted urethra.
The type of prostate laser procedures prescribed by the doctor depends on the patient’s age, health, the extent of the enlargement of the prostate gland, and the severity of the symptoms caused by the condition.
Who Should Undergo and Expected Results
Patients experiencing the following symptoms are usually suffering from BPH, and are ideal candidates for prostate laser procedures:
- Difficulty in passing urine, or problems in starting urination
- Painful urination
- Prolonged urination
- Pauses during urination
- Feeling a full bladder even after urination
- Having frequent urinary tract infections
Patients suffering from the following conditions can also undergo prostate laser procedures:
- Damage to the bladder
- Kidney damage
- Urinary retention
- Bladder stones
- Recurring urinary tract infections
- Hematuria, or the presence of blood in urine
Expected results of prostate laser procedures are:
- Treatment of the symptoms experienced, such as frequent urination
- Prevention of complications caused by the conditions described above
Prostate laser procedures are highly recommended for patients because of the following benefits:
- Prostate laser procedures minimize the risk of bleeding, especially in patients who are taking specific medications that thin the blood or are suffering from conditions that prevent normal blood clotting.
- Because laser procedures are minimally invasive, the patient can enjoy a shorter stay in the hospital or none at all. The procedures are generally performed on an outpatient basis. However, in patients who are in poor health or of advanced age, they are asked to stay overnight in the hospital to monitor possible complications.
- Minimally invasive procedures also make for shorter recovery times.
- The patient will also have less need for a catheter. Following a laser procedure on the prostate, the patient will just require a catheter to assist in urination for only 24 hours or less.
- Immediate results
How is the Procedure Performed?
After an initial consultation to determine if the patient is fit for a prostate laser procedure, he and the doctor can agree to an appointment—usually one or two days to make time for an overnight stay, if needed. The entire procedure is usually performed between 30 minutes and two hours, depending on the size of the patient’s enlarged prostate and the amount of excess tissue that needs to be removed. For more complicated cases, the procedure can take a couple of hours more.
The procedure can be performed under general or spinal anaesthesia, depending on the preference of the patient or doctor’s recommendation. After the anaesthesia has taken effect, the doctor will carefully insert a narrow fibre-optic scope into the tip of the penis. The scope will go through the urethra. Once the scope is in the right position, the doctor will activate the laser to melt or cut away the tissues that block the urethra.
Depending on the type of procedure, the doctor can also introduce a morcellator to remove the pieces of prostate tissue that have been cut away by the laser.
Once the procedure has been completed, the patient will wear a urinary catheter for a day or less. The catheter will be removed after the swelling in the urethra has settled.
Possible Risks and Complications
In some cases, the patient’s urethra might not completely heal 24 hours after the procedure. The patient might also experience the following after having prostate laser procedures done:
- The presence of blood in the urine, which will go away on its own a couple of weeks after the procedure. However, once the blood in the urine becomes thicker or starts to block the flow of urine, the patient should immediately go back to the doctor.
- Difficulty or urgency in urination
- A burning sensation during urination
Foundation of the Prostate Gland
- National Kidney and Urologic Diseases Information Clearinghouse
- Ohio State University: “Anatomy of the Prostate Gland”
- American Urological Association