Green light laser prostatectomy is a safe, effective and efficient treatment to ease the urinary symptoms in patients with benign prostatic hyperplasia (BPH), enlargement of the prostate gland.
It is a minimally invasive procedure that utilizes a 532nm wavelength laser to remove excess prostate tissue blocking the urethra by vaporisation. This laser appears green in colour therefore the name of the device.. The laser with this specific wavelength is chosen as it is selectively absorbed by the red prostate tissue and poorly absorbed by water.
The procedure is also known as Photo selective Vaporization of the Prostate (PVP).
Green light laser prostatectomy has several advantages over other treatment procedures for benign prostatic hyperplasia, including:
- Minimal blood loss. It virtually causes no bleeding as the laser creates a 1-2 mm zone of coagulation necrosis around the area of vaporisation. The laser also cauterises the ruptured blood vessels during the surgery controlling any bleeding.
- Offers immediate symptomatic relief and significant improvement in urine flow after the surgery.
- It is a safer procedure with fewer complications.
- General recovery is much quicker.
- In an otherwise healthy patient, it can be done as an outpatient procedure and the patient is discharged the same day of the procedure.
- Some patients may have to stay overnight in the hospital.
- Long-term symptomatic relief lasting for at least five years.
- The procedure is also safe and effective for patients on anticoagulation therapy
Why is it done?
The prostate is a small, walnut-shaped gland that is only present in men. It is involved in providing nutrition to sperm and assisting in their transport It is common for the prostate gland to become enlarged as a man ages. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to constrict the urethra (water tube).
This leads to a number of urination and bladder problems such as urinary hesitancy, frequent urination, urgency, getting up at night, urinary tract infection and urinary retention. This is referred to as Benign Prostatic Hyperplasia (BPH). BPH is more common in men above 60 years of age
Green light laser prostatectomy is indicated in these patients to remove the excess prostate tissue blocking the urethra to ease the urinary symptoms.
Green Light Laser prostatectomy is performed under general or spinal anaesthesia The laser is delivered through a flexible fibre passed through a cystoscope, a tube like instrument with a light and a camera at one of its ends. The cystoscope along with the flexible fibre is inserted through the urethral opening of the penis. The real time images from the cystoscope are displayed on the monitor in the operating room.
Dr. Love controls the direction and delivery of the laser energy through the flexible fibre tube.
Laser energy is delivered as small bursts, lasting for a few seconds, to vaporise the prostate tissue. Continuous flow of irrigation fluid is maintained to remove the cut prostate tissue, keep the fibre tip cool and to maintain a clear view of the operative area.
The cystoscope with the fibre is slowly manipulated through the urethra, removing the obstructing prostate tissue thereby enlarging the space within the urethra and restoring normal urine flow.
At the end of the procedure a catheter is placed in the bladder and is usually removed the next day after surgery.
Patients can be discharged on the same day of the procedure but many are kept overnight and discharged the next day.
What are the risks and complications?
All surgical procedures are associated with some risk. Although Green light laser prostatectomy is a relatively safe procedure, complications can occur. Some of the less serious complications include haematuria (blood in urine) although this technique causes less of that than TURP, dysuria (pain while urination) and urge incontinence. These all usually resolve within a few weeks of the surgery. Urinary tract infection may occur in a few cases and can be managed with antibiotics.
One of the major complications of green light laser prostatectomy is retrograde ejaculation in which semen flows back into the urinary bladder rather than coming out through the urethra affecting the patient’s reproductive capability. However, when compared to TURP, the gold standard for treatment of prostate enlargement, the risk of retrograde ejaculation with green light laser prostatectomy may be less.
One disadvantage of the green laser prostatectomy is that as prostate tissue is vaporized it is not available for pathological analysis. This is important as there is a small probability of prostate cancer being present in BPH patients.
Therefore men having GreenLight surgery need to have their prostates assessed for cancer beforehand, by PSA testing, rectal examination and, possibly, biopsy or MRI.
The other disadvantage is that, because of the high temperature created by the laser, and the inflammation it causes, the urgency and burning when passing urine can take longer to settle down than with a TURP
Green light laser prostatectomy is an effective alternative to transurethral resection of the prostate (TURP) in patients with enlargement of the prostate gland.
The procedure has additional benefits such as minimal bleeding, fewer complications, reduced indwelling catheter time and shorter hospital stay with quicker resumption of normal activities.