Laser Resection of the Prostate
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Prostate Illustration
Laser resection of the prostate, also called photoselective vaporization of the prostate, or PVP, is an operation for men with prostatic enlargement causing blockage of the channel through which urine flows (the urethra). Most times, this enlargement is simply due to growth of the prostate gland and not cancer. If measures such as medications aren’t effective, surgery is usually an option.
About the Procedure
The most common surgical treatment for an enlarged prostate is called a TURP (transurethral resection of the prostate). This operation is performed through the natural channel without an incision. The inner or obstructing part of the prostate is removed in small pieces to open the channel.
This procedure can now be duplicated with a laser fiber that vaporizes and destroys the prostate tissue and stops bleeding from the vessels within the prostate. The laser treatment has a lower risk of bleeding and a shorter recovery time. Most patients can go home after the procedure. If a hospital stay is required, it is usually overnight.
Click here to view an animated video of this procedure on YouTube.
Click here to view a live video of this procedure on an actual patient.
Preparation
It is important to be off of Coumadin, aspirin, and any other blood thinners for 7 to 10 days before the procedure.
Risks
The most common complication of prostate surgery is bleeding. Small amounts of bleeding after the surgery are expected, but larger amounts may rarely require blood transfusion or catheter placement (if a clot blocks urine flow).
Other possible complications include urinary tract infection and scarring at the bladder neck or in the urethra, which could require dilation or another surgery to open the scar. This is uncommon.
Incontinence is a rare complication. It usually occurs in patients who have had nerve damage to the bladder or weakening of the urinary sphincter that controls flow.
Patients with longstanding obstruction or other problems that have caused their bladder to weaken may not have an improvement in their symptoms after surgery, even though the obstruction has been relieved. Preoperative testing can sometimes predict this.
Sexual side effects include retrograde or dry ejaculation. After prostate surgery, men may not ejaculate the same way they did before. This is usually because the semen now passes backwards into the bladder instead of out. This is not harmful, and is only a problem if a man is trying to conceive a child.
Occasionally, patients report difficulty with erections after this surgery. Erectile problems are very common in men who need this surgery, and it is not clear whether these are related. Most men with good erections before surgery maintain them.
After Surgery
After you leave the hospital, it is important to avoid any vigorous activities for at least 48 hours. If you are having bleeding, you should continue to avoid any strenuous activity until at least 24 hours after the bleeding has stopped. Activities to avoid include rough riding, long car trips, and anything that will get your heart rate or blood pressure up.
It is normal to have small amounts of blood in the urine for several weeks after surgery, but let us know if you are having bleeding that is painful, contains clots, or is of large amounts.
Urinary frequency and minor leakage if a strong urge to urinate comes on may also occur because of irritation from the surgery, but this is expected to resolve as the body heals.
Sexual activity can usually be resumed 4 weeks after surgery. Driving is safe within 48 hours as long as there is no bleeding and you feel able to slam on the brakes if need be.
This laser procedure does not remove the entire prostate. Follow-up screening for prostate cancer with digital rectal exams and PSA screening is still recommended.