Enlarged Prostate: Prostate Laser Surgery
Scientists do not know all the prostate’s functions, although it has many functions for sure. Main function is conducting the sperm from the sperm ducts to the urethra, and producing the small amounts of alkaline secret that is being mixed up with sperm to form the ejaculate. It also squeezes fluid into the urethra.
The problem with this small gland is that it usually begins to enlarge at mid-life. Because the process doesnt stop spontaneously, as men age, the prostate continues to grow and may push in on the urine passage, which is the most common complication.
How Greenlight Laser Prostatectomy Works
GreenLight laser prostatectomy is a procedure in which the excess prostate tissue is removed to relieve constriction of the urethra, allowing easy passage of urine.
During the procedure, which is also known as photoselective vaporization of the prostate , the patient is sedated. The physician passes a cystoscope, a thin tube with a very small camera, into the urethra, the vessel that carries urine from the bladder through the penis and out of the body. A small fiber that transmits laser energy is then passed through the cystoscope.
The laser is used to vaporize excess prostate tissue that is limiting the flow of urine. Most patients can expect very rapid relief of their BPH symptoms, often within 24 hours of GreenLight Laser prostatectomy.
For most men, GreenLight laser prostatectomy is an outpatient procedure, allowing them to return home the same day.
What Are The Benefits Risks And Side Effects Of Turp
This treatment has well known long-term outcomes. Other treatments are generally compared with it. Symptoms generally improve markedly. The effects of treatment last for 15 years or more.
TURP does not remove the entire prostate. No incisions are needed. The hospital stay is 1 to 2 days or until there is no significant blood in your urine. TURP does require anesthesia. As with any surgery, anesthesia poses a risk.
Side effects of TURP may include retrograde ejaculation, erectile dysfunction, urinary tract infections right after surgery, and urinary incontinence. Full recovery takes about 4 to 6 weeks.
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What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy
Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeons sophisticated maneuvers.
Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
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The Need For Further Treatments
There is a chance of the sudden swelling of the prostate gland right after surgery. Some men may need a follow-up treatment after laser ablative surgery because all the tissues are not removed or these tissues may grow back over time, resulting in the prostate gland to become enlarged again. If laser surgery fails to provide lasting results, then it may be necessary to undergo more invasive treatments such as an open prostatectomy surgery.
What Is Greenlight Laser Therapy
GreenLight Laser Therapy is a procedure performed with a small fiber that is inserted into the urethra through a cystoscope. The fiber delivers high powered laser energy which quickly heats up the prostate tissue, causing the tissue to vaporize. The process is continued until all the enlarged prostate tissue had been removed. Natural urine flow is rapidly restored and urinary symptoms are quickly relieved in most patients.
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What Happens After Holmium Laser Enucleation Of The Prostate
- Tissue removed during surgery will be tested in the laboratory for any abnormal findings.
- The patient will be seen by the doctor following surgery to monitor recovery and to repeat tests, such as urinary flow rate, bladder scan, and symptom score. These tests gauge the effectiveness of the surgery. Typically, patients are seen at six weeks and six months after surgery.
- The use of pelvic floor exercises as soon as possible can help improve problems with urinary incontinence.
Bph/enlarged Prostate Program At Tennessee Urology
From more conservative, non-surgical measures to innovative minimally invasive procedures, our urologists provide the most advanced care for men living with BPH.
Laser Vaporization of the Prostate
Laser Vaporization of the prostate is a technique that uses a special laser to heat and vaporize the prostate tissue that is obstructing part of the urethra.
In studies comparing the laser technique with the more traditional surgical procedure called Transurethral Resection of the Prostate , GreenLight Laser Therapy improves BPH symptoms and quality of life as effectively, but with fewer side effects.
Most men are good candidates for laser vaporization therapy, which is an outpatient procedure. In this procedure, a small fiber is inserted into the urethra through a cystoscope. Laser energy is delivered through the fiber to remove the enlarged prostate tissue, restoring natural urine flow and relieving symptoms of BPH quickly.
Advantages of Laser Vaporization Therapy:
- The procedure is minimally invasive and performed on an outpatient basis
- Most men return home only a few hours after the procedure
- Quick recovery and return to normal activities
- Normal urine flow is restored quickly
- Very few long-term side effects
- Long-lasting relief from bothersome urinary symptoms
Risks:
Some patients may experience minimal side effects from laser vaporization including:
Watch how the GreenLight Laser Therapy is performed.
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Laser Technology Has Lowered Complications For This Very Common Procedure Allowing Patients To Heal At Home
This article was originally published June 5, 2020 on PSQH by Amy E. Krambeck, MD.
Benign prostatic hyperplasia , or enlarged prostate, is exceedingly common, affecting half of men in their 50s and about 90% of men aged 80-plus . As a result, although most patients are treated with medication, surgical procedures to treat BPH are very common as well, making up a significant portion of urological surgeries in any hospital.
With any BPH procedure, tissue is removed to open the urethra. Patients typically stay at least one night in the hospital. There has been a successful ongoing effort to reduce inpatient time for BPH surgery by limiting complications, especially postoperative bleeding.
At my Level I trauma hospital, which runs near capacity at all times, sometimes beds were not available for my patients, and they had to spend the night in the recovery room. We postulated that we could free up beds and offer better treatment for our patients by performing BPH surgery on an outpatient basis. Because we were performing very safe surgery with the latest laser technology, it seemed we had finally reached the point where it was safe to send patients home.
Transitioning to outpatient surgery
Patients go home with a catheter, the home care for which is explained by medical assistants using an educational template. The catheter is removed the next day in our office or, if the patient has traveled for surgery, at a physicians office closer to home.
Types Of Radical Prostatectomy
The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.
Open prostatectomy
In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus.
Laparoscopic prostatectomy
In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.
Robot-assisted laparoscopic prostatectomy
Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.
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What Are The Patient Criteria For Robotic
The decision to surgically treat prostate cancer involves many considerations. UC Davis urologic surgeons will discuss your treatment options and help you decide the best course of action. Nearly all patients diagnosed with localized prostate cancer will have the option of choosing robotic-assisted surgery. It is the now most commonly selected prostatectomy approach in the United States. Patients with significant abdominal adhesions or obesity, however, may not be appropriate candidates for the this procedure.
Risks And Complications Of Prostate Surgery
Most people have prostate surgery without complications, but all surgery carries some risks. Your consultant will explain them to you before you go ahead.
Prostate surgery complications can include:
- Retrograde ejaculation, when you dont produce semen when you orgasm its not harmful but may affect fertility
- Needing the loo urgently
- Difficulty getting and maintaining an erection
- Narrowed urethra, causing urinary problems such as difficulties holding urine
- Bleeding
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When To Consider Greenlight Laser Therapy
Patients who are experiencing symptoms due to Benign Prostatic Hyperplasia are candidates for GreenLight. Historically this condition has been treated with medication or an invasive surgical procedure .
Benign Prostatic Hyperplasia is a non-cancerous enlargement of the prostate. Your prostate grew to normal size during your teenage years. Usually, the prostate grows to the size of a walnut. The prostate may begin to grow again when a man reaches middle age. The reasons for this growth are not fully known. By the age of 80, 80% of men have BPH.
Who Needs To Have Holmium Laser Enucleation Of The Prostate
BPH occurs in more than 40 percent of men over the age of 60 and is a leading cause of urination symptoms, including difficulty in passing urine. As men age, the symptoms of this condition can worsen. Although many cases of urinary obstruction from BPH can be treated without surgery, patients who do not benefit from such medical treatments may eventually need surgery to avoid or deal with long-term problems such as retention of urine, urinary tract infections, and bladder stones. Patients who are appropriate for HoLEP are typically symptomatic due to very large prostates.
Patients may not be candidates for HoLEP if:
- They have bleeding problems.
- They have had certain types of prior prostate treatments.
- They cannot lie on their back with their legs raised. This position is necessary for the procedure.
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Prostatectomy At Brigham And Womens Hospital
Most prostatectomy procedures at Brigham and Womens Hospital are performed robotically. Robotic radical prostatectomy surgery uses a combination of high-definition 3D magnification, robotic technology, and miniature instruments to enhance a urologic surgeons skills when removing a cancerous prostate gland.
Adam S. Kibel, MD, Chief of Urology, and Steven L. Chang, MD, MS, use the FDA-approved da Vinci® Surgical System to perform hundreds of robotic prostatectomies each year. The system consists of a surgeons console, equipped with a control panel and a hi-definition monitor, and a patient side-cart, outfitted with slender robotic arms and attended by another surgeon and a nurse.
Unlike traditional open prostate surgery, which requires one large incision and retraction to accommodate human hands, only tiny incisions in the abdomen are required for the slender robotic arms and tiny surgical tools used in a robot-assisted prostatectomy. There are four available arms one equipped with a high definition 3-D magnification camera, two that act as the surgeons arms and a fourth arm that is used for holding back tissue. The camera gives the surgeon enhanced detail, true depth of field and a panoramic view, and the robotic hands broad range of movement enables greater dexterity.
Robotic surgerys miniaturization, increased range of motion, enhanced vision and mechanical precision offer significant benefits for our prostatectomy patients, including:
Why The Procedure Is Performed
An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your doctor may tell you changes you can make in how you eat or drink. You may also try some medicines.
Prostate removal may be recommended if you:
- Cannot completely empty your bladder
- Have repeat urinary tract infections
- Have bleeding from your prostate
- Have bladder stones with your enlarged prostate
- Urinate very slowly
- Took medicines, and they did not help your symptoms or you no longer want to take them
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Comparison To Traditional Methods
Major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.The existing open surgery technique has many flaws such as limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks.
Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not get tired as quickly. Naturally occurring hand tremors are filtered out by the robots computer software. Finally, the surgical robot can continuously be used by rotating surgery teams. Laparoscopic camera positioning is also significantly steadier with less inadvertent movements under robotic controls than compared to human assistance.
The robots can also be very large, have instrumentation limitations, and there may be issues with multi-quadrant surgery as current devices are solely used for single-quadrant application.
Possible Complications After Prostate Laser Surgery
Prostate laser surgery is now commonly used to treat benign prostatic hyperplasia . BPH is a non-cancerous condition that occurs in most men as they age, but though it is not in any way life-threatening, it can lead to very uncomfortable symptoms. They include not being able to pass urine easily, a constant sense of urinary urgency, and the feeling that your bladder has not been emptied completely following urination.
During prostate laser surgery, excess prostate tissue is melted away or cut off with the use of a beam that delivers concentrated light to precise locations, a beam that is inserted into your body through the urethra. Various types of prostate laser surgery exist. vaporize the excess prostate tissue, while Holmium laser enucleation of the prostate is used to cut the excess tissue off, then to be removed by another instrument.
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What Should I Expect When I Get Home
When you are discharged from the ward you will need some baggy trousers or track pants as you may find that your abdomen is uncomfortable and the catheter is easier to manage if your clothing is loose.
There will be some blood, urine and mucus which passes ALONGSIDE or through the catheter and is particularly noticeable after passing a bowel motion this is normal. You should wash the area with soap and water to remove this discharge to reduce any irritation. Keeping a high oral fluid intake reduces the risk of catheter blockage.
You may notice some swelling and bruising around the wounds, the penis and the scrotum which takes several weeks to resolve. You may also notice small firm lumps below the wound these are normal and are simply the knots in the suture material used to close the wound. The suture slowly dissolves and will disappear within 3 months. Most men feel quite tired after surgery and this takes several weeks to resolve.
Following surgery, you will be given a prescription for regular pain medication as well as some laxative medication to keep your bowels regular and thus avoid any straining.
Light walking is encouraged straight after the surgery. After four weeks you may resume heavy lifting.
Showering, bathing and getting the wounds wet is fine the skin has been sealed with glue.
Driving is safe once you are comfortable to do so and feel able to make an emergency stop. This would normally be around 3 weeks following surgery.
Testing For Benign Prostatic Hypertrophy
1. Physical examination– The evaluation of prostate enlargement should always begin with a physical examination, which is done by a rectal exam. Via rectal exam, doctor should estimate the size of the prostate gland.
2. Laboratory tests – Beside physical examination, laboratory tests are also very useful for the proper diagnosing and they include urinalysis and a blood test for PSA. What exactly is PSA? PSA is a substance produced by the prostate, which may be increased in the presence of prostate problems.
3. Uroflowmetry – Uroflowmetry is a diagnostic tool that has also proved to be very effective and useful. This diagnostic tool measures the force of the urine stream and the amount of urine passed.
4. Ultrasound The ultrasound is usually done to detect the presence of urine left in the bladder after urinating. An ultrasound examination of the prostate is useful to determine the exact size of the gland and to check for any areas suspicious for cancer.
5. Cystoscopy Before this procedure, injected solution numbs the inside of the penis so all the sensation is lost. During this exam, the doctor inserts a small tube through the opening of the urethra in the penis. The tube is called a cystoscope and contains a lens which enables the doctor to see the inside of the urethra and the bladder.
The presence of residual urine in the bladder may lead to urinary tract infections, which may travel up the urinary tract to the kidneys.
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