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Laser Prostate Surgery For Bph

How Long Is The Healing Process

Laser surgery for enlarged prostate

Most patients need at least one to two weeks of rest at home before they can return to work. Some patients may require three to four weeks of recovery time before going back to work, especially if the job is physically strenuous. No heavy lifting should be attempted during the recovery period however, patients are expected to walk and do light activities.

What To Expect During Prostate Surgery

Who will be involved?

As well as your chosen surgeon, youll also be seen by an anaesthetist who will administer anaesthetic during the operation.

Preparing for prostate surgery

You may be asked to attend a consultation a couple of weeks before your operation is due. Here, you might undergo some blood or other tests to help check your fitness for surgery. During this pre-operative assessment, youll also have to inform us of any medication you are currently taking.

If you are a smoker, you should try and cut down in the build-up to your operation, this can reduce your risk of complications including chest infections and blood clots.

You may be asked to stop taking medication several days before your surgery, such as blood thinners. Your doctor may also prescribe you an antibiotic to reduce your risk of getting a urinary tract infection.

On the day of your surgery, youll have to stop eating around six hours before the procedure, but you can drink clear fluids until two hours before. You may also be given some compression stockings to prevent any blood clots forming during surgery.

How long does the procedure take?

Its usually between 45 minutes and two hours, depending on the size of your prostate and the technique used.

Anaesthetic choices

Your consultant will advise on whats best for you, based on your health and personal preferences. It will either be:

Pain after surgery

Your hospital stay

What Are The Risks Or Potential Complications Of Holmium Laser Enucleation Of The Prostate

  • Injury to the urethra or development of scar tissue at a later date.
  • Injury to the capsule of the prostate .
  • Injury to the bladder or ureteral orifices .
  • Infection of the bladder, testes or kidneys.
  • Return of urinary obstruction at a later date requiring another operation .
  • Need for transfusion or reoperation due to bleeding.
  • Failure to relieve all symptoms and/or need for prolonged catheterization after surgery.
  • Five to 15 percent of patients are found to have previously undiagnosed prostate cancer in their prostate specimen. Prostate cancer can be treated after HoLEP.
  • Standard risks of anesthesia including blood clots, heart attacks, etc.

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What Are The Side Effects Of Holmium Laser Enucleation Of The Prostate

The most common side effects include:

  • Temporary burning and bleeding during urination. Some blood may be seen in the urine for weeks after surgery. This is usually not an indication of anything serious, only that the healing process is not yet finished.
  • Urinary incontinence is expected in all patients immediately after surgery and they should wear pads for the first few days/weeks. This typically improves over the course of several weeks. Performing Kegel exercises can help decrease leakage from stress maneuvers such as coughing, sneezing, or lifting. The rate of long term leakage from stress maneuvers is low. Patients may also have leakage with urgency and this may be treated with medication. The risk of urge incontinence can be dependent on several factors including age, prostate size, symptoms, and other medical problems.
  • Retrograde ejaculation or âbackwards ejaculation.â In 75 percent of cases, the patient will not see any fluid during ejaculation during sexual activity after surgery.
  • Erectile function is generally not significantly affected. A small percentage of patients have reported improved erectile function while a small percentage have reported decreased erectile function.

Data Resources And Searches

CyberSym

MEDLINE and EMBASE were searched. Further searches were undertaken in the Cochrane Central Register of Controlled Trials , WHO International Clinical Trial Registration Platform , and Clinical Trial.gov . The following terms and keywords were used: laser, transurethral resection of prostate, TURP, benign prostatic hyperplasia, and BPH. Included trials references were searched for more studies and experts in the field were consulted.

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More Information About Greenlight Laser Therapy For Bph

To find out if you are a candidate for GreenLight laser prostatectomy, or to refer a patient, contact the Minimally Invasive Urology Institute at or email .

Lifespan, Rhode Island’s first health system, was founded in 1994 by Rhode Island Hospital and the Miriam Hospital. A comprehensive, integrated, academic health system with The Warren Alpert Medical School of Brown University, Lifespan’s present partners also include Rhode Island Hospital’s pediatric division, Hasbro Children’s Hospital Bradley Hospital Newport Hospital Gateway Healthcare Lifespan Physician Group and Coastal Medical.

What Are The Side Effects

Initially, the urethra and surrounding area will be inflamed, and it will be difficult to urinate. The catheter and flushing process can also be uncomfortable and cause bladder cramping.

The urethra, penis, and lower abdominal area will be tender, red, and swollen for a few weeks after surgery, which can interfere with urination. Most people also feel very weak and tire easily for several weeks.

Common side effects of TURP surgeries include:

  • difficulty completely emptying the bladder
  • urinary urgency or the sudden urge to urinate
  • discomfort during urination
  • small dribbles or clots of blood in the urine, for up to 6 weeks

The minor side effects associated with TURP surgeries usually go away as the urethra and prostate tissues become less inflamed, usually within a few weeks.

Though TURP surgeries may or may not be associated with erectile difficulty in some people, they can decrease the volume of semen produced during ejaculation.

As with any medical procedure, especially those involving anesthesia, the surgery for BPH is associated with some medical complications.

Possible but rare risks associated with TURP procedures include:

  • excessive bleeding

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Gentler And Safer Laser Prostate Surgery For Bph

If BPH is having a significant impact on your lifestyle, there’s now an effective new treatment that’s gentler and safer than the traditional surgical alternatives. Advanced laser prostate surgery for BPH is now available in New Zealand, and could provide you with near-instant relief from enlarged prostate symptoms.

The Need For Further Treatments

GreenLight laser surgery for an enlarged prostate

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.

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Laser Surgery For An Enlarged Prostate Is No More Effective Than Standard Surgery

Two procedures to treat men with enlarged prostates are both effective, new research has shown.

A benign enlarged prostate is not cancer and is not usually a serious threat to health. But it is common in men over 50 and some need surgery to treat troublesome urinary symptoms caused by the growing prostate. The most common procedure is transurethral resection of the prostate which is usually successful but can lead to complications such as bleeding in some men.

The UNBLOCS trial compared the effectiveness of TURP to a new laser procedure which might reduce a patients hospital stay and cause fewer side effects. The thulium laser, ThuVARP, vaporises excess prostate. Men who needed a prostate operation were asked to consent to either procedure without knowing which one they would receive.

One year later, men in both groups were satisfied with their surgery. They reported similar improvements in their urinary symptoms and quality of life. There was no difference between the two procedures in terms of hospital stay or complications. However, men in the TURP group achieved a faster urinary flow rate . TURP was also slightly more cost-effective and faster to perform than the laser procedure.

How Does Laser Prostate Surgery Work

Laser prostate surgery works in a similar way to the TURP procedure. It is just as effective at eliminating the symptoms of an enlarged prostate, and restoring your quality of life. But instead of cutting pieces of the prostate away with a hot electrical wire loop, a laser both cuts and instantly vaporises parts of the enlarged prostate, gently widening the urinary channel.

The main advantage of laser prostate surgery is that the blood vessels in the prostate are instantly ‘welded’ shut as they are cut. That means there is minimal bleeding during surgery, and less chance of secondary bleeding after surgery as well a common problem with the TURP operation.

What’s more, the advanced laser used by Greenlight Urology offers an even smoother, more controlled and more powerful operation than some other lasers. And after laser prostate surgery, a catheter may only be required for a few hours, as opposed to a few days with a TURP procedure.

So when you want the gold standard in laser prostate surgery, choose Greenlight Urology.

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Candidacy For Laser Ablation Surgery

Ideal candidates for laser ablation surgery to treat their enlarged prostate are:

  • Men who wish to avoid the adverse effects of TURP including impotence and incontinence.
  • Elderly disabled patients
  • Patients with severe medical conditions like uncontrolled diabetes, cirrhosis, active alcoholism, psychosis and serious lung, kidney or heart disease.
  • Men on blood thinners.

Which Is Right For You

Laser prostate surgery

To learn your options for treating prostate and urinary conditions, youll need to meet with a urologist. First, theyll properly diagnose your condition. BPH shares a number of symptoms with other prostate conditions, including prostate cancer. Once you have been officially diagnosed with BPH, your urologist will be able to discuss the available options and help you decide which is best for you.

At Urology Specialists of Ohio, we have helped countless patients find relief from BPH and other prostate conditions. You dont have to accept urinary problems as a part of life. For urology in the Springfield and Dayton, Ohio area, contact us today!

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How Does Greenlight Work

GreenLight Laser Therapy is a procedure performed with a small fiber that is inserted into the urethra through a cytoscope. The fiber delivers high-powered laser light. Blood inside the enlarged prostate tissue instantly absorbs the laser light, heating the tissue and causing it to vaporize. This process is continued until all of the enlarged prostate tissue has been removed.

GreenLight has been acclaimed for its ability to precisely vaporize tissue without causing damage to underlying structures. Natural urine flow is rapidly restored and urinary symptoms are quickly relieved in most patientsall with minimal blood loss, minimal postoperative discomfort, and a short hospital stay.

The good news is that GreenLight Laser Therapy offers a minimally invasive alternative to surgery in the treatment of BPH.

Find Your Nearest Spire Hospital

Almost all of our hospitals offer private prostate surgery and have teams of urologists who specialise in this procedure.

There are several methods available for prostate surgery.

TURP

The standard method is transurethral resection of the prostate . During a TURP procedure, which is usually performed under general anaesthetic, your surgeon will:

  • Insert a resectoscope through your penis into your urethra and bladder
  • Pass a small, electrically-heated wire loop through the resectoscope
  • Trim small central pieces of prostate tissue using the wire loop to create a channel where urine can easily pass through, and extract the pieces by suction
  • Insert a thin tube called a catheter through your penis and into your urethra
  • Use the catheter to flush out any blood clots, urine or remaining prostate tissue from your bladder using a saltwater solution
  • The catheter will remain in place for around one to three days after the operation

TURP may also be performed to treat or prevent any further complications as a result of blocked urine flow, including recurring UTIs, kidney and bladder damage, bladder stones, blood in the urine and difficulties in urination.

Laser prostate surgery

With laser prostate surgery, your surgeon will follow the same steps as TURP, but instead of using a resectoscope with an electrically-heated wire to cut away your prostate, theyll use a scope which has a special laser . The laser generates precise and intense heat to cut away sections of your enlarged prostate.

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General Aspects Of The Holmium Laser

The holmium:yttrium aluminium garnet laser has been investigated as an alternative to the Nd:YAG laser in the treatment of BPH because of its clear-cutting abilities, immediate relief of symptoms, and good level of hemostasis . The Ho:YAG laser is a solid-state pulsed laser with a wavelength of 2,010 nm that is highly and rapidly absorbed by water, which constitutes 60% to 70% of the prostate. The laser penetrates only 0.4 mm of the tissue, predominantly causing vaporization. Dissipating heat causes simultaneous coagulation, with minimal evidence of coagulative tissue necrosis. The physical properties of this laser make it suitable for use in different tissues, including stones, due to the fact that water makes up a significant component of most calculi. The first combined holmium and Nd:YAG laser technique for prostatectomy was reported in 1995 by Chun et al and Gilling and Fraundorfer . The combination endoscopic laser ablation of the prostate technique used the Ho:YAG laser, delivered by a side-firing fiber to create a channel, as an adjunct to the Nd:YAG laser to improve on the outcome of visual laser ablation of the prostate . However, the hemostatic properties of the Ho:YAG laser made the addition of the Nd:YAG laser largely redundant so that the improvement in patient outcomes was minimal . This finding led to the development of other techniques that exclusively use the Ho:YAG laser to imitate either a transurethral incision of the prostate or TURP .

How Greenlight Laser Prostatectomy Works

The GreenLight Laser Prostatectomy

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.

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Eligibility And Exclusion Criteria

The eligibility criteria included: 1) Patients with BPH needed surgery intervention 2) RCTs comparing different lasers and TURP , either laser alone or in combination with others, for the treatment of BPH 3) Each laser may be through different surgical techniques:vaporization, resection of tissue pieces, enucleation, or combinations 4) Published in English, German, French, Italian, Russian, Dutch, and Japanese.

Exclusion criteria: 1) Patients with neurogenic bladder disorder, urethral strictures, history of prostate adenocarcinoma or any previous prostatic, and bladder neck or urethral surgery. 2) Non-RCTs, reviews, reports only focusing on laboratory findings, trials published only as abstracts. 3) Not published in English, German, French, Italian, Russian, Dutch, and Japanese.

Outcome measures included: 1) Effectiveness-related outcomes: maximum flow rate , International Prostate Symptom Score , post-void residual volume 2) Perioperation-related outcomes: operating time, hospitalization and catheterization 3) Complications-related outcomes: short-term complications-related outcomes : dysuria, re-catherization, urine retention, clot retention, transfusion, transurethral resection syndrome , urine incontinence, and urinary tract infection long-term complications-related outcomes : bladder neck contracture or stenosis, urethral stricture or meatal stenosis other complication-related outcome: re-operation because of any other complications.

Innovations In Treatment Of Bph

New procedures are less invasive than many older choices, with good results and comfortable recovery.

Although there is no cure for benign prostatic hyperplasia , also known as enlarged prostate, there are many useful options for treating the problem. Treatments focus on prostate growth, which is the cause of BPH symptoms. Once prostate growth starts, it often continues unless medical therapy is started. The prostate grows in two different ways. In one type of growth, cells multiply around the urethra and squeeze it, much like you squeeze a straw. The second type of growth is middle-lobe prostate growth in which cells grow into the urethra and the bladder outlet area. This type of prostate growth typically requires surgery.

The first line of care for treating BPH is often medication. Doctors may prescribe an alpha blocker to relax the prostate, a 5-alpha reductase inhibitor to reduce the prostate’s size, or both. While medications are helpful for many patients, some may impact a man’s sexual function or only reduce, not eliminate symptoms if the patient has a moderate to severe case of BPH.

In cases where patients have moderate to severe BPH or have a middle-lobe growth and need further treatment, there are a range of BPH-related surgical procedures, including ones that are less invasive than older surgeries. A patient and his doctor will choose the best option based on the size and shape of the prostate, as well as the patient’s preference and overall medical condition.

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How Does Holep Treat Bph

Holmium laser enucleation of the prostate is a type of laser surgery used to treat the obstruction of urine flow as a result of benign prostatic hyperplasia. The holmium laser is a surgical laser that has been found particularly effective in performing several types of urological surgeries. In the case of HoLEP, the laser is used to cut and remove the bulky prostate tissue that is blocking the flow of urine.

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 or have had certain types of prior prostate treatments.

HoLEP requires the patient to be under general anesthesia. If a patient cannot have general anesthesia for some reason, a spinal anesthetic can be usedthis allows him to remain awake but blocks all feeling from the waist down.

A surgical instrument called a resectoscope is inserted through the urethra. The resectoscope includes a camera that allows the surgeon to view the internal structure of the prostate gland, and to see where incisions are being made during surgery.

The laser is inserted into the resectoscope and is used to enucleate the enlarged prostate tissue from the outer shell of the prostate, and then to seal up any blood vessels. The tissue that has been removed is deposited in the bladder. When tissue removal is complete, the resectoscope is withdrawn and a urinary catheter is put in place.

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