Laser Trans Urethral Prostate Vaporisation Greenlight Laser

Prostate Surgery

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Item Number: 37207, 105

Why is it done?

Endoscopic vaporization of a benign enlarged prostate, using laser.

Indications:

  • Patients on anticoagulation Warfarin needs to be placed on Clexane 7 days prior.
  • Clopidogrel should be down scaled down to Asprin.
  • Prostates up to 120cc.
  • Where conservative management has failed.
  • Patient choice.
  • This allows patients on anti-coagulation therapy to continue their medication with minimal risk of hemorrhage. It also allows a shorter hospital stay.

Why is it done?

  • This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
  • Symptoms include: a weak stream, nightly urination, frequent urination, inability to urinate, (LUTS) kidney failure due to the weak urination (obstruction), bladder stones, recurrent bladder infections.
  • Medication such as Flomaxtra, Xatral Minipress etc. should always be given as a first resort.
  • Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar.
  • Prostate cancer first needs to be ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
  • A TUVP can also be performed to disobstruct a severe prostate cancer, to allow a normal urination process.

How is it done?

    • patients will receive a general anaesthesia, unless contra-indicated.
    • A cystoscopy is performed by placing a camera in the urethra with the help of lignocaine gel.
    • The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
    • A vaporization of the prostate is then started and should take 60-120 minutes depending on the size of the prostate.

 

  • Prophylactic antibiotics will be given to prevent any infections.
  • Post– operative antibiotics will be continued for 10 days.
  • No specimen will be obtained due to vaporization, unless PSA was suspicious and a MRI with view to prostate biopsy has excluded a prostate cancer.

What can go wrong?

  • Any anaesthesia has its risks and the anaethiatist will explain this to you.
  • No blood loss is expected.
  • In rare circumstances you may develop fluid overload requiring a High Care Facility admission.
  • You will wake up with a catheter in your urethra and bladder. This will remain in the bladder overnight.
  • Lower abdominal discomfort for a few days.
  • NB! Each person is unique and for this reason symptoms vary!

What next?

  • You will spend 1 night in hospital.
  • You will a trial without catheter the next day.
  • You will be discharged as soon as you can completely empty your bladder.
  • You may initially suffer from urge incontinence and dysuria (irritable voiding) and will improve within the next 6 weeks.
  • Allow for 6 weeks for stabilization of symptoms.
  • There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
  • Don’t hesitate to ask Jo if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side–effects

  • Retrograde ejaculation in more than 90% of patients. Therefore if you have not completed your family, this procedure is not for you unless absolutely necessary.
  • Infertility as a result of the retrograde ejaculation.
  • Stress incontinence especially in the elderly and the diabetic patients.
  • Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
  • Urethral structuring in 2-3% of patients, requiring intermittent self dilatation.
  • Regrowth of prostate lobes within 3-5 years requiring a second procedure.
  • NB! Each person is unique and for this reason symptoms vary!

Remember

  • You still have a peripheral zone of your prostate and regular PSA reviews are required up to the age of 75. (This could be seen as controversial).

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TUVP Greenlight