What is green light laser vaporization of the prostate?
Green Light Laser Vaporization of the Prostate is a procedure in which your doctor uses a potassium-titanyl-phosphate (KTP) green laser beam used in treatment of Benign Prostatic Hyperplasia (BPH). BPH only affects men and is characterized by the non-cancerous enlargement of the prostate gland. A common symptom of BPH is urinary retention (the inability to urinate). The KTP green laser beam vaporizes or melts away excess prostate tissue to widen the urinary channel to help you urinate better (Video 1). The green light laser is selectively absorbed by the blood in the prostate making the vaporization of prostate tissue efficient.
Video 1: Green Light Laser Vaporization
Below, Figure A shows an illustration of a normal prostate whereas Figure B shows an illustration of a prostate with BPH. The physician may recommend the green light laser vaporization if the patient's BPH symptoms have not improved after treatment with medications or if the patient has urinary retention, recurrent infection, bladder stones, recurrent bleeding from the prostate, or kidney failure caused by BPH.
Figure C shows an actual image of a patient with BPH with the urethra occluded by the prostate tissue. After the Green Light Laser Vaporization, the urinary channel is much wider allowing for easier urination as shown in Figure D.
What are potential benefits of green light laser vaporization of the prostate?
A minimally invasive alternative to surgery/TURP
Typically an outpatient procedure
Typically catheter free within 24 hours
Provides immediate relief of lower urinary tract symptoms
Generally less blood loss compared to surgery/TURP
Well documented safety and success data
More than 500,000+ patients treated worldwide
Quicker recovery
What are the risks or possible complications?
Hematuria or blood in urine (usually mild)
Urinary tract infections (rare)
Stricture (narrowing) of the urethra (rare)
Retrograde ejaculation (dry orgasm) (common)
Semen released during sexual ejaculation or climax enters your bladder rather than going out of your penis.
This is not harmful to your health and generally does not affect sexual pleasure. However, it can affect your natural ability to have children
Erectile dysfunction
While this is a possibility, this procedure rarely affects your ability to maintain an erection
Need for retreatment or an additional procedure
Urinary incontinence (leakage of urine) (rare)
What is the likelihood of success?
The likelihood of success is high that you will have improvement in your voiding symptoms
What are the problems related to recuperation?
You should rest for about 2 days after the operation and not partake in any strenuous activities (including sex) for 2 weeks.
What are the possible results of non-treatment?
Without treatment, you most likely will continue to have urination problems caused by the enlarged prostate. If your condition worsens, you may possibly have stones in your bladder, bladder infection, or kidney failure.
What are the significant alternatives?
The significant alternatives may include surgery for the prostate/TURP, various minimally invasive procedures for the prostate such as microwave therapy, radiofrequency ablation of prostate or transurethral needle ablation (TUNA), other form of laser therapy, medical therapy, and watchful waiting.
What kind of anesthesia is required?
Green light laser vaporization of the prostate can be done under general anesthesia (completely sleeping), spinal anesthesia (numbing from the waist down), or local anesthesia with intravenous sedation.
What are the risks and benefits of the chosen anesthesia/ sedation?
Your doctor and your anesthesiologist (the doctor giving you anesthesia) can discuss the risks and benefits of each type of anesthesia and select the best one for you.
What is the risk of bleeding, possible use of blood or blood products?
This will depend of the size of your prostate but is generally rare.
Where is the procedure done?
Typically in the hospital or at an outpatient surgery center. You should arrange to have someone drive you home after the procedure.
What do I need to do before the procedure?
Let your physician know of any allergies you may have and all medication you are currently taking including over the counter medications
If you are taking blood thinning medication such as aspirin, motrin, ibuprofen, naproxen, plavix, or warfarin, ask your physician when you should stop taking these medications.
Very important: Do not eat or drink anything after midnight or at least 8 hours prior to your surgery. Usually it is ok to take your regular medication with small sips of water.
What does the procedure entail?
After adequate anesthesia was achieved, your lower belly and your genital area will be cleansed with an antibacterial liquid. Your doctor then inserts a thin fiber optic scope through the tip of your penis into your bladder. Your doctor then uses the laser beam to vaporize or destroy the excess prostate tissue blocking the urine flow. After that your doctor may or may not insert a catheter (a soft tube) into your penis to drain the urine from the bladder. If inserted, the catheter is typically removed within 24 hours.
How long will the procedure take?
Depending on the size of your prostate, it may take 30 min or longer.
What is the average hospital stay?
It typically can be done on an outpatient basis (going home the same day) or just an overnight hospital stay.
What do I need to do after the procedure?
In the hospital:
You will be monitored in the recovery room for about 1-1½ hours
You will be allowed to drink and eat after that
You will be able to walk around with an assistant
You may be sent home with a catheter (soft tube) coming out of the tip of your penis and draining urine into a plastic bag strapped to your thigh or to a larger bag
At home:
Follow your doctor’s instructions. If you have a catheter, your doctor will remove the catheter for you or instruct you how to remove it.
Generally you can expect to have:
Blood in urine or hematuria: You may have blood in urine off and on for a few weeks after the procedure. However, if the bleeding is heavy and the blood is thick like ketchup or if you feel light headed, call your doctor.
Irritating voiding symptoms: Depending on the size of your prostate, you may have irritating voiding symptoms for a few weeks to a few months after the procedure. These symptoms may include the feeling of having to void urgently, frequently, and voiding at night. You may have burning in the penis or in the bladder during or at the end of voiding. If these symptoms are not getting better with time, call your doctor to make sure you do not have a bladder infection.
Avoid constipation by drinking more water, eating more vegetables and fruits, and taking your medications as prescribed by your doctor. Constipation and straining may increase the risk of bleeding.
Avoid strenuous activity and sexual activity for a few weeks after the procedure.
Reviewed by a Board Certified Urologist, March 10, 2016
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