Step 4: Laser Prostate Surgery, Robotic Surgery and Other Surgical Options
When less-invasive options are ineffective at treating symptoms of BPH, surgery is often the answer and usually requires complete removal of the enlarged prostate. All of the surgical options for managing severe BPH symptoms show greater improvement in urine flow rate than oral medications. Our patients have several surgical options. Most of these options are performed in the hospital setting, although some laser procedures can be done comfortably in the office.
Transurethral resection of the prostate (TURP) has been the predominant surgery for treatment of BPH since the 1960s, but that is beginning to change. The procedure itself isn’t changing much, but the cutting electrodes used for years in the TURP procedures are now being replaced by lasers. With the new laser techniques, patients experience substantially less bleeding and reduced risk of needing re-operation.
Another form of TURP is a bipolar TURP. With the bipolar, we use a “button” that creates a plasma that vaporizes tissue. The button TURP also has less bleeding than a conventional TURP. The restrictions and results of the button turp are similar to laser therapy for enlarged prostate.
Transurethral incision of the prostate (TUIP) is a surgical modality where the urologist makes a small incision in the prostate tissue to simply widen the opening between the urethra and bladder outlet.
And finally, simple prostatectomy is an option for some patients. It is an open surgery to remove the inner part of the enlarged prostate gland. The robot can be used to perform this procedure, allowing for a faster recovery than a conventional open surgery. Read about robotic surgery and the importance of surgeon experience before electing this procedure.
About Prostate Laser Surgery at The Urology Place
The most advanced lasers on the market today are the Thulium, Holmium, and GreenLight lasers. We use a Thulium laser as it allows for a more shallow depth of tissue penetration than the Holmium laser, which is highly advantageous during surgery. Our Thulium laser has a 2013nm wavelength that allows for 0.25mm penetration into the tissue, and performs remarkably to to vaporize the prostate tissue while minimizing bleeding.
What’s Up & Coming With Laser Surgery?
We are closely watching outcomes from tests of the GreenLight laser technology, which adds fiber optic technology to the mix as the newest addition to minimally-invasive surgical techniques for the treatment of benign prostate hyperplasia. Long term studies are not complete on the GreenLight laser, but we believe this new technology potentially stands to set a new standard of excellence in surgical outcomes.
What happens during the procedure?
Both TURP and prostate laser surgery involve inserting a scope into the penis to reach the prostate and remove it in small pieces. The laser offers the advantage of minimal char, which allows for faster healing and less irritation.
What is recovery like?
Some patients may still need to spend a night in the hospital after surgery, with removal of your catheter after 24 hours. Laser therapy allows most patients to return to work in just a few days, but strenuous activity should be avoided for approximately 4 weeks. Most patients will have some slight burning for a week or so after the procedure, but it is easily managed with a mild pain and anti-inflammatory medication. For the first few weeks, symptoms may actually be worse as the tissue can actually swell from the inflammation and eventual healing associated with treatment.
Are there sexual side effects to the surgery?
Fewer than 1% of men experience sexual dysfunction after laser therapy. And while traditional TURP caused retrograde ejaculation (semen during orgasm enters the bladder instead of out of the body via the urethra, causing “dry” orgasm) in most patients, Thulium laser enucleation of the prostate has shown to conserve both ejaculation and erectile function.
How long do the results of prostate laser surgery last?
Clinical studies show that laser therapy can offer rapid and lasting relief lasting for at least 5 years.