Dr Jo Schoeman
Urological Surgeon

        

Laser Trans Urethral Prostate Vaporisation Greenlight Laser

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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).

Laser Trans Urethral Prostate Vaporisation Greenlight Laser Laser Trans Urethral Prostate Vaporisation Greenlight Laser (265 KB)