Greenlight laser prostatectomy is a new technology for the surgical treatment of BPH. The Greenlight laser provides many advantages over traditional prostate surgery, particularly in regards to patient safety.
Surgery for BPH is required when obstructive symptoms are severe, do not respond adequately to medication or when secondary complications occur.
Traditionally, “reboring” of the prostate is done with a TURP procedure, where the inside of the prostate is scooped out with an electric loop. While this remains a very effective operation, TURP is prone to cause bleeding and can sometimes lead to severe metabolic and electrolyte complications.
What is Greenlight laser prostatectomy?
Similar to a TURP, this is performed under a spinal or general anaesthetic with a telescope through the penis. A powerful green coloured laser is used to vapourise the inside of the prostate to create an open channel. The laser also vapourises blood vessels so there is usually little or no bleeding. Beacause of this, it is safe to do on patients while they continue to take blood thinning medication. Most patients have their catheter removed the following day and go home. Some patients are even able to go home on the same day as their surgery.
What are the advantages of Greenlight prostatectomy?
There are many advantages for Greenlight laser prostatectomy over a traditional TURP:
- Less bleeding
- Shorter hospital stay
- Rapid recovery
- Lower complication rate
- No metabolic or electrolyte complications
- Can be performed while patient is on blood thinning medication
What are the disadvantages of Greenlight laser prostatectomy:
There are few disadvantages when compared to traditional prostate surgery:
- The procedure takes slightly longer
- Patients are more prone to dysuria (burning when passing urine)
- Greenlight laser is less effective with very large prostates. In this setting, a HoLEP is a much better option.
What are the possible complications?
Some patients get dysuria (burning when passing urine) due to irritation of the urethra. This is usually harmless and settles on its own. Occasionally it may persist and be problematic but this is not common.
Other complications may include:
- Retrograde ejaculation (dry orgasm). This is harmless and happens to most men. It is a sign that the procedure had been successful in relieving any blockage. We would not recommend this sort of surgery to younger men who may wish to father more children.
- Urine infection <10%
- Bleeding <5%
- Erectile dysfunction <5%
- Urethral stricture <5%
- Incontinence <2%
- Bladder or ureteric injury <2%
Will my prostate grow back?
Yes it will. Because we are only shelling out the inside, more than half your prostate remains intact. This can continue to grow, although this takes many years. Most men will have a durable response of up to 10 years.
The following educational video on Greenlight Laser Prostatectomy is produced by Assoc Prof Kevin C. Zorn, one of the world’s leading prostate surgeons from Centre Hopitalier de l’Universite de Montreal (CHUM) in Canada. This video contains scenes from an actual operation.