Prostate Surgery FAQs

What is the procedure for laser prostate surgery?

Before laser prostate surgery, you will be given either a spinal or a general anaesthetic. A spinal anaesthetic is more common for this type of surgery, and will mean you won't be able to feel anything below the waist, but you will still be awake for the operation. However, if you prefer, you can be given a sedative so that you will sleep through the procedure.

A spinal anaesthetic also lasts until after the operation, so the sensation of having a catheter tube in place is reduced.

Antibiotics will also be given prior to surgery, to prevent urinary infection.

Once anesthetised, an instrument called a resectoscope is passed up the urethra tube, into the inside of the prostate. The resectoscope is hollow to allow an irrigation fluid to wash away any blood, giving the surgeon a clear view of the operative field.

Powerful and precisely focused laser energy is transmitted via a thin fibre, from the RevoLix laser machine, through to the end of the resectoscope.

Prostate tissue can either be vaporised, or in bigger prostate glands, larger pieces of tissue can be cut free and pushed up into the bladder. Once a satisfactory channel has been created, these pieces of prostate tissue are flushed out, or cut up if they are too large to fit through the resectoscope.

At the end of the operation, a catheter tube is left inside the bladder to wash out any blood clots and to drain the urine.

What happens after laser prostate surgery?

Thanks to the advanced Thulium laser surgery used by Greenlight Urology, there will normally be only minor bleeding. This means you should enjoy a much faster recovery than you would with a traditional TURP operation.

After laser prostate surgery, the catheter can usually be removed early in the morning the day after surgery. Once you have had plenty to drink and have passed urine a few times, you will be free to go home.

Passing urine will sting to begin with, and drinking bicarbonate sachets will help by making the urine less acidic. Most patients find mild pain relief such as Panadol is usually sufficient, and there generally isn't any discomfort between trips to the bathroom to urinate.

You should avoid heavy lifting for the first two weeks after surgery, as this can cause the scab that will form inside the prostate to peel away and restart bleeding.

It can take up to two months for the inside of the urinary channel to heal completely, so to begin with you may still have some urinary urgency.

You will be seen for a follow up appointment after two months, to be sure that everything has healed properly.

What are the potential complications of traditional TURP surgery?

Traditional TURP surgery causes much more bleeding than laser prostate surgery, both during the operation and often for several days afterwards. This means blood transfusion is often necessary with TURP, and some men need to stay in hospital for many days until the catheter can be safely removed.

Even up to two weeks later, the scab inside the prostate can peel away causing secondary bleeding. This can require readmission to hospital, and reinsertion of a catheter to get rid of blood clots.

Another potential problem with TURP is the absorption of too much irrigating fluid, causing toxicity known as 'TURP syndrome'.

As with any surgery, in an older population these issues could then lead to circulatory problems with the heart, or deep venous thrombosis, stroke and prolonged hospitalisation.

Why is laser prostate surgery a much safer option than TURP?

In contrast to TURP, Thulium laser prostatectomy has an excellent safety record, because the laser energy seals off the blood vessels in the prostate as it cuts. With minimal bleeding, laser prostate surgery is a much safer option, particularly in the very elderly.

Because laser prostate surgery does not use electricity to cut the tissue, a different irrigation fluid can be used – saline, rather than glycine – which is much safer. Absorption of saline can simply be offset by turning down the patient's IV drip.

There is also minimal risk of incontinence with Thulium laser surgery, as the laser energy is so precisely and accurately delivered. With the added advantage of minimal bleeding during surgery, it is much easier for the surgeon to see, and therefore avoid injury to, the sphincter valve.

Are there any potential complications with laser prostate surgery?

As with any surgery, there is a minor risk of potential complications. However, laser prostate surgery is still a much safer alternative to the traditional TURP operation.

In a small proportion of men, excessive scar tissue may form a stricture, which causes the bladder neck or urethra tube to narrow in the first few months after surgery. Often this can be dealt with in the Urologist's office by simply passing dilators. In 1% of cases, a repeat trip to the operating room might be necessary to cut away very tough scar tissue.

What will it be like after laser prostate surgery?

Once the prostate channel has healed, your urinary flow will be stronger, easier to start and you'll empty well.

The extra muscle your bladder has grown to push urine past an obstructing prostate will slim down again. After a few months the bladder can stretch more, and the strong urge to pass urine frequently or at night will ease off. Most older men will still awake once at night to go to the bathroom.

What about sex after laser prostate surgery?

Thulium laser surgery has very little effect on erections, as the nerves to the penis run along the outside of the prostate, away from where the channel is carved out.

Opening up the bladder neck area does usually cause retrograde or 'backward' ejaculation. This is harmless, and the semen will simply flush out with the next urination.

Overall, laser prostate surgery should have very little effect on your sex life.

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