GreenLight Laser prostatectomy

For several decades now TURP has been the standard treatment for men with lower urinary tract symptoms secondary to BPH.  TURP produces durable and reliable improvements in flow rates and subjective symptom scores.  As a result, it has been one of the most common urological operations performed.  Despite its efficacy,  however, it is associated with a significant side-effect profile, including the need for blood transfusion, infections, strictures, sexual problems and incontinence.  In addition, men who undergo a TURP require on average two to three days of catheterisation and hospitalisation before undergoing a trial of void and discharge.

Laser prostatectomy was introduced just over one decade ago to compete with a standard TURP.  This technique  was pioneered by Malek and colleagues in the Mayo Clinic, in the United States, initially using first generation, low powered machines.  The initial models have now been used with excellent results for over seven years.  These initial results demonstrate excellent functional outcomes with improvements in flow rates and symptoms that are as good and as durable as those achieved with a TURP.  However, there is a significant reduction in catheterisation times, hospital stay and complication rates in favour of the laser prostatectomy patients over TURP.

Until recently, there was no randomised controlled trial comparing TURP with laser prostatectomy.  However, a  recent  publication from Melbourne demonstrates that laser prostatectomy is as effective as TURP, but with significant improvements in side-effect profile. These improvements included:  reduced the length of hospital stay, a reduction in catheter time and a 22% reduction in cost.  Indeed the mean duration of catheterisation amongst the laser prostatectomy group was in the order of 12 hours and the length of stay one day.

There has been a recent upgrade of the technology allowing higher energy to be delivered in a more focused fashion.  This has resulted in more precise surgery and reduced treatment times. In contrast to TURP laser prostatectomy allows vaporization of tissue and simultaneously seals the tissue resulting in an almost bloodless field. The net result is that patients who are on blood thinners such as warfarin can be treated whilst remaining on this medication.

This technology has only been available in Australia, in major metropolitan areas.  This technology is now available to men in Northern NSW and Southern Queensland through the provision of this service at St. Vincent’s Private Hospital. This represents the first time that this treatment modality will be offered to men outside Sydney or Melbourne, allowing men with significant symptoms related to an enlarged prostate gland to be treated with state-of-the-art technology.  This will ensure excellent outcomes with minimal impact on their quality of life and a quick and speedy return to normal activity.

Details of the Procedure

In the majority of cases men will be treated with a single overnight stay in hospital. A general anaesthetic or a spinal anaesthetic (small injection in the back) is used for the operation. A telescopic camera is then inserted into the penis and the internal surface of the prostate visualized. The laser beam is then directed onto the prostate surface and tissue vaporized in an almost bloodless fashion. Laser vaporization is continued until all obstructing prostate tissue has been removed.

A small urethral catheter (small plastic tube into the bladder) is inserted at the end of the procedure. This is left in place overnight only. After removal of the catheter men go home once they have successfully passed urine and emptied  their bladder.

Follow-up takes place 6 weeks after the surgery to confirm symptomatic improvement.

Download the GreenLight laser prostatectomy patient information sheet here

 GreenLight Laser Web Link: www.greenlighthps.com