Laser therapy for prostate enlargement
What is Greenlight Laser?
What is BPH?
BPH is Benign Prostatic hyperplasia, an enlargement of the prostate that occurs with normal ageing. It causes two main symptoms, obstructions and irritation.
Obstructive symptoms are due to the effect of the enlarged prostate physically pushing on the urethra, the pipe below the bladder. There is an static component due to the enlargement and dynamic component caused by the muscle tone of the prostate land. The symptoms include;
- Hesitancy – having to wait for the urine to start flowing
- Slow flow
- Intermittency – a stream that stops and starts again
- Straining having to push to get the urine out
- Incomplete emptying – feeling there is still urine in the bladder after finishing
1.) Enlarged prostate with ageing 2.) Prostate protruding into the bladder causing obstruction 3.) A view from above of a thick walled bladder with prostate protruding into the bladder
With obstruction the bladder wall thickens and this leads to irritative symptoms
- Rushing to the toilet – the bladder loses its compliance, meaning it has a fixed capacity. Patients need to rush to the toilet when they feel they need to pass urine.
- Going often – the bladder capacity is reduced making toilet trips more frequent
- Getting up at night – with a lower bladder capacity, patients have to make trips to the toilet at night to empty the bladder
Thickening of the bladder wall muscle occurs in response to obstruction.
What are the treatment options for BPH?
Treatments can be either medical or surgical, with surgery reserved for the more severe cases.
1. Medical therapies – Alpha blockers – Prazosin, tamsulosin. (Pressin, Fomaxtra)
Alpha blockers work on the dynamic, muscle component of the prostate obstruction. The relaxation of the muscle opens the passage, making it easier to pass urine at a lower pressure. Potential side effects include a stuffy nose, dizziness on standing and loss of ejaculation.
5 alpha reductase inhibitors – Finasteride, Dutasteride (Proscar, Avodart) 5ARâ€™s work on the prostate to reduce the size of the gland by blocking the effect of testosterone on glandular tissue. This shrinks the gland by about 30% over 6 months. Potential side effects include hair regrowth and loss of libido.
Combination pills – Tamsulosin / Dutasteride (Duodart) Duodart uses a combination of the two treatment options and has been shown to reduce the risks of developing urinary retention. For this reason it has PBS coverage in Australia.
2. Surgical therapies
Surgery is needed when medical treatments fail or when there is evidence of bladder damage that could lead to bladder failure. Severe symptoms, urine infections, bleeding, bladder stones and incomplete emptying are common indications for surgery.
Surgery involves removal of the obstructing prostate tissue, which can be done with open, telescopic or keyhole surgery. Most commonly it is done by inserting a telescope into the penis and using cutting electricity or laser vaporisation to remove tissue to create an open passageway. This results in a much better flow soon after surgery. It is common to have rushing to the toilet after treatment, as the bladder is unchanged by the operation, at least initially. Over time the bladder muscle thins and the urgency and frequency symptoms settle.
Cutting techniques have been used for over 80 yrs and result in a wide cavity and an excellent flow following. Standard electrical resection has a high rate of bleeding, during and after surgery. Laser cutting with a holmium laser (HoLEP) has a higher complication rate and a need for tissue retrieval from the bladder/ There is less bleeding than a standard TURP and large glands can be done.
An enlarged prostate has a significant blood supply
3. Greenlight Laser
The greenlight laser uses light at a special wavelength that is absorbed into prostate tissue, creating a high heat that vaporises the tissue. There is little bleeding during or after surgery. This procedure requires specialised equipment and training. The company video below gives an insight into the technology
Advantages of Greenlight Laser
Greenlight laser therapy has become the surgical treatment of choice for moderate to severe voiding dysfunction for the following reasons.
- Short Catheter Time
- No need for tissue retrieval
- Minimal blood loss
- Rapid return to activity
- Minimal time off blood thinners
Risks of Surgery
- Complications are uncommon, but known risks of greenlight laser include
- Loss of ejaculation
- Urgency or running the toilet
- Scar formation
- Conversion to standard TURP
What does surgery typically involve?
- General or regional anaesthetic
- Telescopic surgery to vaporise the prostate tissue
- Catheter left in place overnight with bladder irrigation
What can I expect after surgery?
- Stinging / burning passing urine for the first few days
- Some blood or discolouration of urine
- Rushing the toilet
- Returning to normal activity after a few days
- No strenuous exercise or sex for 2 weeks
- Blood thinners can restart soon afterwards, but exact timing should be arranged with your surgeon
Can I still get prostate cancer?
Prostate cancer can still occur, as you still have prostate. The PSA level will fall after surgery, with the removal of tissue and normal reference ranges will no longer apply to you. We will do a PSA level after surgery and use this as a baseline for future comparison.
How long will the treatment last?
You can expect 10 yrs of symptom relief from a procedure.
With GreenLight Laser Therapy, you can get help with your BPH symptoms, to help you quickly get back to the things you like to do.