Greenlight Laser Trans Urethral Vaporization of Prostate

Endoscopic vaporization of a benign enlarged prostate, using laser.

Indications:

• Patients on anticoagulation / anti-platelet therapy
  • Warfarin needs to be placed on Clexane 7 days prior.
  • Clopidogrel should be down scaled down to Aspirin.
  • This allows patients on anti-coagulation therapy to continue their medication with minimal risk of hemorrhage. It also allows a shorter stay in hospital.
• Prostates up to 120cc.
• Where conservative management has failed.
• Patient choice.
• This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
• Symptoms include: LUTS
  • a weak stream,
  • nightly urination,
  • frequent urination,
  • inability to urinate,
  • kidney failure due to the weak urination (obstruction),
  • bladder stones,
  • recurrent bladder infections.
• Medication such as Flomaxtra, Urorec or Minipress etc. should always be given as a first resort.
• Step-up therapy could have been used for prostates larger than 35-50cc where indicated, 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.

How is it done?

• • Patients will receive a general anesthesia, unless contra-indicated.
  • A cystoscopy is performed by placing a camera in the urethra with the help of lignocaine gel.
  • Saline is used to irrigate the bladder, therefore NO DILUTIONAL HYPONATRAEMIA
  • 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 an MRI with view to prostate biopsy has excluded a prostate cancer.

What can go wrong?

• Any anesthesia has its risks, and the anesthetist will explain this to you.
• No blood loss is expected.
• In rare circumstances you may develop fluid overload requiring a High Care Facility admission, especially with the upper edge of prostate sizes.
• 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 (discomfort) and will improve within the next 6 weeks.
• You will pass a grey, wet scab at the 2–3-week mark.
• Some bleeding may be associated with this, especially if you are on anticoagulation therapy.
• 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 follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
• 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. Not a given, therefore continue your contraceptives
• 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 stricturing in <2% of patients, requiring intermittent self-dilatation.
• Regrowth of prostate lobes can occur 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).

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