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Laser Prostatectomy is a surgical procedure with use of laser applied in patients with enlarged prostate that causes them urinary problems.
The great advantage of laser is that it does not cause bleeding during the operation. This is why it is the treatment of choice for patients who have blood coagulation disorders or who receive anticoagulants and cannot interrupt them for a long period.
This procedure is indicated to treat symptoms caused by BPH (Benign Prostate Hyperplasia). It is a therapeutic option for patients who:
- do not respond to pharmacotherapy
- have experienced urinary retention (inability to urinate) more than once
- suffer from overflow incontinence (i.e. incontinence due to bladder overfilling with urine)
- suffer from recurrent urinary tract infections
- are predisposed to bladder stones or diverticula
- present hematuria (blood in urine), due to prostate size, that cannot be treated with pharmacotherapy
- present distention of the kidneys due to large post-void residual urine volume, that may potentially affect renal function
Laser Prostatectomy is indicated when prostate volume is less than 80 ml.
Upon hospital admission, preoperative preparation includes blood tests, chest X-ray and ECG (electrocardiogram). In case you are on anticoagulants, it may be required to interrupt your anticoagulant therapy a few days before the operation. You should always consult your Cardiologist, for there may be need to replace anticoagulants with injections in the abdominal region.
Laser Prostatectomy is usually performed under spinal anesthesia (an injection is made in the spine and as a result you will feel no pain from waist down and will not be able to move your legs). Spinal anesthesia lasts about 3 to 4 hours. In some cases patients may be given general anesthesia. The procedure takes place with the use of a special instrument that is inserted into the urethra through the tip of the penis. A mini camera is attached to this instrument to transfer a high-resolution image from the target site to the screen. In this way, the surgeon is able to operate the prostate without making the need for making any skin incision. A greenlight laser beam of specific wavelength is emitted and directed onto the prostate tissue surface through the instrument . Greenlight laser has such a drastic action on the tissue that the tissue gets vaporized. At the end of the procedure, a urinary catheter will be placed and the patient can be transferred to the room.
The urinary catheter is removed the following morning. Once you start to urinate without the catheter, you will be discharged from hospital. Upon discharge, you will get specific written instructions about:
- when it is safe to restart your anticoagulant therapy
- when it is safe to resume to intense physical activity
- when it is safe to have sex
- what kind of antibiotic regimen you will have to receive postoperatively
You should be aware that urine will have a pinkish color for some time after surgery. You should drink plenty of fluids. You may also present urinary frequency and urgency, symptoms that will gradually subside.
In most cases, patients will have no ejaculation during orgasm. This is called retrograde ejaculation (semen is redirected back to the bladder and eliminated through urine instead of going out through the urethra during ejaculation). Patients who are interested in having children in the future should be aware of this.
With regard to nutrition, for some time after the operation you should be receiving 1500ml of fluids/ day and avoid smoking, drinking coffee and alchohol, for these may induce irritative symptoms.
Within a relatively short time -always according to your doctor’s instructions- you will be able to resume to your usual daily life activities.