Laser Prostatectomy

Content provided by the Faculty of the Harvard Medical School

Laser Prostatectomy

Question:

I am a 66-year-old male. My doctor wants me to have laser prostrate surgery because my bladder is not emptying fully. What are the risks of this procedure?

Answer:

I suspect that your doctor is recommending this because you have an enlarged prostate. Doctors call this benign prostatic hyperplasia. This extremely common disorder affects nearly 50% of men over age 50. In the past, the usual treatment was a transurethral resection of the prostate (TURP). This is commonly called a "roto-rooter" operation.

Today, most men are treated with medicines first. The two types of medicines prescribed are alpha blockers and 5-alpha reductase inhibitors. Alpha blockers relax the muscles around the base of the prostate. This allows better urine flow through the penis and decreases trips to the bathroom. The 5-alpha reductase inhibitors shrink the prostate over several months.

If the medicines stop working, there are side effects, or you cannot urinate at all (an episode called urinary retention), surgery is often considered as the next step.

If the medicines do not work, your doctor may offer a laser prostatectomy. This most commonly uses a machine that vaporizes the prostate in an area where the flow of urine can be more fully restored.

The laser vaporizes the tissue that blocks the flow of urine in the prostate gland. Most men are treated and sent home the same day, though they may need to keep a catheter in place for a day or so. This lets all the urine escape until the body can take over and do it normally. Men can resume light work after a few days and start activity that is more strenuous after 4 to 6 weeks.

Men who have laser surgery may experience some minor bleeding when ejaculating. This occurs less frequently from laser surgery than with TURP. Frequent urination is also a possible side effect.

Generally, these risks don't last long. However, it is important to note that slightly more than 2% of men who have laser surgery will require a second procedure within the next 2 years. Compared to many other procedures, this rate of reoperation is quite low.

Last updated:	July 20, 2009