Laser prostate surgery

Within the surgical techniques to treat enlarged prostate, the laser is a fairly accurate and safe therapeutic option.

Traditionally, prostate surgeries had been performed with conventional methods but in recent decades has emerged a boom in more modern techniques such as laparoscopic interventions and the use of laser.

The latter has been a great ally in this type of operations in which the anatomy is very small, accessibility is limited and where high precision is required. Laser prostate surgery is a minimally invasive medical procedure with a high level of success and safety.

In these laser surgeries, the physician inserts a cannula with a camera at its end through the external urethral opening of the penis. The laser emitted by the tip of the flexible device (next to the camera) removes excess prostate tissue in the urethra without the need for open surgery.

Introduction to the prostate and its conditions

The prostate is a male gland that lies below the urinary bladder, surrounding the urethra and anterior to the rectum. It is about the size of a horse chestnut and has important reproductive functions for men.

BPH enlarged prostate 01

This gland secretes key substances for the maintenance of sperm contained in semen. Most of this fluid is produced by the seminal vesicles. However, the prostate releases substances such as:

The prostate is an organ that receives and redirects seminal content from the ducts of the seminal vesicles and sperm content from the vas deferens (from the testicles, where spermatogenesis occurs). Therefore, it is the anatomical site where all seminal fluids are conjugated with sperm just before male ejaculation.

In addition to secreting some seminal fluid, necessary for ejaculation, the prostate also acts as:

Semen is an ideal microenvironment in which sperm can move and be nourished for hours as they are in the vaginal and uterine canal for fertilization of the female egg in the fallopian tubes.

The regulation of this organ (the prostate) is in charge of the hormonal factors of which testosterone is the most important male hormonal factor.

However. Over the years, the production of testosterone (by the Leydig cells in the testicles) and the number of androgen receptors in the prostate can be altered and increased. This creates a hypersensitization of the gland to testosterone and an uncontrolled increase in metabolic products that could cause it to hypertrophy and inflame, producing an enlarged prostate.

Próstata agrandada con obstrucción urinaria

BPH enlarged prostate 02

Given the prostate anatomy and its close link to the urethra, any enlargement of the prostate can trigger pathological signs and symptoms of the urinary tract. This can lead to discomfort and difficulties in urinating, ejaculating and even in the erection of the penis and the transmission of sexual nerve stimuli. Endangering sexual health and the health of other organs, such as the kidneys.

Within prostate conditions, benign prostatic hyperplasia is the most common in men over 40 years of age (the age group most vulnerable to prostate enlargement).

The prognosis for this disease is often medium-low because patients are detected in advanced stages. Probably due to the paradigms that still exist with respect to the main diagnosis: the rectal exam.

When enlargement of the prostate becomes chronic, complications are quite uncomfortable and in addition, drug therapy has no effect, surgical treatment of prostate surgeries are recommended.

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What is the purpose of laser prostate surgery?

Laser surgery for the prostate is especially indicated (among other pathologies) for benign prostatic hyperplasia (BPH).

Benign prostatic hyperplasia manifests itself with quite specific signs and symptoms, for example:

The blockage in the urinary tract can also be caused by other pathologies and health conditions such as:

What are the benefits of laser surgery compared to conventional techniques?

Compared to open prostate surgery and TURP (transurethral prostatic resection), laser surgery has several advantages and benefits such as:

Short recovery time in the hospital. Often patients must stay overnight (at most) in the hospital so they can return home promptly to continue recovery.
Less incidence of incontinence problems or erectile dysfunction after surgery than with other methods.
Less bleeding during surgery and recovery. This is because the laser can heal blood-containing vascular spots, causing them to close and not bleed as much.
It is not necessary to use a urinary catheter for that long. With laser prostate surgery, bladder catheter use can be reduced to 24 to 48 hours after surgery. The catheter may become somewhat uncomfortable for most patients.
Effective from day one. Improvements in urination can be noticed from the moment of surgery.

Surgery: what does it consist of?

What is the pre-surgery preparation like?

Before the surgery, the doctor will organize a series of check-ups to examine the patient’s state of health, perform some tests (laboratory and medical imaging) and recommend some indications such as:

What is surgical anesthesia?

The anesthesia of prostate laser surgery can be of two different types, depending on the type of laser used and the technique used. This guarantees that the procedure is completely painless. The anesthesia can be general (with the patient unconscious) or spinal anesthesia (with which the operation area is numbed and the patient remains awake).

It is likely that with spinal anesthesia the patient will receive nerve sedatives so that he is calm while conscious during the intervention.

How is the procedure?

After the patient has been anesthetized and stabilized inside the operating room, a thin, flexible cannula is inserted through the urethra into the head of the penis.

This cannula has a high-definition camera at the end that allows the intervening surgeon to observe the procedure from an external monitor. Also, the cannula has a device that emits laser, which will be used selectively to cut, remove or vaporize the prostate tissue.

The surgeon extracts the tissue with special forceps until the urinary canal is free, also by transurethral route.

What is the recovery from surgery like? What is the post-operative care?

After surgery it is possible to notice some normal signs of swelling in the urinary tract. These include painful urination, urinary incontinence (or leakage in underwear), constant feeling of wanting to urinate, burning at the tip of the penis, and, in some cases, some blood in the urine (hematuria).

To prevent this, doctors place a bladder tube (also called a catheter) for a few days or until the inflammatory signs in the urine stop. This is done to allow proper healing of the urethral tissues and to prevent infection (since the tissue is exposed).

In addition, patients are advised to take physical rest and avoid strenuous activities such as running, bicycling, or lifting heavy objects from the floor. Antibiotics to prevent urinary tract infections and analgesics are also often prescribed to treat pain.

Results of surgery

In the vast majority of cases (more than 90 percent approximately), laser prostate surgery significantly improves urine flow in men with some type of prostatic hyperplasia.

These results are usually long-lasting, but in some cases, the prostate tissue may hypertrophy again and require another surgical intervention after a few years. It is vitally important to maintain urological vigilance after the operation in order to anticipate any new alterations.

Types of laser

The laser used in these surgeries corresponds to a type of ultra concentrated light beam that is capable of cutting biological tissue with extraordinary precision. However, the type of light emitted may vary, but the foundation is the same. Among the three types of lasers most used in prostate surgery are:

Selective prostate vaporizer

The laser used concentrates so much heat in an anatomical point that it can vaporize the biological material, so its extraction is facilitated. It has high power to remove hypertrophied tissue.

Holmium prostate laser ablation

Holmium laser is a type of high-precision laser emitter. It is also used to remove kidney stones (renal lithiasis) that could block the urinary tract.

Holmium prostate laser enucleation

The prostate laser enucleator is a highly sensitive medical instrument that allows a large amount of tissue to be removed. Even more tissue than previous laser types. It is used in cases of men with severe BPH.

How do you choose the right type of laser for the patient's needs? How do you know which laser is right for each case?

The type of laser used in the surgery will depend on several factors, but the most important are:

Other factors considered in the choice of surgical laser would be the type of equipment available and the competencies of the physician with a given device.

Are there risks from laser surgery? What are these risks?

Laser surgery of the prostate may carry some risks. However, these are rare and tend to have a good prognosis if properly treated.

Among the risks, there is the development of:

Urinary tract infections due to the fact that the walls of the urethra may be sensitive to colonization by bacteria specific to the bladder (e.g. E. Coli). Antibiotics are prescribed for this purpose and must be strictly adhered to.
Chronic difficulty urinating due to scar tissue blocking the flow of urine.
Erectile dysfunction and difficulty ejaculating. These are fairly rare complications with laser surgery. In fact, it is one of its main advantages, since it minimizes this type of serious sequelae. Open surgery with a scalpel has a greater risk of producing these complications due to the fact that some nerves that go to the penis could be cut, decreasing its sensitivity.

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Frequently asked questions about laser prostate surgery

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Can laser surgery be used to treat prostate cancer?

Although much less common than open surgery with a scalpel, lasers can also be used to surgically treat this disease. However, surgeons and urologists are faced with a problem: the cancer is often poorly located within the prostate, complicating its resection by means of a transurethral laser.

Can i have sex after prostate surgery?

Doctors advise against having sex for at least two weeks after prostate surgery because ejaculation could be painful, hemorrhagic (hemospermia) and slow the healing process of the urethra.

How long does the surgery take?

This type of surgery is usually quite fast compared to traditional techniques. It rarely exceeds two or three hours of surgery (added to the 24 or 48 hours of hospital recovery).