Laser Prostatectomy (HoLEP, ThuLEP)

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Laser Prostatectomy (HoLEP, ThuLEP)

What is a laser prostatectomy?

It is an operation to remove the obstructing part of the prostate gland which is

causing your urinary symptoms, to allow free flow of urine.

What is the prostate?

It is a walnut sized gland that sits at the base of your bladder surrounding the

urethra (the tube through which you urinate). As you get older, the prostate

gland grows and can cause an obstruction to the flow of urine leaving the

bladder, thus causing problems with urination.

What are the advantages of having laser prostatectomy rather

than standard prostate surgery?

Laser prostatic surgery has a number of advantages over standard prostate

surgery (TURP). These include:

  • Less bleeding
  • Reduced catheterisation time after the operation
  • Reduced time in hospital
  • Quicker recovery time

Alternatives to Laser Prostatectomy

  • Drugs
  • TransUrethral Resection of the Prostate (TURP) – the more traditional prostate surgery, which is still more suitable for some patients
  • Long term indwelling catheter or intermittently passing a catheter yourself
  • Open prostate surgery
  • Observation of symptoms

How is a Laser Prostatectomy performed?

  • Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All anaesthetic methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthesia to you before your surgery.
  • The operation is carried out through a telescope passed up your urethra, therefore there are no external cuts or scars. The laser fibre is passed down the telescope and the prostate is cored out in 2-3 large pieces. These pieces float into the bladder and, at the end of the operation, they are chopped up and sucked up by a special instrument called a morcellator. The operation, on average, takes 60-120 minutes, depending on the size of your prostate.
  • At the end of the operation, a catheter (fine tube) is passed into your bladder to drain the urine and any blood. The catheter usually stays in place for 12-48 hours. Occasionally it may be necessary to leave it in place for longer, until any bleeding settles.

After the Operation

  • After your operation you will normally go back to the urology ward. You can start eating and drinking as soon as you recover from the anaesthetic.There is always some bleeding from the prostate area after the operation. The urine is usually reasonably clear of blood after 24-48 hours, although some patients may lose more blood for a longer period of time. It is unusual to require a blood transfusion after laser surgery. It is useful to drink as much fluid as possible in the first 12 hours after the operation, because this helps to clear the urine of any blood more quickly.
  • Sometimes we will flush fluid through your catheter to help to clear the urine of blood. The catheter is generally removed 12-48 hours after your operation, although sometimes it is necessary to leave it in place for longer, and some patients may go home with a catheter in place. 
  • The catheter is removed usually after 5 days. At first, it may be painful to pass urine and it may happen more frequently than normal. Any initial discomfort can be relieved by painkillers and the frequency usually improves within a few days, although it is not unusual for it to last longer. Some of your symptoms, especially frequency, urgency and getting up at night to pass urine, may not improve for several months. This is because these symptoms are often caused by bladder over-activity (which takes time to resolve after prostate surgery) rather than prostate blockage. 
  • Since a large portion of prostate tissue is removed with the laser technique, there may be some temporary loss of urinary control until your pelvic floor muscles strengthen and recover.
  • It is not unusual for your urine to become bloody again for the first 24-48 hours after the catheter is removed. Some blood may be visible in the urine even several weeks after surgery but this is not usually a problem. Let your doctor know if you are unable to pass urine and feel as if your bladder is full after the catheter is removed. Some patients, particularly those with small prostate glands, are unable to pass urine at all after the operation due to swelling of the prostate area. If this should happen, we normally pass a catheter again to allow time for the swelling to resolve and the bladder to regain its function. Usually, patients who require re-catheterisation go home with a catheter in place, and the nursing staff will make an appointment for you to attend the hospital to have your catheter removed at the appropriate time. A second catheter removal is usually successful in almost all cases.

Discharge Information and Advice

When you leave hospital, you will be given a draft discharge summary of your

admission. This holds important information about your inpatient stay and

your operation.

Bleeding

It is quite normal to see an occasional show of blood – this is due to the

healing of the operation site. If you see blood, simply increase your fluid

intake and take more rest until it has settled. If you have prolonged bleeding

(more than 24 hours), increasing difficulty in passing urine or feel feverish or

unwell, please contact doctor.

Bowels

It is important that you don’t get constipated. There are no dietary restrictions

but you should try to eat plenty of fruit and vegetables. If you feel that you

may be constipated, please see your doctor.

Exercise

You should avoid strenuous exercise for a week, although it is important to

get some gentle exercise like walking, as you will be at slight risk of

developing a blood clot in your legs (as after any type of surgery). After the first week, you can usually go back to leading a normal life.

What are the risks?

Most procedures are straightforward; however as with any surgical procedure there is a chance of side effects or complications. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Serious or frequently occurring risks

Common (greater than 1 in 10)

  • Temporary mild burning, bleeding and frequency of urination after the procedure.
  • No ejaculation (semen) is produced during an orgasm in approximately 75% of men if the prostate is fully enucleated
  • Treatment may not relieve all the urinary symptoms
  • Poor erections (impotence in approximately 14% of patients)
  • Infection of the bladder, kidney or testes requiring antibiotics
  • Possible need to repeat treatment later due to re-obstruction (approximately 10%)
  • Injury to the urethra causing delayed scar formation
  • Loss of urinary control (incontinence) which reduces within 6 weeks (10-15% of patients). This can usually be improved with pelvic floor exercises.

Occasional (between 1 in 10 and 1 in 50)

  • May need self-catheterisation to empty bladder fully if the bladder is weak.
  • Failure to pass urine after surgery requiring a new catheter.
  • Bleeding requiring return to theatre and/or blood transfusion (less than 2%)

Rare (less than 1 in 50)

  • Finding unsuspected cancer in the removed tissue which may require further treatment. The prostate tissue removed is analysed to look for cancer.
  • Retained tissue fragments floating in the bladder which may require a second telescopic procedure for their removal.
  • Very rarely, perforation of the bladder requiring a temporary urinary catheter or open surgical repair.
  • Persistent loss of urinary control which may require a further operation or management with incontinence pads or a long term catheter.
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