Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by an enlarged prostate — a condition known as benign prostatic hyperplasia (BPH).
During prostate laser surgery, your doctor inserts a scope through the tip of your penis into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. A laser passed through the scope delivers energy that shrinks or removes excess tissue that is preventing urine flow.
Lasers use concentrated light to generate precise and intense heat. There are several different types of prostate laser surgery, including:
- Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel.
- Holmium laser ablation of the prostate (HoLAP). This procedure is similar to PVP but uses a different type of laser.
- Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEPcan be an option for men who have a severely enlarged prostate.
The type of laser surgery your doctor recommends will depend on several factors, including:
- The size of your prostate
- Your health
- The type of laser equipment available
- Your doctor’s training
Why it’s done
Prostate laser surgery helps reduce urinary symptoms caused by BPH, including:
- Frequent, urgent need to urinate
- Difficulty starting urination
- Slow (prolonged) urination
- Increased frequency of urination at night
- Stopping and starting again while urinating
- The feeling you can’t completely empty your bladder
- Urinary tract infections
Laser surgery might also be done to treat or prevent complications due to blocked urine flow, such as:
- Recurring urinary tract infections
- Kidney or bladder damage
- Inability to control urination or an inability to urinate at all
- Bladder stones
- Blood in your urine
Laser surgery can offer several advantages over other methods of treating BPH, such as transurethral resection of the prostate (TURP) and open prostatectomy. The advantages can include:
- Lower risk of bleeding. Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn’t allow their blood to clot normally.
- Shorter or no hospital stay. Laser surgery can be done on an outpatient basis or with just an overnight hospital stay.
- Quicker recovery. Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.
- Less need for a catheter. Procedures to treat an enlarged prostate generally require use of a tube (catheter) to drain urine from the bladder after surgery. With laser surgery, a catheter is generally needed for less than 24 hours.
- More-immediate results. Improvements in urinary symptoms from laser surgery are noticeable right away. It can take several weeks to months to see noticeable improvement with medications.
Risks of laser surgery can include:
- Temporary difficulty urinating. You might have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.
- Urinary tract infection. This type of infection is a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place. You will likely need antibiotics to treat the infection.
- Narrowing (stricture) of the urethra. Scars after prostate surgery can block urine flow, leading to additional treatment.
- Dry orgasm. A common and long-term effect of any type of prostate surgery is the release of semen during ejaculation into the bladder rather than out of the penis. Also known as retrograde ejaculation, dry orgasm isn’t harmful and generally doesn’t affect sexual pleasure. But it can interfere with your ability to father a child.
- Erectile dysfunction. The risk of erectile dysfunction after prostate treatments is small and generally lower with laser surgery than with traditional surgery.
- Need for retreatment. Some men require follow-up treatment after laser ablative surgery because not all of the tissue is removed or it might grow back over time. Men who have HoLEP generally don’t require re-treatment because the entire part of the prostate that can block urine flow is removed.
Serious long-term complications are less likely with prostate laser surgery than with traditional surgery.