Evolve Laser Ablation of the Prostate
The Evolve Laser System for treatment of BPH is an ablative technique for treating symptoms of an enlarged prostate. Rather than resecting (removing) tissue, the laser burns away obstructing tissue. The end result is similar to the traditional TURP operation, and is similar to the Greenlight Laser.
How is the procedure done?
You will need a spinal or general anaesthetic. A telescope is passed up the urethra to the prostate and the bladder is carefully inspected. A laser fibre is passed down the telescope, and the prostate tissue is ablated until there is a good channel through the prostate. A catheter is inserted, and you are woken up. The procedure normally takes between 30 minutes and one hour. Irrigation fluid is dripped into the bladder and out of the catheter overnight, and in most cases the catheter is removed first thing the next morning. You should be able to go home a few hours after the catheter is removed.
There are some potential advantages of ablation over TURP, and some potential disadvantages.
What are the disadvantages of the Evolve Laser procedure compared to TURP?
- We don’t have long term results beyond 5 years for ablative techniques. It is fair to say that TURP remains the ‘gold standard’ because it has been performed for many years with good results. However, ablative techniques are equivalent to TURP at 5 years post-surgery, and there is no reason to think that the good results wont be maintained.
- No prostate tissue is obtained for histology. With a TURP, tissue is sent off to the lab for examination. This is probably not a great disadvantage as long as a urologist has felt your prostate prior to the Evolve laser, and you have had a PSA blood test checked, if indicated.
- For the first few weeks after the procedure, patients can have quite a lot of frequency and urgency of urination, along with dysuria (pain on urination) as the laser burn settles down. This always settles, but can be uncomfortable.
What are the potential advantages of the Evolve Laser procedure compared to TURP?
- Generally a shorter operating time than TURP
- Less blood loss than TURP
- Lower risk of blood transfusion than TURP
- Hospital stay is usually overnight only. Average length of stay with TURP is 3.4 days
- There is no risk of significant fluid absorption with the saline used for ablation. TURP however, requires the use of glycine, which is temporarily absorbed into the body.
- You may be able to stay on blood thinning drugs for an Evolve laser. Usually, these need to be stopped if you are having a TURP.
- There is a lower risk of impotence (erectile dysfunction) with an ablative technique. Large studies suggest the risk is 1% with ablation, and 10% with TURP.
Common questions about Evolve Laser Prostate Ablation
How long is the hospital stay after an Evolve procedure?
Usually one night after the procedure. Your background medical health and conditions dictate the length of stay to some extent, but most people can go home the next day.
Where is the procedure performed?
Nick Brook performs this procedure at Calvary North Adelaide Hospital.
Will the Evolve Laser treatment affect my sexual function?
About 1% of patients experience impotence after ablative procedures for the prostate. One-third of patients experience retrograde ejaculation after the operation.
Will I continue to need BPH medications after the Evolve Laser treatment?
You should be able to stop these medications immediately after the procedure, but sometimes it helps to keep taking them for a few weeks. This will be discussed with you.
How soon can I get back to work and normal activities?
Most patients resume normal activities within a couple of days. Strenuous activities can be resumed within 2 to 4 weeks. Nick Brook will discuss this and your specific condition with you during your consultation.
How long do the results last?
Clinical studies show that ablative prostate treatments offer lasting symptom relief for at least 5 years. We don’t have long tem results beyond 5 years for ablative techniques. It is fair to say that TURP remains the ‘gold standard’ because it has been performed for many years with good results. However, ablative techniques are equivalent to TURP at 5 years post-surgery, and there is no reason to think that the good results won't be maintained.
Is Evolve treatment covered by insurance?
Yes, Medicare and private insurance plans cover the procedure.
Will I need to have a catheter?
Yes, patients require a catheter following the procedure for a short time. It is typically removed the morning after your surgery. However, patients with compromised bladder function or those who have had a catheter in for some time before surgery may need a catheter for a period afterwards.
Will I have discomfort after the procedure?
Most patients experience mild discomfort, such as slight burning during urination, for a week or so. This can be managed with mild pain and anti-inflammatory medications.
How long before my symptoms improve?
Most patients experience rapid relief of symptoms. Improvement in urine flow is usually noticed within 24 hours of the procedure. For the first few weeks after the procedure, patients can have quite a lot of frequency and urgency of urination, along with dysuria (pain on urination) as the laser burn settles down. This always settles, but can be uncomfortable. If you are troubled, temporary medication can help with this.
Can I have an Evolve laser procedure if I've had previous surgery for an enlarged prostate?
Yes, there is no particular reason why you can’t have an Evolve procedure. Any patient who has previous surgery needs very detailed assessment to determine why the symptoms have returned.
My doctor has recommended that I have a TURP. Can I still have the Evolve procedure?
In general, patients suitable for TURP can be considered for a Evolve procedure. However, you and your urologist will need to make that determination based upon your individual condition and circumstances.
How do I know if I am suitable for Evolve laser treatment?
Only a urologist can determine if you are a candidate, based on a history and physical examination, and other tests, as well as their clinical judgment.
Other treatment options
There are other options that will be discussed with you, if appropriate to your condition and medical history. These include:
- Just watching your symptoms over time
- Tablet treatment instead of surgery
- Different kinds of surgical treatment
What to expect after Evolve Laser Treatment
The catheter will be left in overnight, but usually then comes out after Nick Brook has seen you the following morning. If you are passing urine and not retaining much in the bladder, you can then go home.
You will experience a mild burning sensation for a few weeks when passing urine, and you may see small amounts of blood in your urine, on and off for a short time. It is typical to have some frequency and urgency, that will settle over time. You should be able to return to normal activities quite quickly, but it is advised you take at about a week off work, and don’t lift anything heavy or strain for 4 weeks. You should be able to drive after 1-2 weeks. Try to avoid constipation, as the straining can cause some bleeding.
Potential side effects and complications
All procedures have the potential for side effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure. Risks of the anaesthetic need to be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand.
There are specific risks with this surgical procedure, and these will be discussed with you before your procedure. As a guide to complement that one-on-one discussion with your surgeon, these include:
Common
- Urgency and frequency of urination for up to 4 weeks afterwards
- A small amount of blood in the urine.
- Retrograde ejaculation.
Rare
- Patients with a history of bladder function problems or those who have had a catheter for a long time before the operation may not pass urine immediately and may need to have a catheter reinserted for a number of days after the operation.
- Erectile dysfunction (impotence). Results from large series indicate the rate is about 1%.
- Bladder infection needing antibiotics.
Very rare
- The need to return to theatre for early or delayed bleeding in the urine.
- Sepsis, caused by infection in the bladder.
You should contact your urologist, or go to your nearest emergency department if you have any of the following:
- Large amounts of blood in the urine
- A high temperature, or chills/shaking
References:
- Stovsky MD, Griffiths RI, Duff SB. A clinical outcomes and cost analysis comparing photoselective vaporization of the prostate to alternative minimally invasive therapies and transurethral prostate resection for the treatment of benign prostatic hyperplasia. J Urol. Oct 2006; 176 (4 pt 1):1500-6
- Kavoussi PK, Hermans MR. Maintenance of erectile function after photoselective vaporization of the prostate for obstructive benign prostatic hyperplasia. J Sex Med. Nov 2008; 5(11):2669-71.
Disclaimer
This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.
