GreenLight Laser Treatment for BPH

What is GreenLight Laser Treatment?

GreenLight laser is a treatment that combines the effectiveness of Transurethral Resection of the Prostate (TURP), with fewer side effects. GreenLight uses laser energy to remove enlarged prostate tissue. This results in an open channel for urine flow, but with less risk of sexual and other side effects common with TURP.

For many years, TURP (transurethral resection of the prostate) has been the benchmark for surgical treatment of symptoms caused by an enlarged prostate, but it can be associated with certain complications. For a list of these, see TURP.

The GreenLight Laser is a form of laser prostate surgery that has been available for a few years, and has been put to the test against TURP in clinical studies. The results are very encouraging, and they suggest that:

• GreenLight laser offers outcomes that are similar to TURP, specifically a significant improvement in urinary flow, and this improvement is maintained in the long-term.
• The urinary catheter inserted after the operation is typically removed in 12-24 hours (the average length of catheterisation is longer with TURP).
• Average patient stay in hospital is one day with GreenLight compared to 3.4 days for patients undergoing TURP.
• There is no significant risk of fluid absorption (this can happen with TURP)
• There is a lower risk of blood transfusion with GreenLight
• Less than 1% of GreenLight patients report erectile dysfunction
• One third of patients report retrograde ejaculation with GreenLight (retrograde ejaculation is almost certain after TURP)

How is the procedure performed?

GreenLight Laser Treatment is a telescope (endoscopic) procedure performed under general or spinal anaesthetic to treat symptoms caused by an enlarged prostate.

A small laser fibre is passed down the telescope. The fibre delivers high-powered energy to the prostate, causing heating and then vaporisation of excess prostate tissue. The process is continued until the excess tissue has been reduced. Because of the way the laser works, bleeding is less than with TURP. A catheter is inserted for a short time after the procedure, and when removed, urine flow is restored.

The procedure combines the effectiveness of the traditional operation (TURP) with fewer side effects. The result is a wide-open channel for urine to pass, with fewer side effects, including reduced bleeding and reduced impotence (erectile dysfunction) rates compared to TURP.

Typically, a one night stay is needed, which is less than with most TURPs, and the catheter can be removed much more quickly.

Common questions about GreenLight Laser treatment

How long is the stay in the hospital after a GreenLight procedure?

Usually one night after the procedure, but this may vary according to your general health and any other medical conditions.

Where is the procedure performed?

Nick Brook performs this procedure at Flinders Private Hospital.

Will the GreenLight Laser treatment treatment affect my sexual function?

Less than 1% of patients experience sexual dysfunction. One-third of patients experience retrograde ejaculation after the procedure.

How long before my symptoms improve?

Most patients experience rapid relief of symptoms and improvement in urine flow within 24 hours of the procedure. However, medical history, health conditions, and other factors can influence treatment and recovery.

Will I continue to need BPH medications after the GreenLight Laser treatment?

As with any medication, ask your doctor what is appropriate for you. Most patients are able to stop taking their BPH medications within a few weeks after GreenLight.

How soon can I return to work and other normal activities?

Most patients can resume normal activities within a couple of days. Strenuous activities can be resumed within 2 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 GreenLight laser treatment offers lasting symptom relief for at least 5 years.

Is GreenLight treatment covered by insurance?

Medicare and private insurance plans cover the procedure.

Will I need to have a catheter?

Many patients require a catheter following the procedure for a short time. It is typically removed in 12-24 hours. 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.

Can I have a GreenLight laser procedure if I've had previous enlarged prostate treatments or surgery?

Many patients who have had previous treatments have been successfully treated with GreenLight laser.

My doctor has recommended that I have a TURP. Can I still have the GreenLight procedure?

In general, patients suitable for TURP can be considered for a GreenLight procedure. However, you and your urologist will need to make that determination based upon your individual condition and desired outcomes.

How do I know if I am suitable for GreenLight treatment?

Only a urologist can determine if you are a candidate, based upon your history and physical examination, as well as their clinical judgment.

Other options

There are a number of other options that will be discussed with you, if appropriate to your condition. These include:

• Doing nothing, just watching your symptoms
• Treatment with medication rather than surgery
• Other surgical options for treatment

What to expect after GreenLight Laser Treatment

The catheter will generally be left in overnight, but can sometimes be removed 12 hours after the operation. Usually, you will be able to pass urine soon after the catheter is removed, and then go home. Most patients experience a rapid improvement in symptoms and flow in the first 24 hours.

Most patients return home after one night in hospital and can return to normal, non-strenuous activities within days.

You are likely to experience some a mild burning sensation for a week or two when passing urine. You may see small amounts of blood in your urine for a short time, and there may be some frequency and ugency, that will settle over time as the bladder adjusts to the lack of obstruction from the prostate.

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

• A feeling of urgency and frequency of urination for a short time afterwards.
• A small amount of bleeding in the urine.
• Retrograde ejaculation.

Rare

• Patients with a history of poor bladder function 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 dysunction (impotence). Results from large series indicate the rate is about 1%.
• Infection in the bladder.

Very rare

• The need to return to theatre for bleeding or delayed bleeding in the urine.
• Sepsis, caused by infection in the bladder.

You should contact your urologist urgently, 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

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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.

These figures above are amalgamated from the references listed. Most of these studies are not randomised studies, so the treatment populations may be different, but every effort has been made in this text to provide an accurate assessment of outcomes.

References

1. Spaliviero M, Araki, M, Wong C. Short-term outcomes of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH), J Endourol. Oct 2008; 22 (10):2341-7.
2. Bouchier-Hayes D, Anderson P, Van Appledorn S, Bueja P, Costello A. KTP laser versus transurethral resection: early results of a randomized trial. J Endourol. Aug 2006; 20(8):580-5.
3. 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.
4. Nielsen KT, Christensen MM, Madsen PO, Bruskewitz RC. Symptom analysis and uroflowmetry 7 years after transurethral resection of the prostate. J Urol. Nov 1989; 142(5):1251-3.
5. Malek RS, Kuntzman RS, Barrett DM. Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol. Oct 2005; 174(4 Pt 1):1344-8.
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.