Treatment: Greenlight Laser Treatment

What is Greenlight laser treatment and what is it used for?

Photoselective Vaporisation of the Prostate  (PVP) , or Greenlight laser prostatectomy, is a surgical procedure using a high powered laser to vaporise and remove the occlusive or restrictive part of the prostate, creating a wide cavity through out the length of the gland, in an effort to maximise relief of obstruction by the prostate to relieve and improve bothersome lower urinary tract symptoms. The wavelength of the laser, means that tissue is removed but at the same time bleeding from the prostate is minimised leading to a lower risk of bleeding issues both during and after the procedure compared other surgical procedures, particularly for those men taking blood thinners for other medical reasons. The ability to predictably minimise bleeding allows a shorter period of post-operative catheterisation and more predictable and shorter hospital stay. This was shown in a high quality randomised trial that  also demonstrated equivalent efficacy of Greenlight Prostatectomy to the reference standard TURP in terms of the level of symptom improvement and longevity of effect and benefit

What does a typical Greenlight laser appointment entail?

Greenlight laser prostatectomy or PVP, is performed under either a general anaesthetic or a local spinal anaesthetic (numbed up from the waist down after an injection in the spine). The length of the procedure is determined by the size of the prostate, but on average will take 60 minutes or so. A telescope within a sheath is passed down the water pipe or urethra, to the prostate and the laser energy is delivered through a fibre and under direct vision to the prostate, rapidly vaporising tissue to create a wide cavity through the prostate. At the end of the procedure, a urinary catheter (drainage tube from the bladder) is left in place and typically this can be removed the next day, or witjhin a few days. PVP maybe performed as a daycase or with an overnight stay in hospital.

Is Greenlight laser treatment painful?

The procedure iteslf is not painful, as it is performed with formal anaesthesia. After the procedure, the catheter maybe the cause of mild to moderate discomfort. Patients rarely complain of any real pain.

Are there any risks associated with Greenlight laser treatment?

Once the catheter is removed, care will be taken to make sure that the patient is passing urine normally. There maybe blood in the urine on and off for a few weeks, there maybe some increased frequency and urgency of urination, but like the blood, this tends to settle over 2 to 4 weeks, although, on occasion, it may take longer, even a month or two. Evidence suggests equivalence of longevity of benefit to the standard TURP whilst the risk of dry ejaculation and some loss of erectile function are similar - ranging from 45 - 70% for dry ejaculation and less than 5% for deterioration in erectile function.

Greenlight laser PVP is a surgical option for all shapes and most sizes of prostates, careful discussion with an expert urologist is needed to understand if Greenlight laser is a good option for you.