The Operation
Holmium Laser Prostatectomy (HOLRP) and Thulium Laser Prostatectomy have become the “Gold Standard” for benign prostatic obstruction.
Length Of Operation
Usually one hour but this can vary depending on the size of your prostate.
Hospital Stay
The hospital stay is significantly less with the laser resection using Holmium or Thulium; normally just an overnight stay compared to 3 or 4 days with the older-style “TURP” operation.
Risks / Side Effects
There is very little bleeding with laser resection, whereas the risk of blood transfusion with “TURP” is between 5 and 10%. The recovery time with laser technique is also quicker. Patients normally only need a catheter for 1 day after surgery, rather than 3 to 4 days as with the “TURP”.
The risk of bleeding after discharge home is also less with the laser technique. In about 5% of cases with the “TURP” there is heavy bleeding, sometimes requiring replacement of the catheter.
Please do not hesitate to phone me any time if you feel there is a blockage present.
“Late failure” of the procedure, the very small chance of the procedure not working and development of strictures: equivalent in both the laser technique and the “TURP”.
Anaesthetic
Either a spinal or a general anaesthetic is used and there is very little pain felt following the procedures.
Costs
The costs of both techniques are similar.
After the Operation
It is common to experience some or all of the following symptoms:
- It is normal to pass some blood, either in the form of pinkish to red urine, or the occasional clot. Quite large clots can come away around about day 10. Following both operations you should drink plenty of fluids to keep the urine clear and flowing.
- Although it varies greatly from individual to individual, a certain amount of burning and discomfort is quite normal following prostate surgery. This should steadily improve, but if it gets worse you should visit your GP or contact me to check whether you may have an infection.
- A discomfort at the end of, or at the beginning of passing urine is common and may last for many weeks. This is usually quite mild and gradually improves with time. No treatment is necessary.
- The urine flow is usually quite brisk and forceful following surgery, even after the first day or two when the catheter is out, but it may also spray quite a bit. In addition it is normal to feel quite marked urgency and also pass urine more frequently than perhaps you did before the operation. Again these symptoms settle.
- In both types of operation one may develop late scarring of the water-pipe. This can occur in two places. In both situations after initially a good result, there would be a gradual deterioration in the flow noticed. The two places are:a). At the neck of the bladder, immediately where the prostate joins the bladder, narrowing is known as a bladder neck stenosis and this is remedied by a simple operation cutting the ring of scar tissue that is narrowing the pipe.b). Urethral stricture – a thin ring of scar tissue can occur within the water-pipe itself anywhere from the prostate to the tip of the penis, narrowing the canal and reducing the flow. This is easily treated but may require several re-treatments.
- While erections should not be affected, prostate surgery will result in so-called retrograde ejaculation. At climax instead of semen being ejected from the penis, some or all of the fluid will travel back into the bladder from where it will pass out harmlessly the next time you pass urine. The sensation of orgasm changes very little, if at all.
Summary
Generally these operations are relatively painless and result in a marked increase in the flow. Complications are very occasional and in almost all situations they are minor.