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Laser surgery for benign prostatic hyperplasia


What is benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland in older men. As the prostate grows, it can compress the urethra, causing urinary symptoms. This includes difficulty starting or stopping the flow of urine, increased frequency, and feeling like you are not completely emptying your bladder.

Although BPH is common with age, it is not linked to prostate cancer. Treatments may include medications to relieve symptoms or, in more severe cases, surgical procedures. It is crucial to consult a doctor to evaluate symptoms and determine the best treatment approach.

What laser treatment options does Dr Puche offer?

Vaporization. Green laser.

Green laser prostate vaporization uses the laser to vaporize and remove excess prostate tissue that is causing a blockage in the urethra. With this technique the tissue vaporizes, “disappears.” The green laser emits light that is absorbed by the prostate tissue, generating heat and vaporizing the affected area. This method is less invasive than traditional surgical techniques and is generally performed on an outpatient basis. Green laser vaporization can provide relief from urinary symptoms associated with mild-moderate BPH, improving the patient’s quality of life.

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Dr Puche performing green laser photovaporization

Enucleation. Thulium laser or Holmium laser (HoLEP)

Enucleation is different from vaporization. For this reason, other types of lasers such as thulium or holmium (HOLEP) are used. In this case, the laser is used to cut and remove excess prostate tissue that is blocking the urethra. In this technique, the tissue does not “go away” so it must then be removed with a special endoscopic device called a “morcellator,” which cuts the prostate tissue into small pieces that are easily removed. Enucleation of the prostate with holmium or thulium laser may be an option for men who have moderate-severe BPH, improving the patient’s quality of life.

What laser treatment options does Dr Puche offer?

The laser has clear advantages over conventional surgery. The following can be listed:

How do I know if I should have laser prostate surgery? What can I expect from surgery?

Urinary symptoms derived from BPH are subjective. Each patient perceives and experiences them in a specific way. The final decision to have prostate surgery rests with the patient himself. The duty of the urologist is to provide sufficient information so that the patient understands and accepts the risks and benefits that may arise from this intervention, what can be expected from the surgery and what possible complications exist.

In general terms, laser prostate surgery will help reduce urinary symptoms caused by BPH, which include:

On other occasions, surgery is indicated to solve or reduce complications secondary to chronic urinary obstruction, such as:

Laser prostate surgery can provide a solution or reduce the intensity of these symptoms and complications. Knowing this, the patient and his urologist must decide together and on an individual basis, if the potential complications are acceptable in each specific case.

What complications or risks can laser prostate surgery have?

Although risks and complications are less likely with laser surgery than with traditional surgery, it is necessary to know that they exist. The following can be listed:

  • Temporary difficulty urinating. You may have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a catheter. Usually for a few days.
  • Urinary tract infection. This type of infection is a possible complication after any prostate procedure. The longer the catheter is in place, the greater the chance of infection. You may need antibiotics to treat the infection.
  • Stricture of the urethra. Scars left after prostate surgery can block the flow of urine and other treatment may be necessary.
  • Absence of ejaculation from the penis. A common, long-term effect of any type of prostate surgery is retrograde ejaculation (semen goes into the bladder and does not come out through the penis). It is not painful and usually does not affect sexual pleasure. However, it can interfere with the ability to father a child.
  • Erectile dysfunction. The risk of erectile dysfunction after prostate treatments is small and is generally lower with laser surgery than with traditional surgery.
  • Need to repeat treatment. Some men need follow-up treatment after laser vaporization surgery because not all of the tissue is removed or because it may grow back over time.

How do I choose the best technique and the best laser?

Although it seems easy, this question is tremendously complex. Like many things in medicine, one technique or another and one laser or another is chosen based on many factors. The type of prostate, its shape, its size, the patient’s personal history and other pathologies, the anesthetic risk, the existence of previous surgeries, the preferences of the surgeon and the patient. All of these factors have different weights and must be assessed in each specific patient.

To date, there is no laser that is better than another, nor has it been conclusively demonstrated that one technique is an improvement over another. Therefore, the possibility of choosing between the different treatments available is a guarantee to optimize the results of the surgery for each patient profile.

A día de hoy, no existe un láser mejor que otro ni se ha conseguido demostrar fehacientemente que una técnica sea mejora que otra. Por ello, la posibilidad de elegir entre los distintos tratamientos disponibles es una garantía para optimizar los resultados de la cirugía en cada perfil de paciente. 

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