Prostatectomy: What To Expect During Surgery And Recovery
If youve been diagnosed withprostate cancer, your doctor will consider many factors before recommending the besttreatment. For many men, that may mean a prostatectomy. In this surgery,doctors remove the entire prostate.
The Johns Hopkins Hospital performs more of these procedures than almostanywhere else in the world. One of the most common questions they hear frompatients: What should I expect after surgery?
Johns Hopkins urologistMohamad Allaf, M.D., explains the surgery and recovery.
Do Laser Treatments Have Any Advantages Over Turp
As well as the standard approaches such as TURP, there are a number of other surgical techniques. They mainly differ in terms of the instruments and sources of energy used to remove or destroy the prostate tissue. Most of the other techniques are carried out using laser beams. Like in TURP, the instruments are inserted into the urethra and guided to the prostate.
The laser treatments include:
- Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995 332: 75-79.
IQWiG health information is written with the aim of helpingpeople understand the advantages and disadvantages of the main treatment options and healthcare services.
Because IQWiG is a German institute, some of the information provided here is specific to theGerman health care system. The suitability of any of the described options in an individualcase can be determined by talking to a doctor. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by ateam ofhealth care professionals, scientists and editors, and reviewed by external experts. You canfind a detailed description of how our health information is produced and updated inour methods.
Types Of Radical Prostatectomy
The type of radical prostatectomy performed can vary and depends on the hospital. Keyhole surgery, minimally invasive surgery, involves making five or six cuts to remove the prostate. Robot-assisted surgery means the surgeon uses three robotic arms controlled from a computer. During open surgery, a single cut is made in the stomach.
Unfortunately, incontinence is a common side effect of Prostate Surgery. However, incontinence experienced by men is often only light and temporary. But exactly how long do you have incontinence after Prostate Surgery?
Recommended Reading: Does Enlarged Prostate Affect Ejaculation
Is Greenlight Right For Me
The best way to find out is by talking with your doctor to determine if GreenLight Laser Therapy is a good treatment for you based on your symptoms and treatment goals. Start by taking our BPH Quiz. Then bring a printout of the results with you to your appointment. Need to find a doctor who specializes in GreenLight Laser Therapy? Use our doctor finder to locate one near you.
Interested in receiving more information? to receive the latest updates and resources about BPH treatment options.
Alternatives To Laser Prostatectomy
- Medication medication is usually not as effective as surgery, can have side effects, and you will need to take it for the rest of your life.
- Urolift procedure.
- Transurethral Prostatectomy is the standard operation for prostate enlargement. Laser Prostatectomy has similar effectiveness to TURP in published studies. TURP has a higher risk of bleeding compared to laser prostatectomy so you may need to stay in hospital a day or two longer with a catheter.
- Transurethral Incision of Prostate – also sometimes called Bladder Neck Incision. May be recommended for small prostates.
- Open prostate operation higher risk of complications and longer recovery so only recommended in really large glands, that are too big to manage with minimally invasive surgery.
- Long-term catheter can cause significant discomfort and complications, so only recommended if you are not fit for an operation.
- Observation of symptoms is a good option if your symptoms are mild and dont trouble you.
Also Check: Prostate Transitional Zone
Understanding Greenlight Laser Therapy
Benign Prostatic Hyperplasia
BPH or benign prostatic hyperplasia or hypertrophy is a benign enlargementof the prostate. The prostate is located below the bladder and surroundsthe urethra . Its main function is to produce fluid thattransports sperm during ejaculation. In many middle-aged men the prostatebegins to grow for reasons not fully understood. This benign growth cancause many urinary symptoms in men.As the prostate enlarges it impinges upon the urethra. This pressure canobstruct urinary flow and elicit urinary problems such as:
- Urgency, sudden urge to urinate
- Retention, inability to urinate
In many instances these symptoms can diminish or resolve with the use ofmedications. Typically, an alpha blocker such as Flomax or Doxasozin isused in combination with an alpha reductase inhibitor such as Proscar orAvodart for maximal medical management. These are safe medications thatmany men stay on for years without difficulty. But often these medicationslose their efficacy or don’t relieve the symptoms well and furthertreatment is necessary. Surgical intervention is the next step.
GreenLight Laser Therapy
What Are The Risks
All surgical treatments have inherent and associated risks. The GreenLight Laser System is intended for the removal of soft tissue, including vaporization of the prostate for benign prostatic hyperplasia . Potential risks include irritative symptoms, bleeding, retrograde ejaculation and urinary tract infection. You should talk with your doctor about benefits and risks before moving forward with any treatment option.
Also Check: What Is Perineural Invasion In Prostate Cancer
What Are The Risks Or Potential Complications Of Holmium Laser Enucleation Of The Prostate
- Injury to the urethra or development of scar tissue at a later date.
- Injury to the capsule of the prostate .
- Injury to the bladder or ureteral orifices .
- Infection of the bladder, testes or kidneys.
- Return of urinary obstruction at a later date requiring another operation .
- Need for transfusion or reoperation due to bleeding.
- Failure to relieve all symptoms and/or need for prolonged catheterization after surgery.
- Five to 15 percent of patients are found to have previously undiagnosed prostate cancer in their prostate specimen. Prostate cancer can be treated after HoLEP.
- Standard risks of anesthesia including blood clots, heart attacks, etc.
What You Should Know:
- Laser prostatectomy is a surgery done to treat benign prostatic hypertrophy, also called BPH. BPH is not a type of cancer. BPH is a condition where the prostate gland becomes larger than normal. The prostate is a male sex gland that helps make semen. It is located below the bladder and wraps around the urethra like a donut. The urethra is the tube that carries urine from the bladder into the penis. The urine flows through as it is passed out of the body. With BPH, an enlarged prostate can squeeze the urethra and block urine flow making it harder to urinate .
- A laser prostatectomy may be done on an out-patient basis or during a hospital stay. During this surgery, no incisions are made in your abdomen or genital area. Caregivers insert special tools and scopes through your penis and urethra to do the surgery. A scope is a long metal tube with a light and tiny video camera on the end. This gives caregivers a clear view of the prostate area while watching the images on a monitor. Different types of lasers may be applied to open blocked channels or destroy excess prostate tissues. You and your caregiver will decide which type of surgery for your BPH is right for you. With laser prostatectomy, your prostate may become smaller and the symptoms of BPH may be relieved.
What Are The Side Effects Of Green Light Laser Surgery
Side effectssurgeryGreenLightsurgeryside effects
Similarly, you may ask, how long does it take to recover from prostate laser surgery?
Complete healing may take about 4 to 6 weeks. Do not have sex for 2 to 3 weeks. You may have problems ejaculating. Your semen might flow into the bladder instead of the penis .
Also, how much does green light laser surgery cost? The total cost of Greenlight PVP was $3836 per patient compared to $4963 for TURP and $4978 for bipolar TURP. The linear regression showed that the Charlson Comorbidity Index and type of procedure were independent predictors of total cost.
Subsequently, question is, what happens after green light laser prostate surgery?
The following are a few tips to aid your recovery:
- Fluid Intake. During the first 1-2 weeks after the operation, it is important to drink plenty of fluid to flush any new bleeding from the bladder.
- Antibiotics. Sometimes after GreenLight Laser Prostatectomy, patients are discharged on antibiotics.
Does green light laser surgery cause impotence?
While GreenLight Laser has fewer complications than other surgical treatments, side effects of the treatment still occur. As with all prostate surgery, sexual side effects may include retrograde ejaculation, and in rare instances, erectile dysfunction .
Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
Don’t Miss: Is Zinc Good For Prostate
Why Prostate Laser Surgery
Compared to open prostatectomy and transurethral resection of the prostate, prostate laser surgery offers significant advantages to the patient. They include a general lower risk of post-surgery bleeding, a much shorter hospital stay , and a much quicker recovery. Men who undergo prostate laser surgery for BPH will also, in contrast to other procedures, generally notice an improvement in their urinary output and comfort right away. They are highly unlikely to need a urinary catheter for longer than 24 hours, again unlike with other procedures.
Long-term complications are also much less likely with prostate laser surgery than with more traditional forms of prostate surgery. Though that is good news, laser prostate surgery still carries both short-term and long-term risks, just like practically any other surgery. What are they?
What Happens During A Holmium Laser Enucleation Of The Prostate Procedure
- HoLEP requires the patient to be under general anesthesia . If a patient cannot have general anesthesia for some reason, a spinal anesthetic can be usedâthis allows him to remain awake but blocks all feeling from the waist down.
- An injection of an antibiotic is given to reduce the chances of infection.
- The patient is placed on his back with the legs raised during the procedure.
- A surgical instrument called a resectoscope is inserted through the urethra . The resectoscope includes a camera that allows the surgeon to view the internal structure of the prostate gland, and to see where incisions are being made during surgery.
- The laser is inserted into the resectoscope and is used to enucleate the enlarged prostate tissue from the capsule and then to seal up any blood vessels. The tissue that has been removed is deposited in the bladder.
- The laser is removed from the resectoscope and is replaced by a morcellator. This device is used to suction out the tissue that was left behind in the bladder.
- When tissue removal is complete, the resectoscope is withdrawn and a urinary catheter is put in place.
Recommended Reading: Bph Medications With Least Side Effects
What To Expect After Prostate Laser Surgery
Laser surgery is an increasingly widely-used technique in men who were diagnosed with benign prostatic hyperplasia, an enlargement of the prostate that occurs in most men, to some degree, with age. Compared to traditional prostate surgery methods, prostate laser surgery has some distinct advantages. They include a lower risk of serious post-surgery bleeding, a much shorter hospital stay or the possibility of being treated on an outpatient basis, a significantly reduced need for a urinary catheter, and a much quicker recovery.
Nonetheless, prostate laser surgery, though delivered through concentrated beams of light that either vaporize or cut off excess prostate tissue rather than with a scalpel, is surgery. All forms of surgery carry some degree of risk, and all forms of surgery depend on you the patient to follow the appropriate aftercare guidelines delivered by your surgeon to the letter.
Which Is Better Turp Or Laser
Laser surgery. Laser procedures usually give you symptom relief and better urinary flow similar to TURP . However, some laser therapies produce fewer side effects than others and also reduce the risk of bleeding. Long-term studies are needed to find out whether laser treatments are as effective as TURP .
Read Also: Expressed Prostatic Secretion
What Is Green Light Laser Surgery
GreenLight laser prostatectomy is a procedure in which the excess prostate tissue is removed to relieve constriction of the urethra, allowing easy passage of urine. During the procedure , which is also known as photoselective vaporization of the prostate , the patient is sedated.
Follow The Diet Your Healthcare Provider Recommends
Depending on the type of ablation procedure youre having, you may need to follow a light diet or a low residue diet. Your healthcare provider will check the box below next to the diet you should follow. Start following it the morning of the day before your procedure.
- Light dietFollow a light diet, such as small sandwiches, eggs, toast, crackers, soup, or cereal. Limit the amount of dairy products and avoid fried foods and foods with a lot of seasoning.
- Low-residue dietFollow a low residue diet. This diet limits high-fiber foods, such as whole grain breads and cereals, nuts, seeds, and raw or dried fruits and vegetables. You should also limit the amount of dairy products you have.
Also Check: Does Enlarged Prostate Affect Ejaculation
How Is Laser Enucleation Of The Prostate Performed
For laser enucleation, you will receive general, spinal, or intravenousanaesthesia. Once you are under anaesthesia, the doctor uses a laser resectoscope to enter your bladder through the urethra without making an incision in your lower abdomen . The resectoscope has a small camera through which the doctor can see the prostate.
During laser enucleation, the doctor uses the laser to cut prostate tissue, and in this way, the enlarged prostate can be treated . The doctor then uses an instrument known as morcellator to flush the cut tissue out of your body through the bladder and the urethra.
After the operation, a urinary catheter is placed in your bladder to drain urine. It is also used to continuously flush your bladder and urethra with a sterile solution to prevent blood clots. You will need the catheter for some days until the urethra is healed and you can urinate on your own.
What Are The Side Effects Of Holmium Laser Enucleation Of The Prostate
The most common side effects include:
- Temporary burning and bleeding during urination. Some blood may be seen in the urine for weeks after surgery. This is usually not an indication of anything serious, only that the healing process is not yet finished.
- Urinary incontinence is expected in all patients immediately after surgery and they should wear pads for the first few days/weeks. This typically improves over the course of several weeks. Performing Kegel exercises can help decrease leakage from stress maneuvers such as coughing, sneezing, or lifting. The rate of long term leakage from stress maneuvers is low. Patients may also have leakage with urgency and this may be treated with medication. The risk of urge incontinence can be dependent on several factors including age, prostate size, symptoms, and other medical problems.
- Retrograde ejaculation or âbackwards ejaculation.â In 75 percent of cases, the patient will not see any fluid during ejaculation during sexual activity after surgery.
- Erectile function is generally not significantly affected. A small percentage of patients have reported improved erectile function while a small percentage have reported decreased erectile function.
You May Like: Find Prostate Externally
How Long Does It Take To Recover From Holep
Most patients leave hospital the day after surgery without a catheter and are able to pass urine well. It may take a few weeks for urinary symptoms to settle down, however, patients are up and about the next day.
Most patients will require 1-2 weeks before returning to work and driving again. You should also avoid lifting heavy objects and physical straining during this time.
Risks And Complications Of Prostate Laser Surgery
Post-surgery bleeding through the urethra is normal, and it may last a few days to a few weeks. If your bleeding appears to be increasing rather than decreasing, if you notice that you are passing clots, or if the blood you are passing is very thick, you need to follow up with your surgeon.
Burning sensations and a need to pass urine frequently are also normal after surgery, however, if it continues and you are worried, please ask your healthcare provider about the possibility that you have a urinary tract infection, which needs to be treated with antibiotics. UTIs become more likely in men who had a catheter in place for longer. As your bladder has become used to a situation in which you have difficulty urinating, you may find, after your surgery, that the opposite becomes true and that you need to pee more often. This resolves with time.
Some men experience a narrowing of the urethra, causing a difficulty in urinating once again, after their surgery. This is due to scar tissue and will require additional treatment. Likewise, there is the possibility that you will need follow-up surgery because your excess prostate tissue was removed inadequately or because it returned over time.
Also Check: Is Cranberry Juice Good For Prostate Infection