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Laser coagulation of the prostate |
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Laser is a safe tool that need a special experience for its application. The coagulation or heating of the tissues leads to its shrinkage and diminution of the size of the prostate without affecting the integrity of the mucous membrane lining the urethra. This permits a smooth healing and rapid recovery avoiding the hazards of an operation.
The prostate is the male gland situated underneath the bladder neck and resting on the muscles of the pelvic floor. It surrounds a part of the urethra. It is composed of two lateral lobes, a median lobe and the so called seminal Colliculus. This is a small rounded part at the tapered region of the prostate distally where the semen ejects during ejaculation and is considered as the lowest limit of the prostate during operations.
The prostate is responsible for the secretion of the largest part of the semen and is highly influenced by the male hormone testosterone. It enlarges at aging causing trouble at micturition. The mechanism of enlargement is not yet understood. The treatment is usually medical or surgical.
There are many types of laser that are used by me, namely the green light laser, the ND-YAG laser and the Revolex laser.
Who qualifies for the operation ?
Patients who do not profit from medications or have agonising symptoms in particular the obstructive symptoms like weakness of the urinary stream, dribbling after micturition or even complete obstruction of urine. The irritative symptoms, for example running for bladder evacuation in urgency, burning during bladder evacuation and patients suffering from disturbed sleep may also indicate the coagulation of the prostate with laser.
Patients who do not want to may go through the risk of operation by electro resection as bleeding, incontinence or urethral stricture may profit also from the operation.
How does the operation work ?
The patient lies on his back with legs bent in a stretcher. A special catheter is inserted in the bladder through the abdominal wall under local anaesthesia ( this is not a routine procedure or a must). The catheter drains the bladder until complete healing and until the complete reduction of the prostate volume and insurance of good urinary stream through the urethra. The urethra and bladder are inspected with a cystoscope. The prostate is vaporised using the glass fiber of the green light laser where energy is applied from the side of the fiber (side firing) untill the bulk of the lobe is evaporated on both sides. The tissues of the prostate will be devoided of blood and hence they do not bleed on cutting. A urethral catheter is inserted through the urethra.
The patient may stay for few hours maximally a single night in the clinic.
Healing:
Patients are dismissed after treatment to be followed up on out patient basis. The abdominal bladder catheter (suprapubic catheter) usually stays until the patient is able to void urine spontaneously. It is looped and hidden under dressing on the abdominal wall without causing any annoyment to the patient. If this is guaranteed, the suprapubic catheter is removed.
Frequently Asked Questions (FAQ):
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- Is it necessary to have anesthesia?
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Yes, I perform the laser coagulation under light anesthesia.
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- What is meant by a suprapubic catheter?
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This is a form of urinary diversion of temporary nature. It is a draining catheter put in the bladder through the abdominal wall. It is considered the cleanest and safest method of urinary drainage.
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- How does laser work?
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Through the light energy that is converted into heat energy to coagulate tissues and render them bloodless and lifeless.
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- Does the operation effect appear immediately?
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No, there should be a week until the healing is complete. That is why I use a suprapubic catheter until normal urination is resumed.
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- Does this mean that the prostate remains inside?
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No, it is coagulated and its substance evaporates bloodlessly.
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- Should I wear a urethral catheter after the laser coagulation?
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No, I rely on the suprapubic catheter only. The urethral catheter may be put for one or two days. Once spontaneous micturition is resumed, the suprapubic catheter will be removed.
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- Can laser produce incontinence?
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No in the regular standard application it is complications free. The injury to the urinary sphincter can only happen if one coagulates the sphincter directly. This is a rare occasion.
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