Laser Prostatectomy

What is laser prostatectomy

A laser prostatectomy is simply an operation performed through an operating cystoscope (telescope in the bladder) that removes prostate tissue that is obstructing outflow from the bladder – the energy source utilized is a laser.

Who needs a laser prostatectomy?

As the prostate is the gland that sits immediately below the bladder through which the urethra (the tube you pass your urine through) passes, it can block the flow of urine as it grows – as it does in all men. When this happens men usually notice they pass urine more slowly, go to the toilet more frequently and need to pass urine at night more often than usual. This can progress all the way to urinary retention – where a man cannot pass urine at all.

Men who have a laser prostatectomy usually fall into one of the following categories and have:

  • Urinary retention.

  • Failed medical therapy.

  • Recurrent urinary tract infections.

  • Recurrent bleeding.

Are there alternatives?

There are a number of options available to treat symptoms caused by an enlarged prostate, though obviously not all are suitable for all men. Alternatives include:

  • Observation and monitoring.

  • Medical therapy.

  • Urolift device.

  • TURP (the same operation using some form of electrocautery as the energy source).

Are there different types of laser prostatectomy?

There are different types of laser used to perform laser prostatectomy. All types aim to achieve removal of the obstructing prostate tissue in a minimally invasive way.

The two most common types of laser are:

  • Holmium – enucleation technique used.

  • Greenlight – vapourisation technique used. This type of laser is especially effective for men who are on warfarin or other ant-coagulants as they do not have to be stopped for the surgery.

What happens in a laser prostatectomy?

Slightly different surgical techniques are used for each type of laser, but from the patient’s perspective there is little difference.

You will receive either a general or spinal anaesthetic – your anaesthetist will discuss which one is best for you prior to the procedure.

The operating cystoscope (telescope) is passed into the bladder, which is then inspected to make sure there is no other pathology present. The laser fibre is then introduced into the instrument and used to remove the obstructing prostate tissue.

A 3-way irrigating catheter is usually left in the bladder overnight (mostly for your comfort) and is usually removed the next morning. You will be discharged home once you have successfully passed urine.

What should I expect after going home?

For a few days after your procedure, it is normal to experience any of the following:

  • A mild burning when you pass your urine.

  • A need to pass urine more frequently, and occasionally more urgently than you usually do.

  • Some blood in the urine.

All usually settle quite rapidly without the need for any treatment.

What can I do to help?

  • Drink plenty of water.

  • Take Ural or Citravescent in a glass of water 4 times a day.

  • 2 Panadol every 4 hours.

  • Rake any antibiotics you have been prescribed.

  • Avoid constipation.

  • Do not do any heavy lifting or straining for about 2 weeks after your operation.

  • Commence regular walking as soon as you can – this helps prevent colt formation in the legs.


Are there any possible side effects?

Most procedures are straightforward; however as with any surgical procedure there is a chance of side effects or complications. Some of the possible side effects are listed below:

Relatively Common

  • Mild burning, bleeding or frequency of urination after the procedure - it can take a few weeks for the internal wound from the operation to heal.

  • Retrograde ejaculation (no obvious semen at orgasm) occurs in the majority (approximately 75-80%) of men after the procedure.


  • Urine infection requiring antibiotics.

  • Possible need to re-operate in future due to recurrent obstruction.

  • Failure to pass urine after surgery requiring another catheter.


  • Bleeding requiring return to theatre and / or blood transfusion.

  • Impotence – difficulty in achieving a satisfactory erection.

  • Urinary incontinence – usually very rare and temporary loss of urinary control.

  • The need to self-catheterise after the procedure to fully empty the bladder.

  • Injury to urethra causing delayed scar formation, which can obstruct urethra.

  • Very rarely, perforation of the bladder requiring temporary insertion of a catheter or open surgical repair.