Greenlight Laser TURP

Picture of Greenlight Laser TURP

Greenlight laser TURP is the latest surgical method for obstructive benign prostate enlargement (BPH). Through a cystoscope, a laser fibre that emits a green beam is used to vapourise the prostate to create a cavity that heals over the next 3 weeks. The advantage over conventional TURP is that the greenlight laser seals the blood vessels more effectively, making this a bloodless procedure. General anaesthesia is preferred because it is a slower to do and can sometimes up to 2 hours. A catheter is still inserted into the bladder at the end of the surgery but unlike conventional TURP, usually no irrigation fluid is needed. The catheter can be removed the next day. As such, the hospital stay of just one night compared to 3 to 4 nights for standard TURP. The other advantage is that blood-thinning medication, such as Aspirin, Plavix or warfarin need not be stopped beforehand. Laser TURP is more expensive because of the added cost of the laser fibre and machine.

Picture of Greenlight Laser TURP

Complications include:

  • urine infection (UTI). The prostate itself can harbour bacteria which is released during the surgery. Hence, it is important to ensure that the urine is sterile before surgery and antibiotics continued even after the operation.
  • bloody urine. This can last up to 3 weeks but less compared to standard TURP. Some men may also experience frequent urination, urgency and incontinence which can take up to 3 months to subside.
  • dry ejaculation. This is due to the backward passage of sperm during sexual intercourse. It is inevitable because the bladder neck is also destroyed and the semen preferentially goes into the bladder. The semen mixes with the urine but is not harmful whilst in the bladder.
  • re-bleeding (secondary bleeding). This occurs in 1% of cases and appears between the 7th to 10th day after surgery. It is due to urine infection or re-opening of a blood vessel. If the bleeding is heavy, clot retention may even occur. If so, re-hospitalisation is needed as the catheter needs to be re-inserted to evacuate the blood clots. Occasionally, one may be brought back to the operating theatre to seal the bleeding points.
  • Retention. Some patients may not be able to pass urine after the catheter is removed. This is usually due to excess swelling of the remnant prostate. The catheter will need to be re-inserted if this happens.

Desired outcomes:

  • no blood transfusion ( < 1% chance )
  • low UTI rate ( < 5% occurrence )
  • no re-admission for secondary bleeding ( < 1% rate )