Laser Prostatectomy/TURP

Why have a TURP or laser prostate suregery?

TURP (transurethral resection of prostate) or laser prostate surgery are telescopic (through the penis) surgical procedures used to relieve prostatic obstruction from an enlarged prostate (either due to benign or cancerous cause). Many patients will have already tried medical treatment for their urinary symptoms, or had a period of time tolerating their symptoms. When medication is not strong enough to improve symptoms, or if there is a desire not to take medication, this type of surgery is a good option.  Virtually all patients with an enlarged prostate can be considered for some type of prostate procedure. TURP is the traditional, established type of operation to relieve prostatic obstruction; it uses a electric current to take small strips of prostate tissue away, thereby making the passage through the prostate wider and urinary stream stronger. An edited example of the TURP procedure follows.

Different types of laser (including the Green Light Laser also known as GLL or PVP, which means photoselective vapourisation of the prostate) can also make the passage through the prostate wider and stream stronger. The laser technique involves accurate high power laser destruction of excess prostate tissue while sealing blood vessels. A thin laser fibre is introduced through a cystoscope (telescope in the penis) into the prostate and prostate vapourised under vision by the surgeon. An edited example of the GLL procedure is seen below.

The image below shows the obstruction caused by the prostate (left), which is removed by surgery (in this case by laser) and is after healing is sustained (right).

Laser surgery and TURP probably have equally good short and medium term results on improving urinary stream and probably has equivalent longterm results although this continues to be debated. The alternatives to these types of surgery are; continuing without surgery, using a catheter to empty the bladder and open surgery. Recently, a new minimally invasive surgical alternative has been endorsed by the health assessment agency NICE; this procedure is referred to as Urolift® (click to find out more).

Why choose us?

Our consultants carry out large numbers of prostate operations using both laser and TURP techniques, on NHS and private patients. They were amongst the first surgeons to introduce Green Light Laser prostate surgery to the region. For these reasons they are very experienced at this type of surgery, and will be able to advise whether surgery is required, and if it is, which type of surgery would be appropriate.

Coming in for this procedure

Before the operation you will be invited to come to the hospital for a pre-operative assessment (including blood tests and heart trace). On the day of the operation you will be asked to give written consent for the operation. The operation is performed under either general or spinal anaesthesia and usually takes under 1 hour. You will have a catheter tube draining urine from the bladder after the operation that will stay for until the urine runs clear. Pain is usually minimal and controlled by tablets. Patients are often fit to go home on the day of surgery, or the day after for laser prostate surgery, and after 2-3 days following TURP. There are risks and side effects associated with all forms of treatment and these should be carefully considered before surgery. Serious complications associated with surgery (heart, lung, and thrombosis problems that could lead to death) are very rare. The commonest adverse effects of this surgery are bleeding (either during or in the first couple of weeks after surgery), infection, incontinence and ejaculation problems. There is a small chance that urinary problems will not be improved by this type of surgery, that over time the prostate will regrow and cause further flow problems, or that scar tissue will form in the urethra (a urethral stricture) or bladder neck again causing recurrence of problems. Urinary symptoms of needing to pass urine urgently or frequently can persist for several weeks (or occasionally months) after this surgery. Laser prostate surgery has similar risks compared to TURP, although it has the advantage of causing less bleeding and generally has much faster recovery period. A disadvantage of our laser technique is that the tissue is vapourised and therefore cannot be examined for cancer.

Follow-up after this procedure

It is usual to be followed up in the outpatient clinic to check that urinary problems have settled, and if a TURP operation has been performed, to discuss the results of the tissue examination.

What next?

If you would like to discuss prostate surgery then please contact us and book a consultation with Mr Sam Liu, Mr Lyndon Gommersall, Mr Christopher Luscombe or Mr Anurag Golash.