GreenLight™ Laser Therapy

What Is GreenLight™ Laser Prostate Vaporization?

A GreenLight™ a minimally invasive surgery that uses a laser beam to vaporize the obstructing inner part of the prostate gland that is causing your urinary symptoms. This allows for a clear and open passage of urine, improves bladder emptying and other associated symptoms of an enlarged prostate (BPH).

A medical team views an image on a screen while they perform a GreenLight surgery

What Is the Prostate?

The prostate is a walnut-sized gland that sits at the base of the bladder surrounding the urethra, the tube through which you urinate. As you get older, the prostate gland grows and can cause an obstruction to the flow of urine leaving the bladder thus causing problems urinating.

Why Do I Need a Laser Prostatectomy?

If you’re having difficulty emptying the bladder, slower urinary flow, frequent daytime and night time urination or unable to urinate and requiring a catheter then this surgical procedure is likely to improve your symptoms. Read our Enlarged Prostate / BPH page to learn more about your condition.

How Is the GreenLight™ Laser Prostate Vaporization Done?

It is performed through a telescope that is placed through the penis, and does not require any external cuts or scars. Through the camera, the surgeon fires a laser beam that heats up and vaporizes the central portion of the prostate gland that obstructs the urinary flow. This is done until there is a wide channel with no obstructing tissue. At the completion of the operation, a catheter tube is placed through the penis into the bladder to drain the urine. This catheter usually stays in 1-3 days and is removed by our staff in the office.

What Are the Benefits of the GreenLight™ Laser?

You might receive the following benefits. The doctors cannot guarantee you will receive any of these benefits. Only you can decide if the benefits are worth the risk.

  1. Relief of urinary obstruction
  2. Reduced chance of bleeding from the prostate.
  3. Less bothersome urinary symptoms.
  4. Improved ability to urinate and empty the bladder.
  5. Decreased risk of infections
  6. Decrease risk of bladder stone formation
  7. Potential to stop all prostate / urinary related medications
  8. It is the current gold standard treatment of symptomatic enlarged prostates
  9. Less chance for hospital stay and bleeding as compared to the traditional TURP method.

What Are the Risks Associated with GreenLight™ Laser Vaporization of the Prostate?

Before undergoing this procedure, understanding the associated risks is essential. No procedure is completely risk-free. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate additional surgery, prolonged hospitalization, and/or extended outpatient therapy to permit adequate treatment.

Common

  • Bleeding is the most common complication. Typical bleeding is very mild (cranberry juice). Some people have wine colored or dark urine, which is essentially old bleeding that is resolving. Some people may pass small pieces of blood that are small blood clots. These are not harmful but may sometimes clog up the tubing and make it difficult to void. Is If you do experience heavy and persistent bleeding that looks like you’re urinating tomato soup and or unable to urinate because of heavy clots, contact the surgeon immediately. You may need additional treatment to stop the bleeding or to remove blood clots. Bleeding can be life-threatening and may necessitate a blood transfusion.
  • Pain that may be related to the catheter. Urgency to urinate due to the catheter. Burning with passage of urine after the catheter is removed. These symptoms usually resolve over the course of a few days. You may find that medications such as Pyridium, Uribel or AZO, and increasing fluid intake for a few days after the procedure, may help.
  • Temporary mild burning, urgency or frequency of urination after the procedure. This is very common and is the result of the edges of the prostate where the surgery was done healing. The duration of these side effects depends typically on the amount of prostate that had to be vaporized and may last from a few weeks to a few months.
  • You may not ejaculate normally. No semen is produced during orgasm (dry orgasm) in 80% patients after the procedure (retrograde ejaculation). This is a very common side effect and is present because men ejaculate through the prostate. If part of the prostate is removed, then some of the ejaculate will be going backwards into the bladder. This typically a permanent result of the operation. This is not harmful, however, if you are planning to have any more children, this surgery may make it difficult for you to father children.

Occasional

  • Urine infection requiring antibiotics. This risk is more common in patients who have a catheter prior to surgery or patients who have a history of recurrent infections. Some patients require antibiotics prior, during and after surgery. If you’re experiencing fevers, chills or other signs of an infection just prior to or on the day of surgery, please make the surgeon aware as operating with an active infection may raise your risk of a serious blood infection and may be lethal.
  • Possible need to re-operate in future due to recurrent obstruction. Typically, the prostate continues to grow even after the operation. On average, it takes about 7-10 years for the prostate to regrow enough to worsen your urinary symptoms. Hence why it is still important to see the urologist even years after your surgery was complete. In certain cases, we have patients continue with medicines that shrink the prostate to slow down the regrowth of the prostate
  • Failure to pass urine after surgery requiring another catheter.
  • Difficulty to empty the bladder may happen if the prostate area is still swollen after the recent surgery, some patients need to have a catheter draining their bladder a bit longer until this subsides.
  • There are rare cases where patients develop scar tissue either at the prostate or the tip of their penis making it difficult to urinate. This may require further procedures to fix.
  • The operation may not relieve some of your symptoms. This is seen in about 10% of patients
  • Some patients, especially with very large prostates, require more than one trip to the operating room to safely vaporize enough prostate tissue to allow them to urinate. We always discuss this possible scenario with all patients with extremely large prostates.
  • If patients have a history of chronic enlarged prostate problems, this may result in the bladder being more overactive. Unfortunately, the bladder over activity is not reversible and is not improved with the prostate operation. Thus, patients may have improvement in their flow and may empty their bladder better after surgery, but their urgency, frequency and sometimes urge related leakage may not improve and will require continued bladder medications for overactive bladder.

Rare

  • Impotence – difficulty getting an erection that occurs in 1% of patients. This has become a very rare complication and is usually due to aggressive vaporization of the prostate outside of the prostate boundaries. This risk is lessened by the Greenlight™ procedure as the laser is able to control bleeding very well and allows the surgeon to see the borders of the prostate better.
  • Urinary incontinence – Temporary or permanent loss of urinary control. This is typically a result of the damage of a muscle (sphincter) that sits below the prostate that occurs in 0.5% of patients. Damage may be caused if the surgeon vaporizes outside the borders of the prostate by accident. This risk is lessened by the Greenlight™ procedure as the laser is able to control bleeding very well and allows the surgeon to see the borders of the prostate better.
  • Permanent urinary retention – permanent need to use a catheter or the need to self-catheterize after the procedure to fully empty the bladder. This condition is NOT a result of the surgery, but rather a result of chronic urinary retention prior to surgery resulting in a very weak bladder. This problem is typically discovered prior to surgery with bladder function testing like Pressure Flow or Urodynamics. Some patients are given a chance to see if their bladder function improves with the opening of the prostate with this operation, but the bladder never fully recovers and the bladder muscle does not work well, thus resulting in urinary retention. The medical term for this is an “atonic or neurogenic” bladder. Some patients are still good candidates for this surgery even if their bladder does not work, just to open up the prostate with the Greenlight™ so as to make catheterization easier on the patient in the future.
  • Bleeding requiring return to the operating room and getting a blood transfusion.
  • Injury to urethra causing delayed scar formation, which can obstruct urethra.
  • Very rarely perforation of the bladder (hole in the bladder) requiring temporary insertion of a catheter or open surgical repair.
  • Injury to the ureteral openings (opening of the kidney tubes that drain into the bladder) requiring temporary stenting  (plastic tube in the kidney) or ureteral repair
  • Injury to the rectum requiring repair and possible temporary colostomy. This is an extremely rare complication that occurs due to aggressive vaporization of the prostate well outside of the prostate boundaries.

Risks Associated with ANY Surgery:

  1. Anesthesia-related complications
  2. Blood clots in the veins (in the legs or lungs). These can be life-threatening and usually require treatment with a prolonged course of blood thinners.
  3. Heart attack
  4. Stroke
  5. Pneumonia
  6. Allergic reaction to drugs and/or equipment
  7. Electrolyte (salt) imbalances

Alternatives to GreenLight™ Laser Surgery

  • No treatments at all (aka observation) – Observation is a great option for patients with mild symptoms. If you are considering surgery, likely your symptoms are getting bad enough where you are seeking more drastic help. We are not inclined to force any patients to undergo any procedures that they are unwilling to do. Certainly, patients may elect to undergo absolutely no intervention. We do, however, want all patients to be aware of the possible risks of delaying intervention and the possible outcomes of letting the enlarged prostate problems get out of hand. Please click here to learn more.
  • Medications – 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 – either done in the surgery center or office, the procedure is done by placing a small rigid camera in the penis and prostate and deploying clips on either side of the prostate so as to compress the obstructing parts of the prostate and open up the urinary channel
  • Microwave of the Prostate – this is an office procedure that involves placing a small catheter tube in the penis that contains a microwave antenna and heats the prostate over a short period. The heating of the prostate will eventually make the prostate smaller and improve urinary symptoms
  • Rezuum – an office procedure under a local anesthetic, where via a camera placed into the penis and prostate, steam is injected into the prostate and heats the prostate, which eventually makes the prostate shrink.
  • Transurethral Prostatectomy (TURP) 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 (TUIP) – also sometimes called Bladder Neck Incision. May be recommended for small prostates that are a bit too narrow.
  • Open or Robotic Suprapubic Prostatectomy – recommended in really large glands, that are too big to manage with minimally invasive surgery. This is not a common treatment and is usually only done when the prostate is extremely enlarged and involves either the open or robotic/laparoscopic methods to remove the prostate via an incision in the belly and bladder and core out the inner part of the prostate. This is not the same operation that we do for prostate cancer, but is similar in the approach.
  • Long-term catheter – recommended if you are not fit for any operation and unable to urinate at all or retaining very large volumes of urine in the bladder. May be a catheter through the penis or a tube that is placed below the belly button to drain the bladder.

Where Is the Surgery Done?

The operation is performed in the surgical center or hospital operating room.

Will I Be Asleep for This Surgery?

Surgery is done under either general anesthesia with you completely asleep or spinal anesthesia (a shot in the back to numb everything below the belly button temporarily, similar to what is done for c-sections or vaginal deliveries). The anesthesiologist will meet you on the day your operation to discuss the options. Your primary doctor and the anesthesiologist will also check that you are fit enough to undergo anesthesia.

How Long Does the Operation Take?

The amount of time the surgery takes depends on the size of the prostate and the amount of tissue that is needed to be resected. On average, this takes about 60-90 minutes.

Will I be staying in the hospital or going home?

Most patients are able to go home the same day of surgery with the catheter tube and a small bag draining the bladder at home. You and your family/friends will be taught how to take care of the catheter and drainage bag before you leave the hospital. You may also read more about these instructions on our Catheter & Drainage Bag instructions page.

In certain cases, the patients do stay overnight in the hospital for observation. Typically, this is decided prior to surgery, however, at times the anesthesiologist may decide to keep patients as needed and thus please be patient if this is the case as this is done purely for your safety.

Getting Ready for Your Operation

If you smoke, try and cut down or preferably stop, as this reduces the risks of heart and lung complications during and after the operation.

If you do not exercise regularly, try and do so for at least half an hour per day e.g. brisk walk or swimming. This will help both with anesthesia and with overall recovery.

You are required to visit your primary care doctor for “clearance” for the operation. Typically, this is a general checkup that includes checking your heart, lungs, blood work, EKG, chest x-ray and any other necessary tests to ensure that you are fit and ready for surgery. Your primary doctor will notify you if you need to see any other specialists such as a cardiologist or pulmonologist to make sure that you are ready for the operation.

Tell the doctor if you:

  • take medication to thin your blood (anticoagulants), such as: aspirin, clopidogrel, plavix, dalteparin, fragmin, rivaroxaban, xarelto, heparin, lovenox, warfarin, coumadin, prasugrel, effient
  • take steroids such as prednisone or arthritis medications
  • take any other medications, such as herbs, vitamins, minerals, or natural or home remedies.
  • have taken any antibiotics in the past 3 months.
  • have any sort of heart condition, implanted devices such as knee or hip replacements.
  • are allergic to any medications or latex.
  • had a urinary tract infection (uti) in the last month.
  • had an infection or were hospitalized after a previous prostate biopsy.
  • have a history of achilles tendon injuries or tendonitis.
  • have difficulty hearing.
  • work at a hospital or nursing home.

5 to 7 Days Before Your Procedure

Stop taking:

  • aspirin and medications that contain aspirin, unless directed otherwise by the doctor
  • vitamin e, multivitamins
  • Stop taking other stronger blood thinners (like plavix, xarelto or warfarin) as directed by your primary doctor or cardiologist

2 Days Before Your Procedure

  • Stop taking pain medicines like: ibuprofen (advil® or motrin®) or naproxen (aleve®)

What Should I Expect After The Operation?

After your operation, you will be placed in the recovery area called the “PACU”. You can start eating and drinking there as soon as you recover from the anesthetic. The nurses will provide any pain medicines, will monitor your breathing and vital signs. You may not remember any conversations or your time in the recovery area. Once the nurses and anesthesia staff have cleared you to go home, you will be provided a smaller bag to collect urine from the catheter that is strapped on your leg.

You should arrange for a ride home.

Discharge Information and Home Advice

Catheter

A urinary catheter is a tube that runs from the bladder out through the tip of the penis and drains into a bag. It is important to drain the urine in this way until the urine is clear. Your catheter is usually removed 1-3 days after your operation. Avoid pulling on the catheter as this may provoke bleeding. It is common for urine to occasionally squirt around he catheter at the tip of the penis. It is also very common to have a bit of blood dripping around the catheter at the tip of the penis.

We advise putting a small amount of antibiotic ointment such as Neosporin or Bacitracin at the tip of the penis several times per day to allow the catheter to glide smoothly.

Seek help if all the urine is coming around the catheter and none is draining into the urinary drainage bag. You and your family/friends will be given instructions on the catheter care.

Bleeding

It is quite normal to see an occasional show of blood in your urine during the first month after surgery – this is due to the healing of the operation site. If you see blood, simply increase your fluid intake. If you have prolonged heavy bleeding (>24 hours), significant pain or increasing difficulty passing water, please contact the Broward Urology Center.

Pain

Because there are no external cuts, this procedure is relatively pain free. You may experience some discomfort from the catheter, but this is usually easily treated with mild painkillers. Tylenol may be used for pain. However, we will provide you with a prescription for a stronger pain killer should you need one. Beware, stronger pain killers may cause constipation

Diet

It is important that you do not get constipated. There are no dietary restrictions but you should try and eat plenty high fiber food or anything that would get your bowels moving. You may use milk of magnesia or an enema if you get severely constipated. You will be provided with a stool softener as one of the prescriptions after surgery to prevent constipation.

Showers

There are no restrictions on taking showers even with the catheter in the penis. Staying and keeping yourself clean is always important. Please do not take baths, go into the pool or ocean with the catheter in place.

Exercise

You should take it easy for a month, although it is important to take some gentle exercise like walking, to reduce the risk of developing a blood clot in your legs. Try to avoid any activity that makes you strain as this will increase your chances of bleeding from the prostate.

You can resume normal sexual activity 2 weeks after your operation.

Work

Recovery may take several weeks. However, most patients feel a lot better as soon as the catheter is removed. We will be able to advise you when it will be safe to return to work as this depends on your occupation. Most patients with a sedentary office job require about a week of recovery, but those who do a lot of straining and lifting, may need several weeks before they are clear to go back to work. We can provide you with an excuse from work an any other paperwork for your job at our offices.

Driving

You may resume driving a motor vehicle you feel well and do not have significant pain or discomfort. You are absolutely not allowed to drive or operate any other motorized device while on narcotic pain killers.

For Further Information

DISCLAIMER

This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional. Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.