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GreenLight Laser PVP of the Prostate

Introduction

GreenLight laser PVP of the Prostate (Greenlight PVP) is another procedure used to treat bladder outlet obstruction secondary to benign prostatic hyperplasia. This technique relies upon the GreenLight laser being absorbed by the prostate tissue and being vaporised, thereby removing tissue and creating a wide channel to allow for the improved flow of urine. The varposiation of tissue leads to far less bleeding, and therefore this procedure is ideal in those patients who cannot stop their anticoagulant medications.

Indications

Similar to the Transurethral Resection of the Prostate, GreenLight laser PVP is indicated in the following conditions:

  • Bladder outlet obstruction secondary to benign prostatic hyperplasia that has failed medical therapy, and in those who must remain on their anticoagulant medications.
  • Acute urinary retention.
  • Failed trial of void.
  • Haematuria likely to be coming from the prostate that is refractory to medical therapy.
  • Recurrent urinary tract infections associated with chronic retention of urine.

Preoperative Instructions

A urine test will be performed to ensure the patient does not have an active urinary tract infection, as this will require treatment prior to the procedure. An ultrasound may be performed so that the urologist can gain an understanding of the size of the prostate which can impact upon the operative time and risks associated with the procedure. Patients who cannot stop certain anticoagulation medications such as warfarin, clopidogrel, rivaroxaban and apixaban are able to continue to take these medications perio-operatively.

Procedure

Initially a cystoscopy is performed to assess the lower urinary tract and the understand the configuration of the prostate. A special laser scope is then placed through which the laser fibre passes and this is there used to vaporize the obstructing tissue of the prostate. Once the tissue has been vaporised a catheter is placed in the bladder. This catheter allows for irrigating fluid to run into the bladder to wash out any blood that may be present in the bladder and further reduce the risk of bleeding.

Postoperative Instructions

The patient will awaken with a catheter in and irrigating solution running into the bladder. Irrigation of the bladder usually stops in the even after the surgery and the catheter is removed the following morning. At this point the patient undergoes a trial of void where they are observed to ensure they can empty their bladder appropriately. The patient is then discharged home with a review in approximately 8 hours. During this time the patient may notice urinary frequency, urgency and dysuria (pain/burning on urinating). These symptoms all gradually settle down in the first few months, but some of these symptoms can persist for up to a year. Medications can be used to manage these symptoms whilst the patient waits for them to resolve.

Risks

Some of the risks associated with a Greenlight PVP are:

  • Dysuria.
  • Urinary urgency and frequency.
  • Infection.
  • Retrograde ejaculation.
  • Urethral stricture.
  • Bladder injury.

Treatment Alternatives

A GreenLight Laser PVP is usually performed in patients who cannot stop their anticoagulant medications and are not suitable to other procedures. Therefore, to manage bladder outlet obstruction in these patients Greenlight PVP remains the gold standard surgical option.

Related Information

Benign prostatic hyperplasia (BPH)
Transurethral resection of the prostate (TURP)
UroLift