Laser surgery

Laser surgery uses a high-energy laser to destroy overgrown prostate tissue. The laser doesn't penetrate tissue deeply, so surrounding tissue isn't harmed.

Types of laser surgery include:

Photosensitive vaporization of the prostate (PVP). A newer form of laser treatment for prostate gland enlargement, this procedure and its results are similar to transurethral resection of the prostate (TURP). However, PVP uses laser energy — instead of the electrical current used by TURP — to destroy prostate tissue. In general, PVP is better for smaller prostates and may result in less bleeding and a shorter recovery time than with TURP.
Holmium laser enucleation of the prostate (HoLEP). This is a laser procedure used for men with urinary retention due to a greatly enlarged prostate. HoLEP has shown to provide results similar to TURP, but with less chance of bleeding and a shorter recovery time. Initial studies also indicate that HoLEP may produce results that last longer than other types of laser surgery — but the technique is more difficult for surgeons to learn.
Transurethral evaporation of the prostate (TUEP) and visual laser ablation of the prostate (VLAP). These are two of the original laser procedures developed for treating enlarged prostates. These procedures have been replaced by the more modern procedures mentioned above and are seldom used today.

What to expect. Laser surgery is done under general or spinal anesthesia. Depending on what type of surgery you have, you may need to stay overnight in the hospital and you may go home with a urinary catheter. Modern laser therapies use a high-energy, low-penetration laser that destroys prostate tissue on contact. After laser treatment, you can resume sexual activity and return to any type of work within a few weeks.

Who it works best for. Laser surgery can be a good option for men who have platelet problems that slow blood coagulation, or men who are taking blood thinners, because it causes less bleeding than TURP. Certain types of laser surgery can be used for enlarged prostates of any size. As a general rule, laser surgery is best for mild to moderately enlarged glands and not for the very large prostates.

Outcome. Vaporizing laser surgery often provides immediate symptom relief, but you may experience painful urination for days to weeks. Compared with TURP, laser surgery causes less blood loss and recovery is quicker. Symptoms scores can decrease as much as 17 points initially.

Side effects. Laser surgery generally causes fewer and less severe side effects than does TURP. However, laser surgery can cause painful urination for several days to several weeks. Retrograde ejaculation also is a common side effect of laser surgeries.

Need for re-treatment. Laser surgery to relieve BPH symptoms is relatively new, so its long-term effectiveness is unknown. Laser surgeries cause an initial reduction of symptoms similar to TURP, but over time symptoms may worsen again — and the need for re-treatment may be higher than with TURP. Some types of laser surgery may create more permanent results, but more studies are needed to determine their long-term effectiveness.