Operations and procedures

Prostate laser enucleation is a minimally invasive endoscopic surgery for the treatment of urinary problems caused by benign enlargement of the prostate. During the surgery, the enlarged part of the prostate that compresses the urethra and obstructs the normal flow of urine is removed using a thulium laser.

The method is also well suited for large prostates and in many cases makes it possible to avoid more extensive open surgery. Compared with conventional surgical methods, laser enucleation has the advantages of a lower risk of bleeding and faster recovery.

When is prostate laser enucleation necessary?

Benign enlargement of the prostate, or benign prostatic hyperplasia, is a common age-related condition in which enlargement of the prostate narrows the urethra passing through it and makes the outflow of urine from the bladder more difficult.

Surgery is recommended when urinary symptoms caused by prostate enlargement are pronounced, interfere with daily life, or do not respond sufficiently to medication.

Indications for laser enucleation may include, for example:

• a weak or intermittent urine stream;
• difficulty starting urination;
• frequent or urgent need to urinate;
• repeated urination at night;
• a feeling that the bladder does not empty completely;
• a large amount of residual urine in the bladder;
• recurrent or persistent urinary retention;
• recurrent urinary tract infections related to prostate enlargement;
• formation of bladder stones;
• recurrent blood in the urine related to prostate enlargement;
• risk of impaired kidney function caused by obstruction of urinary outflow.

The need for surgery and the most suitable treatment method are determined by the urologist based on the patient’s symptoms, prostate size, examination results, previous treatment, and general health condition.

Surgery

The surgery is performed under general anesthesia, and the entire procedure is carried out endoscopically through the urethra. No skin incision is required.

The surgeon passes an instrument equipped with a camera through the urethra to the prostate and uses a thulium laser to separate the enlarged inner part of the prostate, or adenoma tissue, from the surrounding prostate capsule. The prostate is not removed in its entirety during the surgery.

The separated prostate tissue is moved into the bladder. The tissue is then fragmented into smaller pieces using a special instrument called a morcellator and removed from the bladder. If necessary, the removed tissue can be sent for histological examination.

The energy of the thulium laser allows the tissue to be separated precisely while simultaneously sealing blood vessels, which results in minimal bleeding during surgery.

Laser enucleation can also be used for very large prostates, for which conventional methods might in some cases require consideration of open surgery.

After surgery

At the end of the surgery, a urinary catheter is temporarily inserted into the bladder. If necessary, bladder irrigation is performed through the catheter to prevent blood clots from accumulating in the bladder.

The timing of catheter removal depends on the extent of the surgery, the colour of the urine, and the patient’s recovery. After the catheter is removed, it is assessed whether the patient is able to urinate independently and whether the bladder empties sufficiently.

If recovery proceeds normally, it is often possible to leave the hospital and return home as early as the day after surgery.

The urine stream and bladder emptying may improve quickly after surgery. Frequent or urgent urination may nevertheless persist for some time because the bladder needs time to recover from long-term obstruction of urinary outflow.

Recovery

During the first days and weeks after surgery, the following may occur:

• stinging or burning during urination;
• a more frequent need to urinate than usual;
• an urgent need to urinate;
• a small amount of blood in the urine;
• temporary difficulty holding urine.

During the recovery process, a small amount of blood may occasionally reappear in the urine. This usually decreases gradually.

In general, patients can return to everyday activities relatively quickly, but full recovery usually takes several weeks. More detailed instructions are provided by the treating physician according to the extent of the surgery and the patient’s recovery.

Effect on sexual function

Prostate laser enucleation generally does not cause significant deterioration in erectile function. However, a common side effect of the surgery is retrograde ejaculation, also known as dry ejaculation. In retrograde ejaculation, semen flows into the bladder during orgasm instead of leaving the body through the urethra. This is not harmful to health, and the sensation of orgasm is generally preserved, but it may significantly reduce the possibility of conceiving a child naturally. If there is a desire to have children in the future, this should be discussed with the urologist before surgery.