WHAT IS “PVP”?
Photo vaporisation of the prostate (PVP, often referred to as a “greenlight laser”) is a relatively new technology for surgical treatment of Benign Prostatic Hyperplasia (BPH). It is most often performed for benign enlargement but may in some cases be done for prostate cancer.
The prostate is a gland in men which sits between the bladder and the urethra (water pipe). It forms part of the male urinary and reproductive tracts. It is essential for normal fertility and produces some of the fluid that makes up semen. If the inner part of the prostate gland can obstruct the urethra during urination, which may result in:
- reduced urinary flow or dribbling
- incomplete bladder emptying
- urinary frequency
- urgency and occasional urge incontinence
- getting up at night to pass urine (nocturia)
The aim of PVP is to relieve this obstruction by widening the channel through the prostate to allow better outflow from the bladder and therefore improve your symptoms. The procedure is performed under a general or spinal anaesthetic. A fine instrument called a cystoscope is placed into the urethra and a powerful “side firing” green coloured laser is used to vaporise the inside of the prostate until a good channel is achieved. The powerful green coloured laser not only vaporises the prostate but also blood vessels so there is usually little or no bleeding. Because of this, it is safe to do on patients while they continue to take blood-thinning medications. Most patients have their catheter removed the following day and go home. Some patients are even able to go home on the same day as their surgery. Unlike with a TURP, NO tissue is sent to the pathology lab be analysed.
WHAT CAN I EXPECT AFTER THE PROCEDURE?
- At the end of the operation, a thin tube (catheter) is inserted into your bladder, which drains urine into a bag. The catheter may sometimes be connected to a system that washes the blood and blood clots out of your bladder. This is known as bladder irrigation. When there is no longer a risk of clots, usually after 1 day, the catheter will be removed and you will be able to go home if you are passing adequate amounts of urine.
- Bladder spasms – due to the catheter. Sometimes medications are required if these are severe.
- Burning when you pass urine is common and can last up to several weeks. You can take Ural sachets to help with this
- Passing of debris – you may notice small floating “dead bits” of the prostate in your urine, as part of the healing process for a few weeks.
- Bleeding – this usually reduces over time, but can be intermittent and should stop after 2-4 weeks. You should increase your oral fluid intake to at least two to three litres of fluid per day (unless you have any medical reason not to do so) and you can back off on your fluid intake if your urine is clear.
- Other urinary symptoms (eg. frequency, urgency) can last for several months after the procedure and are usually a result of the bladder adapting to not having the blockage that was previously created by the prostate. These can sometimes be worse than before the operation.
- Retrograde ejaculation – most men are able to have erections and orgasms after a greenlight laser. However, they may not ejaculate because the bladder neck is opened up along with prostatic tissue. This causes the semen to collect in the bladder and will be expelled when you next pass urine. There are no long-term risks of retrograde ejaculation.
WHAT ABOUT DIET?
- Drink plenty of fluids (8-10 glasses or 2-3 litres, unless you are on a fluid restriction due to a heart condition)
- Avoid acidic drinks such as orange or cranberry juice which may increase burning, stinging and irritate the bladder
- Eat a diet high in fibre to prevent the need for straining when using your bowels
WHAT ABOUT EXERCISE/ACTIVITY?
- Avoid for 2 weeks after surgery unless otherwise instructed by your doctor:
- strenuous activity
- heavy lifting (eg. grocery shopping, picking up children)
- sexual activity
- engage in sports
- There is no restriction on walking
WHAT ABOUT MEDICATIONS?
- You can resume your usual medications
- If your blood thinning medication was stopped, your Doctor will let you know when to recommence
- You can take 1-2 paracetamol every 4-6 hours for pain and discomfort (no more than 8 in a day)
- Ural sachets (urine alkaliser) available from chemists and supermarkets, reduce acidity of the urine and provide relief from symptoms such as burning and stinging
WHAT ARE THE POSSIBLE COMPLICATIONS?
- Significant bleeding, possibly with clots – this may occur up to 6 weeks after the procedure and is usually a result of the scab coming away during the healing process. It is usually possible to flush the blood through by increasing your oral intake
- Urinary retention (unable to pass urine) – if this happens you must go to the Emergency department
- Urinary infection
- Urinary symptoms do not change – sometimes surgery does not cure your urinary problems. Occasionally things get worse before they get better. Even though the blockage has been cleared, the bladder irritability may continue and you may still have symptoms such as being unable to empty your bladder completely and nocturia (passing urine more than twice during the night).
- Urinary incontinence – this is usually temporary and improves after a few months. If it persists it is usually due to bladder overactivity or, less commonly, due damage to the urinary sphincter
- Erectile dysfunction (impotence or ED) – this rare after PVP, but more common in men who already had a degree of ED before the procedure. It may require treatment with medications.
- Urethral strictures – when scarring occurs in and around the water pipe, it can cause further blockage to the urine flow. Strictures may need to be dilated or need further surgery.
NOTIFY GEELONG UROLOGY or your GP if you experience any of the following:
- Heavy bleeding – urine that looks like pure blood
- Increased discomfort, severe pain and burning when passing urine
- Cloudy or offensive urine
- Fever (temperature over 37.5 degrees), chills, shakes or feeling generally unwell
- Increasing difficulty or unable to pass urine
FOLLOW UP APPOINTMENT
Your doctor will generally speak to about the results of the procedure before you are discharged home and an appointment for your follow-up will be organised. If an appointment time is not given to you on discharge from hospital, you will need to phone Geelong Urology to make an appointment.
If you have any queries please contact Geelong Urology on 03 5229 9105 during business hours OR leave a message on the After Hours Urology Paging Service 03 9387 1000