Laser Prostatectomy

You have an enlarged prostate gland. This is also called benign prostatic hyperplasia (BPH). BPH is not cancer, but it can cause problems with urination. To relieve your symptoms, your doctor may recommend laser prostatectomy. During this procedure, a laser (concentrated light energy) is used. The laser removes prostate tissue from around the urethra. The urethra is the tube that carries urine from the bladder out of the body. The surgery lets urine to flow more freely. Note that the laser destroys the prostate tissue so it can’t be looked at for signs of cancer. 

Cross section of prostate showing cystoscope inserted into urethra and prostate. Laser in cystoscope is removing prostate tissue.

Types of prostate laser surgery

The type of laser surgery your doctor will do may depend on your health, the size of your prostate, and the type of tools available. The different types of prostate laser surgery are:

  • Photoselective vaporization of the prostate (PVP). The laser is used to vaporize or melt away the extra prostate tissue.

  • Holmium laser ablation of the prostate (HoLAP). This type of surgery is similar to PVP, but uses a different kind of laser.

  • Holmium laser enucleation of the prostate (HoLEP). In this procedure the laser cuts and removes extra tissue. An instrument called a morcellator is used to cut the tissue into small pieces. This makes them easier to remove. 

Possible risks and side effects of laser prostatectomy

  • Bleeding

  • Infection

  • Pneumonia

  • Blood clots

  • Scarring or narrowing of the urethra. This can cause trouble urinating.

  • Only some relief of symptoms

  • Erectile dysfunction (rare)

  • Loss of bladder control (very rare)

In some cases, a muscle involved in ejaculation must be cut during surgery. If this happens, semen may travel back into the bladder instead of out of the penis during ejaculation. This side effect is called retrograde ejaculation. It is harmless. The feeling of orgasm won’t change. But very little semen will leave the body during ejaculation. Note that retrograde ejaculation can also be a side effect of certain medicines.

Getting ready for the procedure

Your healthcare team will give you detailed instructions on how to get ready for the procedure. Be sure to follow them.

  • Tell your healthcare team about all medicines you take. This includes herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.

  • You will probably be told not to eat or drink anything after midnight on the night before your procedure.

  • When you arrive for the procedure, you will have an intravenous (IV) line placed. This gives you fluids and medicines during the procedure.

  • You will be given medicine to keep you from feeling pain (anesthesia) before the procedure. You may have one or more of the following:

    • Local anesthesia. Your bladder and urethra are numbed.

    • Regional anesthesia. Your body below the waist is numbed.

    • General anesthesia. You are in a state like deep sleep.

During the procedure

Your doctor can help explain the details of your surgery. These details depend on the type of laser surgery that will be done. In general, you can expect the following:

  • The procedure itself usually takes less than an hour.

  • A thin, tube-like telescope (cystoscope) is put through the opening in your penis and into your urethra. This tool lets your doctor see your urethra and your prostate, either through the cystoscope or on a video screen.

  • The laser is put through the cystoscope. The laser is then used to destroy the extra prostate tissue.

  • You may get a urinary catheter. This helps your bladder drain for a short time after the procedure. It’s removed when it’s no longer needed.

After the procedure

You may go home the same day after your surgery. Or you may stay a night in the hospital. An adult friend or family member should drive you home. To get the best results from your laser prostatectomy, follow your doctor’s instructions. Keep your follow-up appointments.

Closeup of leg with plastic bag taped to side of thigh. Tube attached to bag goes up leg. Bag is partly full of urine.

Your prostate will likely be sore at first. This will get better as you heal. Here are some things you can expect:

  • You may be sent home with a catheter to drain urine from your bladder. If so, you may wear a leg bag until it's no longer needed. The catheter will allow the area to heal and help you avoid painful urination.

  • Your doctor may also prescribe antibiotics to prevent infection and pain medicine to ease any discomfort.

  • In about a week, you’ll visit the doctor to have your catheter removed. If swelling still makes urination difficult, the catheter may be left in longer. After the catheter is removed, you may need to urinate more often. This is normal and should get better with time.

  • For the first few weeks after your procedure, you may notice that your urine is cloudy. Or you may have blood or blood clots in your urine. This is normal while your body rids itself of the treated tissue. These symptoms may begin to get better during the first few weeks. But it may take a few months before they go away. Your doctor can tell you when you can resume sexual activity and how soon you can return to work.

  • You also may be told to avoid lifting anything over 10 pounds or bending over to lift things from the ground.

  • You should drink plenty of fluids to help flush out your bladder.

Getting back to sex

You may be glad to know that BPH and its treatments rarely cause problems with sex. Even if you have retrograde ejaculation, orgasm shouldn’t feel any different than it did before the procedure. Retrograde ejaculation happens when semen goes into the bladder instead of the urethra during ejaculation. This is common after procedures for BPH. This should not cause any health problems or affect your sexual function. If you notice any problems with sex, talk with your doctor. Help may be available.


When to call your healthcare provider

Contact your doctor right away if:

  • You have a fever over 100.4°F (38°C).

  • You have excessive bleeding.

  • You have pain not relieved by medicines.

  • You notice that no urine is draining from the catheter or the catheter falls out.

  • You have frequent or very strong urge to urinate.

  • You’re not able to urinate, or notice a decrease in urine flow.