Using Green Light Laser for Enlarged Prostate Treatment

January 8, 2019

BPH

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Green light laser for enlarged prostate is one option available to men to treat urinary tract symptoms associated with BPH (benign prostatic hyperplasia) that requires medical intervention. The procedure involves the use of a scope and laser combination device that is inserted into the urethra through the tip of the penis.

Once the device reaches the prostate, which surrounds the urethra, the surgeon uses the green light laser to remove prostate tissue that is hindering urine flow. The high energy emitted by the green light laser is absorbed by blood in the prostate, which then causes the tissue to vaporize. The laser also seals the blood vessels that are under the treatment area, which reduces blood loss.

Advantages of Green Light Laser for Enlarged Prostate

Green light laser for enlarged prostate, which is also known as photosensitive vaporization of the prostate (PVP), offers a number of advantages over transurethral resection of the prostate (TURP), which frequently is used to treat BPH. Comparisons of green light laser and TURP for BPH have come up with the following general findings.

  • Green light laser is associated with a lower risk of bleeding than is TURP. This advantage can be good for all men, but especially those who have a bleeding disorder or who take blood thinners.
  • Green light laser for enlarged prostate results in much less swelling than does TURP
  • Men who undergo green light laser for prostate experience a reduction in urinary tract symptoms overnight while it takes several weeks or longer for those who have TURP.
  • Use of green light laser results in less risk of developing retrograde ejaculation than does TURP
  • The need for hospitalization is typically shorter for green light laser than it is for TURP. In fact, some men go home the same day as the procedure.
  • Men usually recover from green light laser treatment faster than they do from TURP. The need for use of a catheter after green light laser is usually less than 24 hours, but longer for men who undergo TURP.
  • A new meta-analysis conducted in Spain found that the overall cost of green light laser for prostate was less than for TURP because of a “shorter inpatient length of stay that offsets the cost of the new technology.”

The risk of complications associated with green light laser—that is, the risk of infection, urinary incontinence, and erectile dysfunction—is lower than with TURP. Some studies have shown that the risk of experiencing erectile dysfunction after green light laser is 1 to 2 percent and 4 to 5 percent after TURP. However, other research has indicated that the risk of erectile dysfunction after either procedure is similar.

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Studies of Green Light Laser for Prostate

Results of a systematic review and meta-analysis of the use of green light laser for prostate versus TURP was published in the February 2013 issue of BJU International. The reviewers considered factors such as maximum flow rate (Qmax), postvoid residual, quality of life, International Prostate Symptom Score (IPSS), duration of the operation, blood loss, catheterization time, length of hospitalization, need for transfusion, and various complications.

At three months following the procedures, the reviewers did not see any significant differences in Qmax, postvoid residual, and IPSS between men in the TURP and green laser light groups. At the six-month follow-up, all the variables were similar between the two groups except for quality of life, which was better for those in the TURP group. Overall, green light laser was associated with less blood loss and need for transfusions, shorter hospitalization and catheterization, and less side effects, but the procedure took longer than did TURP.

In another meta-analysis, 11 studies with a total of 1,398 patients were evaluated. The findings were similar to those in the BJU International review.

A recent study published in International Urology and Nephrology looked at the impact on sexual function following green light laser when considering the volume of a man’s prostate. The researchers found that men who had a prostate volume of 70 ml or greater had more erectile dysfunction and overall unsatisfactory scores regarding sexual issues than did men whose prostate was less than 70 ml.

Is green light laser for enlarged prostate better than other surgical options for BPH and urinary tract symptoms? More comparative studies are needed in this area, but thus far green light laser has shown some clear advantages over TURP.

References

Benejam-Gual JM et al. Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate. Actas Urologicas Espanolas 2014 Jul-Aug; 38(6): 373-77

Ding H et al. Photoselective green-light laser vaporization vs TURP for BPH: meta-analysis. Asian Journal of Andrology 2012 Sep; 14(5): 720-25

Guo Z, Jin X. The volume of prostate can impact the male sexual function following photoselective vaporization of the prostate: results of a prospective analysis of 128 patients with 2-year follow-up. International Urology and Nephrology 2013 Aug; 45(4): 961-66

Teng J et al. Photoselective vaporization with the green light laser vs transurethral resection of the prostate for treating benign prostate hyperplasia: a systematic review and meta-analysis. BJU International 2013 Feb; 111(2): 312-23

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