Laser therapy for benign prostatic hyperplasia

Several laser methods to treat an enlarged prostate gland (benign prostatic hyperplasia, BPH) are now being used.¹ Laser therapy (also called photoselective vaporization of the prostate, or PVP) uses a laser beam to remove the part of the prostate that is blocking the urethra. The procedure is done under either a general or spinal anesthetic. Most men who have laser treatment of BPH are able to leave the hospital the same or the next day.

While several laser methods are used, in general they all either sear (laser ablation) or vaporize (laser vaporization) the prostate tissue.

• As the seared tissue heals, it shrinks, dead tissue falls off, and the blockage is reduced. This may require several days.
• With vaporization, a channel is immediately opened, allowing the free flow of urine.

Studies comparing laser methods with transurethral resection of the prostate (TURP) have found that:^{2, 3}

• Visual laser ablation is less effective at relieving symptoms, but it requires a shorter hospital stay.
• Laser vaporization treatment is as effective as TURP and requires a shorter hospital stay.
• Complications are less common with laser treatment.
• The risk of needing a second operation to treat BPH symptoms in the next 12 months is greater for the laser treatments.

Other considerations include the following:

• Depending on the type of laser used, it may not be possible to collect tissue during surgery that can be tested for prostate cancer. This is important because prostate cancer is found in 10% of men who have TURP for an enlarged prostate. For more information on prostate cancer, see the topic Prostate Cancer.
• Some men may choose laser therapy because of the shorter hospital stay and lower risk of complications.
• Laser prostatectomy causes less bleeding than other types of surgery. However, discomfort during urination lasts longer after laser surgery, and a catheter may be needed for a longer time.
• Some experts say that the laser studies have had weaknesses and that the safety and efficacy of these treatments cannot be determined at this time.²

Prostate surgery using a laser may not be available in all hospitals.

Citations

1. Aho TF, Gilling PJ (2003). Laser therapy for benign prostatic hyperplasia: A review of recent developments. Current Opinion in Urology, 13(1): 39–44.

2. Webber R (2005). Benign prostatic hyperplasia. Clinical Evidence (14): 1076–1091.

3. Hoffman RM, et al. (2003). Laser prostatectomy versus transurethral resection for treating benign prostatic obstruction: A systematic review. Journal of Urology, 169(1): 210–215.