What is laser prostate surgery?

It is the use of laser energy, transmitted through optical fiber, to cut the prostate. Several types of lasers can be used for this procedure. Currently, the most commonly used are HOLEP (Holmium laser enucleation of the prostate) and TULEP (Thulium laser enucleation of the prostate).

How is prostate surgery performed with a laser?

In this procedure, a camera that allows the passage of a fiber optic laser cable is inserted through the urethra and advanced up to the prostate. The incision of the inner part of the prostate begins slightly above the urinary sphincter muscle and is continued until the boundary between the inner and outer parts of the prostate is reached. Once this boundary is reached, the inner part of the prostate is gently pushed or cut away with the laser, much like peeling an orange.

Using this technique, the inner part of the prostate is separated from the outer part, either in one, two, or three pieces, and removed into the bladder. At this stage, a device known as a morselator, which works like a meat grinder, comes into play. This device grinds the larger prostate pieces that cannot pass through the urinary tract, while also pulling them out of the body in small, minced pieces.

Why choose laser prostate surgery over traditional closed prostate surgery (TURP)?

In TURP surgery, the prostate is removed in small 3-5mm thick, 1-2cm long pieces (often referred to as prostate chips). In patients with a particularly large prostate, hundreds of pieces must be cut to remove the prostate tissue that is obstructing the urinary tract. This significantly increases the duration of the surgery.

However, in laser surgery, the prostate can be removed in at most 3 large pieces and expelled into the bladder. This eliminates the problem of prostate size, making it easier to manage larger prostates. Removing many small chips in TURP leads to a considerable amount of bleeding with each cut, which can result in significant blood loss, especially in larger prostates.

In contrast, with laser surgery, the same blood vessels are cut only once, where they enter the prostate, and bleeding is controlled more effectively, reducing blood loss significantly.

To use an analogy, if we compare the prostate to an orange: the skin of the orange represents the outer part of the prostate, while the flesh represents the inner part, which obstructs the urinary tract when it grows. In TURP, the fleshy part of the orange is repeatedly cut and removed, which causes juice (bleeding) to flow. On the other hand, in HOLEP surgery, the fleshy part of the orange is gently peeled off from the skin, resulting in minimal juice (bleeding) leakage, and therefore, significantly less bleeding during the procedure.

Is open prostate surgery becoming obsolete?

Yes. In prostates larger than 100cc, TURP surgery involves removing the prostate in small pieces, which makes the procedure very time-consuming, and sometimes the desired amount of prostate tissue could not be removed. As a result, open surgery was preferred for patients with larger prostates. However, with laser surgery, regardless of how large the prostate is, it can be removed in at most three large pieces through the urinary tract and expelled into the bladder.