Laser Prostate - After PVP

What are the possible side-effects and complications?

1) Bleeding.

It is very common for there to be some minimal blood in the urine after the procedure but this normally settles down within 1-2 weeks and usually occurs just as urination starts. A very tiny amount of blood in the urine is sufficient to cause it to be look blood stained. Significant bleeding is very uncommon.

2) Burning in the urine (dysuria).

Many patients experience little or no discomfort at all.
Early laser treatments resulted in really quite severe burning when passing water. The PVP has considerably less problems with burning but most patients experience some mild discomfort on urination for a week or so after the operation often in the tip of the penis. For larger prostates this may continue for slightly longer although many patients with large prostates report very minimal discomfort.

3) Impotence.

There have been no reported problems with erections after this procedure.

4) Incontinence.

Some urgency may be experienced after the procedure as the bladder will be used to having to generate high pressure to overcome the obstructing prostate. As the obstruction has been removed a few patients have found that they need to rush to the toilet at first. This settles down quickly after the operation for most people but some patients may benefit from a medicine to calm the bladder down. This is uncommon however.

For people with normal continence before the procedure there have been no reported problems with incontinence after this procedure and this would have to be considered an extremely unlikely outcome.

5) Prolonged catheterisation.

Unfortunately we find that some patients with long-term catheters before the operation have significant damage to the bladder muscle. This may result in the bladder not being able to empty even if the prostate has been removed. Occasionally these patients need to be discharged with their catheter and have it removed the following week. The same may occur with very massive prostates but this is usually not the case.

6) Retrograde ejaculation.

There is a circular muscle at the base of the bladder in the male. The only purpose of this muscle is to contract during ejaculation so that the semen is expelled from the penis rather than taking the shorter route into the bladder (retrograde ejaculation).

Sometimes it is necessary to cut this muscle in order to achieve a good outcome from the surgery as it lies under the prostate at the bladder neck. This is much less common than with the TURP where 80% of patients have retrograde ejaculation. Under half of PVP patients have this side-effect. This is completely harmless but obviously decreases the chance of fathering children without assistance. If children are contemplated please discuss this with the urologist prior to surgery.

Is it safe?

Yes.

Due to the lack of bleeding and the lack of fluid absorption during the procedure it is safe. The fitness for anaesthetic will be assessed prior to surgery and any problems will be fully discussed.

I have performed PVP on patients in whom, due to size of prostate, a TURP would be considered dangerous.

Follow-up

Routinely an appointment is made for 3 months after the procedure to assess flow rate and symptoms again. As no tissue is available from the prostate for examination at the time of operation I routinely also recommend annually checking the PSA blood test.

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