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Benign Prostatic Hyperplasia is a condition in which the prostate enlarges as men age. More than 50% of men over the age of 60 have urinary symptoms attributable to BPH. These symptoms can include; weak urinary stream, urinary frequency, urgency, waking up at night to urinate, difficulty initiating stream, dribbling and difficulty emptying the bladder. While BPH is a benign condition and unrelated to prostate cancer, a man's quality of life can be greatly affected. Patients that continue to have bothersome urinary symptoms despite medical therapy may benefit from surgical treatment.


Millions of patients have been successfully treated worldwide using a variety of FDA approved laser technologies. The laser enucleation technique is rapidly evolving into the standard of care for the surgical treatment of BPH. The procedure is performed by inserting a thin laser fiber into the urethra through a specialized cystoscope.  The laser is used to incise the prostate into several lobes. The beak of the scope can be used to core out the obstructing prostate tissue from the capsule creating a wide open channel. Traditionally the Holmium laser is used for laser enucleation and thus the acronym (HoLEP) is frequently used. Alternative laser modalities have been developed in the treatment of BPH including diode lasers which have excellent cutting and ablating properties. When a diode laser is used for enucleation, the acronym is DiLEP. Regardless of the laser modality used, the technique of enucleation is the same. 


Is the Protouch Laser system FDA approved?

              Yes, the Protouch laser received FDA clearance in February 2010. Other lasers used for enucleation to treat BPH are Holmium and Thullium 


How many enucleation procedures using the Protouch laser have been performed?


              Thousands of patients have been successfully treated with the Protouch laser. Millions of patients have been successfully treated worldwide using a variety of FDA approved laser technology and is evolving into the standard of care for the surgical treatment of BPH (benign prostatic hyperplasia)


Is the procedure covered by insurance?


              Yes laser procedures are all covered. The insurance companies do not differentiate the type of laser but rather differentiate between the technique of ablation (vaporizing tissue) vs. enucleation.


How does the Protouch laser system work?


              All ablative lasers work by removing obstructive prostate tissue through vaporization. Certain lasers can also excise or “cut” the obstructive tissue in a bloodless fashion (enucleation).  The ProTouch safely performs both types of procedures with less side effects. The ProTouch wavelength is more efficient because it is extremely hemostatic. Recent peer reviewed articles substantiate that the 1470 wavelength is the most hemostatic wavelength with the least amount of thermal damage. It also coagulates larger vessels very efficiently.


              The procedure is performed by inserting a thin laser fiber into the urethra through a specialized cystoscope with a camera. The urologist is able to safely view and control the treatment area, tailoring it to a patient's individual anatomy. The dissection is carried down to the prostatic capsule to create an open channel. The tissue plane between prostate adenoma and capsule could be recognized endoscopically creating a wide open channel. Natural urine flow is usually immediately restored and the urinary symptoms improve. 


Where is the LEP procedure performed?


              The LEP procedure is performed in a hospital operating room as an outpatient.


Will I have to spend the night in the hospital?


              Most men can go home 1-2 hours after the procedure. Occasionally men will spend the night if they have no one at home with them for the first night or they live far away. Although bleeding is rare this may be an indication for overnight observation.


Will I need anesthesia?


               General anesthesia is used to perform the procedure.


Will I feel any pain during the LEP procedure?


               No, patients do not report any pain during the procedure.


Will I feel pain after the procedure?


               Most men are given a mild pain medication but most don’t need to use.  Men may feel some pressure and burning during urination. Anti-inflammatory medications like Aleve, Ibuprofen can be helpful. These symptoms usually resolve within a few days to a week or so. If the burning persists a different medication ease the discomfort will be prescribed.


Will I have urgency or difficultly controlling urination following the surgery?


              You may have less warning time and less tissue holding urination back. If you have urgency now, you will likely have this following surgery. This may worsen during healing but improves in most men. Caffeine and alcohol can worsen these symptoms. Urgency comes from the bladder having to overwork forcing urine through the enlarged prostate. Having the LEP usually reverses the damaging process but some men may need to continue to take medications to control their overactive bladder. 


Will I have blood in the urine?


              Almost all men will notice some blood in the urine but rarely is there any change in a man’s blood count. As long as you are not having many large clots and trouble emptying, the bleeding will usually resolve with fluids and rest. If you are on a blood thinner, this healing process may take longer.


Will I have a catheter after surgery?


              All men go home with a catheter to drain the bladder overnight. You will awake with this already in place. The catheter is a hollow tube held in by a fluid filled balloon. The urine will drain into a bag that is easily emptied. The catheter will be taken out in the office on the first postoperative day. Some men can be taught how to remove the catheter themselves. Men with very large prostates and those on blood thinners may keep the catheter in an extra day or two. 


Will I still need to take my prostate medication following the LEP procedure?


              Generally no. If you are on an alpha blocker (ie. Flomax, Uroxatrol, Rapaflo) you can stop this after the first office visit following the procedure when you see a good, strong stream. If you are taking a 5ARI (ie Proscar or Avodart) we usually ask you to complete your current prescription but do not refill.


Does the surgery affect sexual function?


              The incidence of erectile dysfunction is low and this procedure should not impact erections. The procedure will cause retrograde ejaculation (semen is expelled into the bladder instead of out of the penis). This can cause difficulty fathering a child but should not impact the pleasurable sensation. There is no danger, damage or harm from this.


How long can I expect the effects of the procedure to last?


              Clinical studies have reported durable outcomes out longer than 10 years. Most men will rarely need another procedure during their lifetime. Curr Opin Urol. 2018 May;28(3):301-308. Evidence-based outcomes of holmium laser enucleation of the prostate.

Large T1, Krambeck AE.

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