BPH, or benign prosthetic hyperplasia, is a non-cancerous enlargement of the prostate that is a virtual certainty for men as they get into later life. It is estimated that approximately 50% of men over 50 have an enlarged prostate, while upwards of 90% of men over 80 do as well. The symptoms of an enlarged prostate vary by anatomy and severity of the enlargement. For some patients, a little urgency, dribbling, and some waking at night to urinate are all they experience, and the symptoms are pretty manageable with medication, such as Flomax, and some minor lifestyle changes and improvements that allow for better urinary control.

However, for others, especially those who have permitted the BPH to proliferate uncontrolled, the symptoms can be much more disruptive and, in rare cases, even dangerous. As the prostate starts to squeeze the urethra, some patients have significant daily symptoms that force them to stay home out of worry that they may urinate on themselves or that they will not be able to reach the bathroom in time during events or activities. Occasionally, the obstruction is so bad that it causes urinary retention, where urine stays within the bladder, with significant distention and consequent pain. Urinary retention is an emergency because it can destroy the bladder muscle if left untreated. Remember, if you suddenly can’t pee, call 911 or go to your nearest emergency room for treatment.

Because BPH is so prevalent, a wide range of therapies are available to control it. Some, like a Rezum water vapor therapy, take only five minutes and are performed in the office. Others, like transurethral resection of the prostate (TURP), are performed in a hospital setting and require shaving away prostatic tissue to relieve the pressure on the urethra and allow for normalized urination. That said, one of the most advanced and successful BPH treatment options is the GreenLight laser.

How green light laser works

The GreenLight laser is a minimally invasive procedure that does not require any external surgical access. A small cannula or catheter is placed up the urethra to the level of the prostate. At this point, Dr. Natale deploys the green light laser to vaporize prosthetic tissue quickly and efficiently while having exceptional control over the destroyed or ablated tissue so that no surrounding structures, including nerves, are destroyed. The entire procedure requires approximately an hour of operative time under sedation. Because the prostatic tissue is vaporized, patients typically experience some relief immediately after the procedure, though they tend to improve progressively over the next several weeks. It can take up to three months for the bladder to acclimate to the lack of obstruction.

The GreenLight laser can be a good option for patients with midsize to larger prostate as it can remove a significant amount of prostatic tissue with relative ease and speed. This procedure is also suitable for patients with blood clotting disorders, as the heat from the laser cauterizes any blood vessels that may be severed. This is also suitable for patients who do not expect to have children in the future, as there is a high likelihood of retrograde ejaculation.

Post GreenLight considerations

The GreenLight laser is an aggressive treatment for BPH and, therefore, comes with some moderate discomfort after the procedure. This is usually well managed with over-the-counter medication that will be laid out in your post-operative packet. Patients should also expect to see some blood and potentially tissue flecks in their urine for up to a week or two after their procedure. 

The risks and considerations are ultimately minimal, considering how much tissue is removed during the procedure.

It’s crucial also to remember that you may still have some lower urinary tract symptoms for up to three months after surgery. Your body, especially your bladder, must rebalance itself after eliminating the obstruction. During this time, you may experience involuntary bladder contractions and some frequency and urgency of urination. However, the symptoms tend to improve rapidly over days two weeks after surgery. You will have concerns to look out for listed in your postoperative packet, and of course, we are always available to answer any questions you may have, should you feel that something is not quite right after your procedure.

Retrograde Ejaculation

While we touched on it briefly above, retrograde ejaculation is an important thought for patients considering GreenLight therapy or any thermal therapy for BPH, for that matter – those that require heat or cold to achieve the desired result. These therapies increase the risk of retrograde ejaculation or semen flowing backward into the bladder rather than out through the urethra. Significantly, a green light carries a high chance of this occurring. For men who are not concerned about visible ejaculation or who are not planning on having more children, GreenLight represents a fantastic option. On the other hand, for younger patients who may still be in their family planning stages or for whom visible ejaculate is important, a non-thermal option may be more suitable. Ultimately, we have a plethora of surgical and non-surgical options available to patients with varying degrees of enlarged prostate.

Durability of symptom improvement

After the procedure is done and you have recovered, the most important question becomes how long the symptom improvement will last. Unfortunately, no BPH procedure guarantees the elimination of lower urinary tract symptoms in the future. Instead, through lifestyle improvement and treatment for BPH, we can safely estimate that most patients will enjoy minimal symptoms after a GreenLight for upwards of 10 or even 15 years. However, prostatic tissue will eventually grow back, and another procedure may be necessary.

The bottom line

The GreenLight laser is an exceptionally effective procedure to treat lower urinary tract symptoms associated with BPH or prosthetic hyperplasia. It is well-suited to many patients with moderate to significant prostatic enlargement and has an excellent track record of durability, with some patients experiencing up to 15 years of relief. However, as with any BPH treatment, there are side effects and considerations that every patient needs to understand, and one can do so by consulting with Dr. Natale. 

After consulting with an experienced and knowledgeable urologist like Dr. Natale, you can decide whether to undergo GreenLight therapy or any other BPH treatment. The pros and cons of each procedure will be discussed, and we can help you make the appropriate decision for your circumstances and needs.