Holmium laser bladder neck incision

What is this?

This involves telescopic laser incision through the prostate and bladder outlet to widen the urinary channel with temporary insertion of a catheter for bladder drainage

What alternatives are there?

Drugs, use of a catheter/stent, observation or conventional bladder neck incision using electrical current rather than a laser

What to expect before procedure

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. You will usually be admitted on the day of surgery. Your general fitness, to screen for the carriage of MRSA will be assessed and sometimes some baseline investigations performed prior to your admission. This can, on occasions, be done by telephone or you may be asked to attend a pre-admission clinic approximately 14 days before your admission, depending on your medical history. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. The operation, on average, takes 20-30 minutes. You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies. The laser is used to incise through any tight areas in the bladder outlet and prostate. Often, this allows sufficient widening of the urinary channel but, sometimes, a small amount of prostate tissue is removed at the same time to ensure the channel is clear and open. A catheter is normally left to drain the bladder at the end of the procedure.

After the procedure

There is always some bleeding from the prostate area after the operation. The urine is usually clear of blood within 12 hours, although some patients lose blood for longer. It is unusual to require a blood transfusion after laser surgery. It is useful to drink as much as possible in the first 12 hours after the operation because this helps the urine clear of blood more quickly. Sometimes, fluid is flushed through the catheter to clear the urine of blood. You will be able to eat and drink on the same day as the operation when you feel able to. The catheter is generally removed at midnight on the first night after surgery. This allows your bladder time to fill overnight so that, in the morning, the doctors can decide whether you can go home without the catheter At first, it may be painful to pass your urine and it may come more frequently than normal. Any initial discomfort can be relieved by tablets or injections and the frequency usually improves within a few weeks. Some of your symptoms, especially frequency, urgency and getting up at night to pass urine, may not improve for several months because these are often due to bladder overactivity (which takes time to resolve after prostate surgery) rather than prostate or bladder neck blockage. It is not unusual for your urine to turn bloody again for the first 24-48 hours after catheter removal. Some blood may be visible in the urine even several weeks after surgery but this is usually not a problem. Let your nurse know if you are unable to pass urine and feel as if your bladder is full after the catheter is removed. Some patients are unable to pas urine at all after the operation due to temporary internal swelling within the prostate area. If this should happen, we normally pass a catheter again to allow the swelling to resolve and the bladder to regain its function. Usually, patients who require re-catheterisation go home with the catheter in place and return after a week or so for a second catheter removal which, in almost all cases, is successful. The average hospital stay is 1 day only.

Potential side effects