Laser prostate surgery (HoLEP and thulium laser) for an enlarged prostateBarhi hui prostate ke liye laser surgery (HoLEP aur thulium laser)

Yeh kya hai aur kyun kiya jata hai

Prostate ka aik andar ka hissa hota hai jo barh kar urethra ko dabata hai, aur aik bahar ka khol. Laser enucleation mein urethra se aik patli doorbeen guzaari jati hai aur laser fibre se andar ke hisse ko khol se alag kiya jata hai, jaise phal ka gooda chilke se alag kiya jata hai. Alag hua tissue bladder mein dhakela jata hai, chhoti aala se chhoti tukron mein tora jata hai aur nikaal liya jata hai. Bahar ka khol apni jagah rehta hai.

Yeh wahi masla theek karti hai jo TURP karti hai (dekhein TURP ki guide), jaise kamzor dhaar, peshab bilkul na aana, ya barhi hui prostate ke masail (dekhein barhi hui prostate ki guide). Laser enucleation har size ki prostate ke liye, bohat bari prostate ke liye bhi, istemal ho sakti hai.

Doosri laser qismein tissue ko vaporise (jala kar khatam) karti hain. Yeh chhoti prostate ke liye istemal hoti hain, aur laboratory ke muaine ke liye koi tissue nahi bachta. Aap ka urologist batayega ke kaun si qism di ja rahi hai aur kyun.

Procedure se pehle

• Pehle peshab ka test hota hai. Peshab ke infection ka operation se pehle ilaaj hota hai (dekhein peshab ke tests ki guide).
• PSA aur doosre tests: PSA test, aur kabhi scan ya bahao ka test, pehle hota hai (dekhein PSA test ki guide aur uroflowmetry ki guide).
• Khoon patla karne wali dawayein aur kisi bhi allergy ke baare mein team ko batayein. Apne taur par koi dawa band na karein. Khoon patla karne wali dawaon ke saath laser enucleation ko tay karna aksar TURP se aasaan hota hai, lekin faisla aap ka urologist karega.
• Bay-hoshi: yeh aam tor par poori bay-hoshi ya spinal anaesthetic mein hota hai. Khaane peene ke baare mein jo hidayaat milein un par amal karein.
• Aap se razamandi (consent) maangi jayegi. Manyi (ejaculation) aur peshab par qaboo par asar, aur laser mein surgeon ke tajurbe ke baare mein poochhein.
• Qeemat, operation kahan hoga aur kya aap ke hospital mein dastiyab hai, yeh bhi poochh lein, kyunke is ke liye khaas aalaat aur training chahiye hoti hai.

Procedure ke dauran

Anaesthetic ke asar ke baad doorbeen peshab ki nali se guzar kar prostate tak pohanchayi jati hai. Laser andar ke tissue ko hisson mein alag karti hai, aur use bladder mein dhakela jata hai. Phir aik chhoti aala tissue ko tukron mein tor kar nikaal leti hai. Tissue laboratory bheja jata hai.

Aakhir mein bladder mein catheter rakhi jati hai, aur peshab saaf rakhne ke liye thori der paani chalaya ja sakta hai. Catheter aksar TURP ke muqable mein jaldi nikal di jati hai, aur bohat se mard agle din ghar chale jate hain.

Procedure ke baad aur recovery

• Catheter thori der rehti hai, aksar aik do din. Peshab shuru mein gulabi hota hai aur aam tor par jaldi saaf ho jata hai.
• Reesna aur achanak hajat: bohat se mard kuch haftay thora sa peshab rees'ta hua ya achanak hajat mehsoos karte hain jab tak bladder sambhal na jaye. Pelvic floor ki kasrat madad karti hai. Yeh aam tor par behtar ho jata hai.
• Jalan aur peshab mein khoon kuch haftay aata jata rehta hai. Bohat paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho.
• Qabz, zor lagane, bhaari wazan uthane aur zor wali kasrat se kayi haftay parhez karein, jaisa mashwara ho. Gaari, kaam aur jinsi taluq ke baare mein team se poochh lein.
• Fayda aahista aahista barhta hai jaise jaise soojan utarti hai.

Mumkina khatrat

• Aam: peshab mein khoon, jalan, zyada baar peshab aana, thori der ka reesna ya achanak hajat, aur khushk manyi (retrograde ejaculation). Manyi bahar aane ke bajaye bladder mein chali jati hai. Yeh nuqsandeh nahi, lekin aap aam tareeqe se aulad paida nahi kar sakte, is liye agar mazeed bachon ki khwahish ho to pehle se baat karein.
• Kam aam: peshab ka infection, khoon jis ke liye mazeed ilaaj chahiye, khoon ka lothra jo catheter band kar de, aur baad mein peshab ki nali ya bladder ki gardan ka tang ho jana.
• Ghair aam: khaas hissay ki sakhti mein masla, peshab par qaboo ka lambay arsay ke liye khatam hona, ya mazeed ilaaj ki zaroorat.
• Bohat kam: bladder ya peshab ki nali ko chot, taang ya phephre mein khoon ka lothra, ya anaesthetic ke khatrat.

Laser enucleation ke liye khaas training chahiye. Apne surgeon se un ke tajurbe ke baare mein poochhein, kyunke nateeje aur shuru ke side effects is par munhasir hote hain.

Follow-up aur nateeje

• Tissue ka nateeja: nikala gaya tissue laboratory bheja jata hai. Bohat kam kabhi koi chhota cancer nikal aata hai jis ki kisi ko umeed nahi hoti. Poochh lein ke nateeja kab aur kaise bataya jayega (dekhein prostate cancer ki guide).
• Follow-up visit: aam tor par kuch haftay baad aap ka bahao aur peshab par qaboo dekha jata hai. Bahao ka test dobara ho sakta hai (dekhein uroflowmetry ki guide).
• Agar alamaat dobara aayein to apne urologist ko dikhayein.

Aam sawalaat

What it is and why it is done

The prostate has an inner part that grows and squeezes the urethra, and an outer shell. In laser enucleation, a thin telescope is passed along the urethra and a laser fibre is used to free the inner part from the shell, much as the flesh of a fruit is separated from its skin. The freed tissue is pushed into the bladder, broken into small pieces with a small instrument, and removed. The outer shell stays in place.

It treats the same problem as TURP (see the TURP guide), such as poor flow, being unable to pass urine, or complications of an enlarged prostate (see the enlarged prostate guide). Laser enucleation can be used for prostates of any size, including very large ones.

There are other lasers that vaporise (burn away) prostate tissue instead. They are used for smaller prostates, and no tissue is left for the laboratory to examine. Your urologist will explain which type is offered and why.

Before the procedure

• A urine test is done first. A urine infection is treated before the operation (see the urine tests guide).
• PSA and other tests: a PSA test, and sometimes a scan or flow test, are done first (see the PSA test guide and the uroflowmetry guide).
• Tell the team about blood thinners and any allergies. Please do not stop any medicine on your own. Laser enucleation is often easier to plan around blood thinners than TURP, but your urologist must decide.
• Anaesthetic: it is usually done under a general or spinal anaesthetic. Follow the instructions about eating and drinking.
• You will be asked for consent. Please ask about the effect on ejaculation and bladder control, and about the surgeon's experience with the laser.
• Ask about the cost, where it will be done and whether it is available at your hospital, as it needs special equipment and training.

During the procedure

With the anaesthetic working, the telescope is passed along the urethra to the prostate. The laser frees the inner tissue in sections, and this is pushed into the bladder. A small instrument then breaks the tissue into pieces and removes them. The tissue is sent to the laboratory.

At the end, a catheter is placed in the bladder, and fluid may be run through it for a short time to keep the urine clear. The catheter often comes out sooner than after TURP, and many men go home the next day.

After the procedure and recovery

• The catheter stays in for a short time, often a day or two. The urine is pink at first and usually clears quickly.
• Leaking and urgency: many men leak a little urine or feel a sudden urge to go for some weeks, until the bladder settles. Pelvic floor exercises can help. This usually improves.
• Burning and blood in the urine may come and go for some weeks. Drink plenty of water unless told otherwise.
• Avoid constipation, straining, heavy lifting and strenuous exercise for several weeks, as advised. Ask the team about driving, work and sex.
• The benefit builds up gradually over some weeks as the swelling settles.

Possible risks

• Common: blood in the urine, burning, passing urine more often, short-term leaking or urgency, and dry ejaculation (retrograde ejaculation). The semen goes back into the bladder instead of out. It is harmless, but you cannot father a child in the usual way, so discuss this beforehand if you may want more children.
• Less common: a urine infection, bleeding that needs more treatment, a blood clot blocking the catheter, and a narrowing of the urethra or bladder neck later on.
• Uncommon: a problem with erections, long-term loss of bladder control, or the need for further treatment.
• Rare: injury to the bladder or urethra, a blood clot in the leg or lung, or the risks of the anaesthetic.

Laser enucleation needs special training. Ask your surgeon about their experience, because results and short-term side effects depend on it.

Follow-up and results

• Tissue result: the tissue removed is sent to the laboratory. Very occasionally a small cancer is found that nobody expected. Ask how and when you will be told (see the prostate cancer guide).
• Follow-up visit: you will usually be seen some weeks later to check your flow and bladder control. A flow test may be repeated (see the uroflowmetry guide).
• If symptoms come back, see your urologist.

Common questions