Benign Prostatic Hyperplasia (BPH) is a condition where the prostate gland enlarges, causing symptoms such as a weak stream, urgency, and frequent nighttime urination. When medications no longer provide sufficient relief, surgical intervention becomes necessary to clear the obstruction. GreenLight Photovaporization of the Prostate (PVP) is a minimally invasive surgical option that uses concentrated light energy to precisely remove the excess prostate tissue, restoring normal urine flow.
The Mechanism of Photovaporization
The GreenLight system utilizes a high-powered laser beam with a specific wavelength of 532 nanometers. This unique wavelength is highly and selectively absorbed by oxyhemoglobin, the oxygen-carrying molecule found in red blood cells.
When the laser energy is absorbed by the hemoglobin, the temperature of the blood and surrounding water inside the prostate cells rapidly increases. This intense heat causes the intracellular water to instantly vaporize, turning the obstructive prostate tissue into steam and removing it layer by layer. This process is called photovaporization.
The simultaneous sealing of surrounding small blood vessels by the heat leads to immediate coagulation. This results in significantly less bleeding compared to older surgical methods, such as Transurethral Resection of the Prostate (TURP). The controlled depth of penetration, only a few millimeters, allows for precise tissue removal while minimizing thermal damage to deeper layers of the prostate capsule.
What Happens During the Procedure
GreenLight PVP is typically performed in an outpatient setting or requires only a short hospital stay, often under general or spinal anesthesia. The procedure begins with the surgeon inserting a thin, tube-like instrument called a cystoscope through the urethra and into the bladder. No external incisions are required for this transurethral approach.
A laser fiber is then passed through a channel in the cystoscope, positioning the tip directly against the enlarged prostate tissue. The surgeon systematically directs the laser energy to vaporize the adenoma. The surgeon works outward from the center, creating a wide, open channel for urine to pass from the bladder.
The procedure’s duration varies depending on the size of the prostate gland, but it often takes between 30 and 45 minutes. Any remaining, non-vaporized tissue fragments are naturally passed out of the body in the urine over the following days.
Post-Operative Recovery and Care
A temporary urinary catheter is usually placed after the operation to drain the bladder. It is often removed within 24 hours, though some patients may require it longer. Most patients notice a dramatic improvement in urinary flow immediately after the catheter is removed.
It is common to experience temporary side effects. These can include mild burning or stinging during urination, which may persist for a few weeks. Patients might also observe temporary blood in the urine, which typically resolves quickly.
To promote healing, patients are advised to take it easy for the first 48 hours and to increase fluid intake to help flush the bladder. Strenuous activities, such as heavy lifting or vigorous exercise, should be avoided for about two weeks to prevent bleeding. Most individuals can return to normal activities within a few days of the procedure.
Eligibility and Long-Term Results
GreenLight PVP is an option for men experiencing moderate to severe BPH symptoms, particularly when oral medications have been ineffective or poorly tolerated. Its suitability for patients who must remain on anticoagulant or antiplatelet therapy is important, as the procedure minimizes the risk of significant bleeding. Patients with large prostate glands, up to 150 milliliters, can be treated effectively, though this may require longer operative times.
The long-term outlook for GreenLight PVP is favorable, with outcomes comparable to traditional surgery but with fewer perioperative complications. Studies show that significant symptom relief is sustained for many years following the procedure. Re-treatment rates are generally low, with success rates of over 75% at five years.
A common side effect is retrograde ejaculation, where semen enters the bladder instead of exiting the penis during orgasm. This condition is not harmful and does not affect the sensation of orgasm or erectile function. Rare, serious complications include bladder neck contracture or urethral stricture, which may necessitate further endoscopic treatment.