Greenlight Laser (GL) is used in the treatment of BPH (Benign Prostatic Hyperplasia), also known as enlargement of the prostate. The surgery is performed with a telescopic surgical instrument designed to vaporize the obstructing prostate tissue (a resectoscope). Before this is performed, another type of telescopic instrument called a cystoscope is passed into the urethra, which goes through the middle of the prostate and is passed into the bladder. These areas are thoroughly inspected with this telescope using a solution of sterile fluid (irrigant) passing through the cystoscope. This allows the physician to see the inside lining of the bladder and urethra.

The cystoscope is then removed and then the laser resectoscope (which is slightly larger than the cystoscope) is passed into the bladder. The laser resectoscope is fitted with a laser fiber that vaporizes the tissue away.

Bleeding rarely occurs with this laser procedure. Unlike the classic TURP (Transurethral Resection of the Prostate) procedure, there is no prostate tissue that is available to be sent to pathology since the tissue is vaporized away with the laser.

The operation takes about 1-2 hours depending on the size of the prostate. The usual hospital stay is no more than one day, but most patients are able to leave the same day as the procedure.



Unless your doctor has specifically told you otherwise, it is very important to stop taking Coumadin, aspirin, or pain medications that are non-steroidal anti-inflammatory drugs at least one to two weeks before the date of your surgery. These medications can prevent your blood from clotting, and may increase the likelihood of bleeding from the procedure. Please discuss this with your physician before your surgery is scheduled.

You will be given either a spinal anesthetic or a general anesthetic for the surgery. The anesthesiologist will call you before surgery to discuss this with you.

Do not eat or drink anything after midnight the night before surgery.



From the recovery area, you will either be discharged home (following the laser procedure), or be admitted to your hospital room.

You will have a small catheter inserted into your bladder immediately after surgery. The catheter may stay in place for several days until your urine is clear amber, and there is no sign of blood.

You may have fluid constantly run in and out of the bladder through this catheter for a day or two until the bleeding has stopped. Bladder spasms can occur if the catheter becomes blocked by a clot and urine cannot drain out. If this happens, you may notice a sudden cramping sensation in your lower abdomen. Let the nurse or doctor know as soon as possible. The catheter can be irrigated if blocked, and medication may be given to reduce the bladder spasms.

You are encouraged to drink plenty of fluids (one 6-8 oz. cup of fluid every hour). This helps to produce more urine to wash out the bladder so that the urine remains clear. When the urine is a faint pink color and there are no clots, the catheter will be removed.

If you have any discomfort after surgery, pain medications will be prescribed as needed. You can begin a liquid diet the afternoon of the surgery, and then you can have a light dinner. You can then return to your normal diet the next day.

You may not have a bowel movement for several days after surgery. Take stool softeners every day until your bowels become regular.

You will likely be sent home with the catheter draining into a leg bag. If this occurs, you will be instructed to return in a few days to have the catheter removed.



After removal of the catheter, which occurs either the same day of the procedure or the day after surgery, most patients can pass urine in the normal way, but urination is urgent and frequent for a time. These symptoms are variable from individual to individual, and can last from a few days to a few weeks. If the urgency is severe, you may find it hard to control your urine flow. It is advisable to keep a urinal nearby.

In some patients who have had GL, the urine may dissolve the scabs, which form on the healing surface of the prostate two weeks after the surgery. When these scabs fall off, you may see some blood or fleshy material in the urine. If this happens, do not worry. Increase your fluid intake, which will clear up the urine within a day or so. In addition, sexual activity may induce bleeding in the urine, and it may be wise to withhold sexual activity for a few weeks after the operation.

If you have heavy bleeding or a clot blocks your urine flow and you cannot pass any urine, call you doctor immediately. You may need to go to the nearest emergency room. Your doctor will arrange for you to have a catheter passed into the bladder so the clots may be irrigated out.



It takes 4-6 weeks for complete healing of the surgical area to occur. During this time, patients should not do any heavy lifting, straining, exertional exercises, jogging, or engage in sexual intercourse. This will prevent and minimize the risk of bleeding.

The amount of time you stay home from work depends on the nature of your job, and the amount of physical effort your work requires. Discuss this with your physician before the surgery.

Urination should be noticeably improved within a few weeks after the surgery. The speed of this improvement depends on the quality of the bladder muscle. If you have persistent bleeding, burning on urination with frequent urination, passage of many large blood clots, inability to urinate, or fever, call your physician.



Infection. Urinary infection may occur post-operatively. If it occurs, you will be treated with antibiotics. Notify your physician if you develop fever greater than 100.5°F, or foul-smelling or cloudy urine.

Incontinence. This can occur, but is very rare after this type of surgery. Less than 1% of patients develop long term incontinence. The incontinence is due to uncontrolled overactivity of the bladder muscle, which can be treated by drugs. The incontinence may also be caused by weakness of the external sphincter muscle, which may require surgical treatment such as collagen injection or placement of an artificial urethral sphincter.

Retrograde Ejaculation. A thin muscle called the internal sphincter lies on the surface of the prostate at the bladder neck. This muscle closes the bladder neck during normal ejaculation so the semen comes out of the penis. This muscle is removed along with the blocking prostate tissue during GL. In the majority of men following surgery, the semen containing sperm goes into the bladder during ejaculation. This is called retrograde ejaculation. The semen will come out in the urine the next time you empty your bladder. In most men, retrograde ejaculation does not usually interfere with the sensation of orgasm.

If you intend to father more children in the future, this will not be possible without assisted reproduction techniques. If this is an issue that is important to you, please ask your urologist for more information. Retrograde ejaculation is not harmful to you.

Impotence/Erectile Dysfunction. If you have normal erections before GL, there is a slight chance that you may have trouble with your erections following the surgery. Sometimes, this is temporary, and men regain the ability to have erections within a few months following surgery. If you are having trouble with your erections, a variety of treatments are available to help alleviate the condition. Your urologist can discuss this with you.

Urinary Stricture. This is a scar that forms in the urethra or bladder neck area after the surgery. This is rare. If this happens to you, the scar tissue may need to be removed. This is usually an outpatient procedure.

Peyronie’s Disease. Peyronie’s Disease is a scar of the inner linings of the penis that is rarely associated with cystoscopy. It is manifested as a curvature of the erect penis. While rare, it can occur following any procedure where an instrument is placed within the urethra. Your urologist can discuss this in more detail with you.

Need for Repeat Surgery. The procedure has not been around long enough for us to know what percentage of patients may need repeat surgery.



The American Urological Association Symptom Score For Benign Prostatic Hyperplasia helps men determine how bothersome their urinary symptoms are, and check how effective their treatment is. This questionnaire has also been adopted worldwide, and is known as the International Prostate Symptom Score (IPSS). It is provided below in PDF format for easy viewing and/or printing.

AUA Symptom Score For BPH