GreenLight Laser Vaporisation

How GreenLight vaporisation works

GreenLight vaporisation is one of the laser treatments offered for an enlarged prostate. A resectoscope is passed along the urethra and a side-firing laser fibre vaporises obstructing prostate tissue. The result is a clear channel through the prostate, so patients can void and pass urine more easily. Irrigation uses normal saline. There is no external incision.

The 532 nm wavelength is preferentially absorbed by haemoglobin, which is why it vaporises vascular tissue efficiently and tends to leave behind a well-sealed, low-bleeding surface.²¹

Strengths

• Excellent haemostasis. GreenLight is well documented for bleeding control, including in patients taking anticoagulant medication.^{21, 22}
• Usually day surgery. Many men go home the same day or the following morning.
• Good fit for smaller prostates. The vaporisation rate is efficient enough for small-to-medium glands (up to around 80 cc) where full enucleation is not required.
• Outcomes in older men. Published series in men aged 75 and over report acceptable safety and symptom improvement.²³

Limitations and patient selection

Some studies have reported good outcomes with GreenLight,²² but retreatment rates can be higher than with HoLEP over longer follow-up.²⁴ For that reason Dr Kooner uses GreenLight selectively - generally for:

• Patients with smaller prostates where HoLEP enucleation is not needed.
• Patients on anticoagulant medication where the priority is to minimise bleeding.
• Patients in whom a shorter operating time and same-day discharge are particularly important.

The tissue is vaporised rather than removed, so there is no specimen sent to pathology. If there is a pre-operative suspicion of prostate cancer, HoLEP (which does produce a specimen) or a separate biopsy pathway is usually preferred.

GreenLight vs HoLEP

• Mechanism. GreenLight vaporises tissue; HoLEP enucleates it.
• Size limit. GreenLight is most commonly used up to around 80 cc; HoLEP has no meaningful upper size limit.^{4, 5}
• Hospital stay. GreenLight is often a same-day procedure; HoLEP is usually an overnight stay.
• Durability. HoLEP has lower long-term retreatment rates in the published literature.^{8, 17, 24}
• Pathology. HoLEP produces morcellated tissue for histology; GreenLight does not.

For small-to-medium prostates where a shorter day-surgery procedure is the priority and the specimen is not needed, GreenLight is a reasonable alternative. For very large glands or men who want the longest durability, HoLEP is usually chosen.

Recovery after GreenLight

• Catheter. A small catheter is typically left in for 24-48 hours and then removed.
• First two weeks. Some burning on passing urine, urgency and intermittent blood-tinged urine as the vaporised surface heals. Drinking extra fluid helps.
• Work and driving. Many men return to office work and short-distance driving in 1-2 weeks. Heavy lifting and cycling are deferred for about four weeks.
• Sexual activity. Avoid intercourse for approximately two weeks, then resume at your own pace. Retrograde ejaculation is common after GreenLight as it is after other transurethral BPH procedures.
• Follow-up. A review with flow study and bladder scan is arranged around 6 weeks.