Green Light Laser
The Green Light laser is one of several lasers introduced after 2006 for treating BPH. Before these lasers were popularized, patients largely underwent trans-urethral resection of the prostate (TURP) in the operating room to treat difficulties with an enlarged prostate. The Green Light Laser became the laser market leader through a very extensive marketing campaign. Its timing was perfect because medicines had been popularized for BPH by then, thus drastically reducing the number of TURPs being performed. This led to fewer urologists leaving their residency fully comfortable performing a TURP, an acquired skill. The Green Light laser is a simple procedure with a short learning curve. Its marketing suggested it to be a minimally invasive alternative to TURP, so patients welcomed it. TURP, to that point, was at times dangerous to perform due to the technology available and almost always involved hospitalization. Greenlight laser was marketed as a safer, potentially outpatient procedure.
Urologic Surgeons of Washington was an early adopter of the Greenlight laser, and its differences with the TURP became evident early on. Postoperative irritative symptoms are far higher with the Greenlight. Also, we found that unless the prostate was very small, we almost always encountered bleeding that necessitated us performing a partial TURP anyway. Also, soon after Greenlight laser was popularized, TURP device manufacturers developed the bipolar TURP making the TURP just as safe as the Greenlight.
The Greenlight laser does not cut tissue but rather burns it at a very high temperature, called vaporization. It bursts cells by boiling the water inside them. The problem is that once all the cells on the prostate surface are vaporized, the laser has a hard time penetrating the tissue, and thus, this is not a good approach for prostates other than medium or small-sized prostates.
Eventually, better office procedures such as the Rezum, the TUNA/Prostiva, and Urolift were popularized. These offer a truly minimally invasive option. The Greenlight still requires anesthesia as a TURP does, and these days many TURPs are also performed in an outpatient setting. For these reasons, we at Urologic Surgeons generally offer office procedures to those with medium or small prostates and a bipolar TURP to those that require more aggressive treatment. We feel that if a patient must go through the trouble of anesthesia at a facility, they are best offered the more successful bipolar TURP with the hope of sending them home the same day. Our providers still offer Greenlight laser in special circumstances, but we do not favor it as a primary therapeutic tool.
