After GreenLight: What to Expect

These notes explain what is normal while your prostate heals after GreenLight laser surgery, and when to call us. Dr. Robbins will tailor the advice to you at your follow-up visits.

Blood in the urine

It is common to have light pink to cherry-red urine after the procedure. This small amount of blood usually clears as the prostate heals, and may last a little longer if you take a blood thinner such as aspirin, Coumadin, Plavix or Pradaxa. Ask us before you stop or restart any blood thinner.

While you heal, avoid strenuous activity, drink plenty of fluids to rinse the urinary system, and avoid constipation so you do not have to strain.

Burning when you urinate

Burning, urgency and frequency are common for a week or two while the treated surface heals. The discomfort is mainly while urine passes, particularly at the end of urination; otherwise there is usually not much pain. It comes from inflammation in the channel through the prostate that the laser opened. An anti-inflammatory medicine such as ibuprofen (Motrin) may be recommended to ease it.

Healing can take longer in men with diabetes, in older men, in men taking prednisone and in men who have had radiation to the prostate. If the burning increases after surgery, or comes with a fever, call us: you will need an examination and a urine culture.

Small pieces of tissue in the urine

It is common to pass small fragments in the urine. They are the thin treated layer in the prostate channel coming away as new lining grows underneath — a natural part of healing. Drink plenty of water to keep the urine clear.

Urgency and frequency

An overactive bladder — needing to go often, in small amounts, in a hurry — is common while the prostate and bladder neck are inflamed, and after years of obstruction. It usually settles over the first weeks. If it does not, you will need an examination, a urine culture and a bladder ultrasound to make sure you are emptying, and a medicine that relaxes the bladder muscle may help.

Leakage

Occasionally men leak urine after the prostate is opened, whether by laser or by conventional surgery. With less resistance from the prostate, the sphincter muscle below it may need exercise — Kegel exercises — to strengthen continence.

• Stress leakage happens with coughing, standing up or straining. It is more frequent in older men, after a long time with a catheter, and in men with diabetes or neurological conditions such as Parkinson’s disease, Alzheimer’s disease or spinal disc disease. Exercises, sometimes with a pelvic physiotherapist, help.
• Urge leakage comes from a bladder spasm rather than movement. A medicine that relaxes the bladder muscle can help.
• Constant leakage is very rare. It may follow weakness of or injury to the sphincter muscle, and is more likely in men who had a catheter for a long time before surgery or have a neuromuscular condition. It is treated with intensive Kegel exercises and pelvic physiotherapy with biofeedback.

Ejaculation

Retrograde ejaculation (dry orgasm), where semen goes into the bladder rather than out through the penis, is common after GreenLight, as after other prostate surgery, and is usually permanent. It is not harmful.

Erections

If your erections are weaker after surgery, tell us — medicines such as Viagra or Cialis can be offered.

Getting back to normal

When you return to work and activities depends on your health and your job, and Dr. Robbins will give you advice for your situation. Typical timings, which your surgeon confirms at follow-up:

• Desk work: after 3–5 days (1–3 days if you work from home).
• Driving: after 2–5 days.
• Exercise, lifting and sex: after 2–4 weeks. Heavy lifting may need longer to avoid delayed bleeding, especially if you take a blood thinner.

You can eat a full, regular diet. Drink plenty of fluids, especially water. While you heal, avoid drinks and foods that irritate the bladder: alcohol, caffeine (tea and coffee) and spicy foods.

Your office visits

Please come to the office with a relatively full bladder. A urine flow study and a bladder ultrasound scan will be done to check how fast and how completely your bladder empties. You will also be asked to complete the International Prostate Symptom Score (the AUA Symptom Score) the day before your visit — it is part of our Health History form.

About the procedure itself: GreenLight laser surgery.