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One advantage of laser prostatectomy is smaller instruments, which should produce fewer strictures, scars resulting from injury to the bladder neck or urethra. And, if the bladder neck is not treated, there should be no retrograde ejaculation and no sexual dysfunction. These techniques cause less bleeding, and unlike the TUR they can be performed on an outpatient basis under local anesthesia. Also, there’s no fluid absorption (so no risk of TUR syndrome).

To date, the biggest problems with these still relatively new techniques have been prolonged urinary obstruction after the operation in some patients, and the need for a catheter (either in the urethra or a suprapubic tube, attached directly to the bladder) for several days after surgery. Also, it takes longer for laser prostatectomy to improve urinary flow than for TUR. So, laser surgery may not be best for an impatient patient. The ideal candidate for laser prostatectomy should have a prostate that weighs less than sixty grams or two ounces; should not have urinary retention; and should have mainly obstructive, not irritative, symptoms.

Another problem is that no tissue samples are available for pathologic study. And if the energy beam creates holes in the prostate, there can be distressing irritative symptoms that persist until the tissue has dissolved and been flushed from the body.

Moreover, lasers may not be as widely available as other forms of treatment because of their cost: Laser fibers are very expensive, and most of them can’t be reused. For each laser procedure, the laser fiber alone costs about $800. (The laser machines themselves cost hospitals about $100,000, but they can be used for other procedures.)

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