Retention of Urine and Incomplete Bladder Emptying after Greenlight Laser of Prostate Surgery for BPH
by Dr. Alex Shteynshlyuger, a board-certified urologist, and specialist in the treatment of enlarged prostate, BPH and urinary retention. He is one of the first urologists in the US and NYC to offer Urolift and prostate enucleation, an alternative to traditional TURP as a treatment for enlarged prostate.
What is the Cause of Incomplete Bladder Emptying and Retention after Greenlight Laser Surgery?
Retention of urine after Greenlight laser of the prostate can occur in 5-20% of patients undergoing surgery, depending on whether or not they had urinary retention prior to surgery and the extent of Greenlight laser surgery.
Immediately after Greenlight laser surgery, most common causes of urinary retention are (1) urinary blood clot retention and (2) retention after anesthesia. Urinary blood clot retention is caused by small blood clots blocking the urethra or urethral catheter. Anesthesia and narcotic pain medications can contribute to urinary retention immediately after surgery, typically within the first 48-72 hours.
Urine retention and incomplete bladder emptying after the first week after Greenlight laser surgery is usually caused by persistent obstruction of the prostate either due to swelling of the prostate or large residual prostatic tissue blocking urinary flow. This can be caused by the incomplete or inadequate removal of prostate tissue in the face of a very large prostate.
The onset of slow urine stream after initial good urine stream most often happening within 1-3 months after Greenlight laser surgery is often an indication of the development of urethral stricture (scarring in the urethra)
Treatment of Urinary Retention after Green Light Laser of Prostate
Usually immediately after surgery if a patient has persistent urinary retention, urethral Foley catheter or clean intermittent catheterization is advised.
If urinary retention persists after a few weeks after surgery, reevaluation is necessary to determine the cause of persistent urinary retention and to decide on treatment. At New York Urology Specialists, usual evaluation involves measuring blood levels of creatinine to check kidney function, a urine test to check for urinary tract infection (UTI), pelvic ultrasound and uroflow, as well as cystoscopy. A urodynamic study may be performed in patients where the cause of urinary retention is not obvious.
Non-Obstructive Urinary Retention after Greenlight Laser Surgery
If patient evaluation reveals that patient has non-obstructive urinary retention, which means there is no blockage, narcotic medications, and anticholinergic medications if being taken are stopped if possible. If a patient has persistent non-obstructive urinary retention after Greenlight laser of the prostate, InterStim neuromodulation can help to stimulate the nerves and muscles of the bladder to push the urine out in patients with non-obstructive urinary retention. InterStim is not an option for treating urinary retention in patients who have blockage due to urethral stricture or enlarged prostate.
Obstructive Urine Retention after Greenlight Laser Procedure for Enlarged Prostate
There is also important to note that severe constipation can cause urinary retention and it is important to make sure that a patient has regular daily bowel movements.
In patients with obstructive urinary retention that persists after 3 weeks after Greenlight laser surgery, evaluation with cystoscopy is necessary. If urinary retention is caused by meatal stenosis, urethral stricture bladder neck contracture, treatment to address these problems is necessary.
If incomplete bladder emptying is caused by residual prostate tissue that is still blocking urine flow numerous options are available. Men can try restarting medication such as Flomax and Proscar. If the blockade is minimal, a procedure such as Urolift or Rezum for BPH can be tried.
Most reliable approach to treating urinary retention after Greenlight laser procedure to redo the procedure. At New York Urology Specialists typically we prefer laser enucleation of the prostate to Greenlight laser for redo procedures because laser enucleation of the prostate can remove more obstructive tissue which is especially important for patients with very large prostate and urinary retention. In fact, studies show that some patients in urinary retention who have poor bladder function may still be able to urinate spontaneously after laser enucleation of the prostate as performed at New York Urology Specialists. Other treatment options include Holmium laser of the prostate, HoLEP, Plasma Button Vaporization and bipolar TURP.
What are the Risks of Urinary Retention after Greenlight Laser Prostatectomy?
Urinary retention can cause UTIs, damage to the kidneys and the bladder if the bladder is not properly emptied. Urinary retention and incomplete bladder emptying can also lead to pelvic pain and discomfort. Occasionally patients also feel rectal discomfort and perineal pain as well as pain at the tip of the penis. It is important to address urinary retention promptly.
Why Choose New York Urology Specialists for Treatment of Urinary Retention after Green-Light Surgery for Urinary Retention
- All treatment is performed by a Board-certified urologist experienced in treating men with symptoms of BPH using medical therapy, minimally invasive therapies, lasers and open surgery.
- We are one of the few practices in the region to offer a full range of options for treatment of BPH.
- We offer BPH treatment options under local anesthesia which avoids the risks, costs, and recovery from general anesthesia. Most men are able to return to office work and other normal activities the next day.
- Extensive Experience: Hundreds of men treated successfully using medical therapy, Urolift, lasers for BPH (Holmium, Thulium, Evolve, Greenlight lasers), Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
- We treat men with BPH who have heart problems (hypertension, CAD, CHF), renal failure (ESRD) on hemodialysis, men on blood thinners such as aspirin, Lovenox, Coumadin (Warfarin), apixaban, rivaroxaban (Xarelto).
When it comes to experience and innovation – New York Urology Specialists are a step ahead. Better Science Means Better Care. We specialize in minimally invasive highly effective treatment for symptoms of enlarged prostate and BPH. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.
Medicare and major insurances accepted. We offer affordable rates and financing options.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urinary problems in men. He uses modern effective and proven treatment methods including prostate enucleation and Urolift for BPH. He is highly recommended by top primary care physicians in the New York area.
He has successfully performed hundreds of prostate procedures in adults. Urolift procedures are performed in the office under local anesthesia, in a surgical center and affiliated hospitals under anesthesia.
We offer affordable, highest-quality urology care with or without insurance. Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.