Laser Enucleation of the Prostate Consent

Informed Consent For Surgical Operation / Procedure

Procedure: Laser Enucleation of the Prostate (HoLEP / ThuLEP / ThuFLEP)

1. Patient Identification

I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):

Procedure: _______________________________
Diagnosis: ________________________________
Major illness & comorbidities: ________________________________

2. Authorization for Procedure

I authorize Dr. __________________ to perform the above procedure, along with such assistants and associates as may be selected by him/her.

I understand that members of the surgical team, including residents or trainees under appropriate supervision, may perform parts of the procedure according to their training and competence.

3. Nature of Procedure

Laser Enucleation is a minimally invasive endoscopic procedure performed through the urethra without external incisions.

A high-powered laser is used to peel away the obstructing prostate tissue from its capsule.

The tissue is pushed into the bladder, where a morcellator removes it for pathological examination.

A urinary catheter is typically left in place for 1–2 days after surgery.

4. Benefits and Indications

The procedure is intended for patients with:

  • Benign Prostatic Hyperplasia
  • Bladder outlet obstruction

The procedure aims to:

  • Improve urinary flow
  • Reduce urinary frequency and urgency
  • Provide durable relief from obstruction
  • Treat prostates of varying sizes

I understand that complete resolution of all bladder symptoms may take several weeks while the raw prostatic bed heals

5. Risks and Complications

Intra-operative

  • Bleeding
  • Bladder or ureteric injury
  • Conversion to TURP or open surgery

Post-operative

  • Hematuria
  • Temporary urge incontinence (10–15%)
  • UTI/Fever
  • Retrograde ejaculation (70–80%)

Long-term

  • Urethral stricture or bladder neck contracture (2–5%)
  • Permanent incontinence (under 1%)

Patients taking blood thinners or those with very large prostates may have increased risk of transient bleeding.

6. Postoperative Course

I understand that:

  • Day-care surgery or overnight admission may be required.
  • A urinary catheter is typically maintained for 1–2 days.

I understand that urinary symptoms may take several weeks to completely settle as the treated prostatic bed heals.

7. Alternatives to Procedure

I have been informed of alternatives including:

  • Medical management
  • TURP
  • Simple prostatectomy
  • UroLift
  • Rezum
  • Observation/watchful waiting

8. Anaesthesia and Pain Management

I understand the risks associated with local, regional, or general anaesthesia.

Pain management options have been explained.

9. Photography / Data Use

I consent to:

☐ Medical photography/video for academic purposes

☐ Use of anonymized clinical data

10. Intraoperative Decision Consent

I authorize the surgeon to perform additional procedures considered necessary if unexpected findings arise during surgery.

11. Team-Based Care

I understand that supervised residents, fellows, or assistants may participate.

12. Patient Statement

I confirm that:

  • The nature of surgery has been explained.
  • Risks, benefits, and alternatives have been explained.
  • My questions have been answered satisfactorily.
  • I voluntarily consent.

Patient to write in own handwriting:

“I have understood the procedure, risks, benefits and alternatives explained to me in a language I understand.”

Signatures

Patient Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Doctor Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Witness Name & Signature: ____________________________________

Contact No.: ______________________________

ATTENDANT CONSENT (If applicable)

Reason patient unable to consent:

Attendant Name: __________________________________________

Relationship: _____________________________________________

Signature: ________________________________________________

Contact No.: ______________________________________________

INTERPRETER STATEMENT (If applicable)

I confirm an accurate explanation in understandable language.

Name: _________________________________________________

Signature: ______________________________________________

Contact: ________________________________________________

HIGH-RISK CONSENT (If applicable)

High-risk factors explained due to:

Patient Signature: ________________________________________

Doctor Signature: _________________________________________

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