For GPs and referrers

When to consider referral

• Moderate to severe LUTS (IPSS generally 8 or above) not controlled by alpha blockers or 5-alpha-reductase inhibitors.
• Acute urinary retention, recurrent retention, or failed trial without catheter.
• Recurrent UTI, bladder stones, haematuria or upper-tract change attributable to BPH.
• Intolerance of BPH medication (for example postural hypotension, ejaculatory side effects).
• A patient who prefers surgical management over long-term medication.
• Men on anticoagulants where bleeding risk with other techniques is a concern - GreenLight is specifically well documented in this group.²

Useful work-up before referral

• IPSS and quality-of-life score.
• Urine dipstick and MSU.
• PSA (with patient consent, where clinically appropriate).
• U/E and coagulation screen if on anticoagulants.
• Flow rate and post-void residual if available.
• Prostate ultrasound or MRI volume if previously measured.

How to refer

Send referrals to Urology NSW:

• Fax: 02 8382 6991
• Email: Raji.Kooner@svha.org.au
• Phone (urgent or to discuss): 02 8382 6980

Please mark referrals "GreenLight / BPH assessment" if the patient is specifically interested in GreenLight laser vaporisation, or "BPH surgical options" to leave the technique choice open.

How a procedure is chosen

Dr Kooner does not default to a single operation. The recommendation depends on:

• Prostate size. GreenLight is well suited to small-to-medium glands; HoLEP is preferred for larger prostates.⁴
• Bleeding risk. GreenLight's 532 nm haemostatic profile is favourable in men on anticoagulants.^{1, 2}
• Need for pathology. HoLEP yields tissue for histology; GreenLight does not.
• Patient priorities. Day-surgery discharge, durability, sexual function and recovery timeline.

Secondary care pathway

After consultation the patient is given a tailored recommendation with written information. The typical post-operative pathway for GreenLight is outlined on What to expect. Referrers receive a letter describing the procedure chosen, catheter duration, and follow-up plan.