Holmium Laser Enucleation of the Prostate (HoLEP)

HOLEP stands for Holmium Laser Enucleation of the Prostate. It is a surgical procedure used to treat benign prostatic hyperplasia (BPH), a condition where the prostate gland enlarges and causes problems with urination. BPH is a common condition in older men and can lead to symptoms such as frequent urination, difficulty starting or stopping urination, and a weak urine stream.

HOLEP is considered a minimally invasive alternative to traditional surgical methods like transurethral resection of the prostate (TURP). It has the advantage of reduced blood loss, shorter hospital stays, and a faster recovery compared to some other surgical options for BPH.

Why would you need a HoLEP?

Holmium Laser Enucleation of the Prostate (HoLEP) may be recommended if you are experiencing significant symptoms related to benign prostatic hyperplasia (BPH), a condition where the prostate gland enlarges and causes obstruction of the urinary flow. Common symptoms of BPH include:

Frequent Urination: An increased need to urinate, especially at night (nocturia).

Urgency: A sudden and compelling need to urinate.

Difficulty Starting Urination: Trouble initiating the urine stream.

Weak Urine Stream: The flow of urine is weak and may be intermittent.

Incomplete Emptying: Feeling that the bladder is not fully empty after urination.

Urinary Retention: Inability to empty the bladder completely.

If you are experiencing these symptoms and conservative measures, such as lifestyle changes or medications, have not provided sufficient relief, your healthcare provider might consider surgical interventions like HoLEP. HoLEP is particularly suitable for individuals with larger prostates or those with severe symptoms that significantly impact their quality of life.

It’s important to note that the decision to undergo HoLEP or any other surgical procedure should be made in consultation with your healthcare provider. They will evaluate your specific condition, overall health, and discuss the potential risks and benefits of the procedure with you. Individual circumstances can vary, and the choice of treatment depends on factors such as the size of the prostate, the severity of symptoms, and your overall health.

HoLEP procedure

Here is an overview of how the HoLEP procedure is typically performed:

1. Anesthesia:

Before the surgery, you will be given either general or spinal anesthesia to ensure you are comfortable and pain-free during the procedure.

2. Insertion of the Laser Fiber:

A thin tube called a cystoscope is inserted through the urethra and into the prostate. The cystoscope contains a camera that allows the surgeon to visualize the prostate.

3. Laser Incision:

A holmium laser fiber is then passed through the cystoscope. The holmium laser is used to make precise incisions in the prostate tissue, creating an enucleation plane that separates the inner portion of the prostate from the surrounding capsule.

4. Tissue Enucleation:

The surgeon carefully enucleates (removes) the separated prostate tissue using the laser. The holmium laser is capable of cutting and coagulating tissue with high precision.

5. Morcellation:

The excised prostate tissue is morcellated, which means it is fragmented into smaller pieces. This allows for easier removal through the cystoscope.

6. Removal of Tissue:

The morcellated prostate tissue is suctioned out through the cystoscope or flushed out with irrigation fluid.

7. Postoperative Care:

After the procedure, a catheter may be temporarily placed to help drain urine from the bladder. The catheter is usually removed within a day or two after surgery.

Advantages of HoLEP

With the HoLEP technique, the intervention area is prevented from damaging the urinary tract. Thus, there is no urinary incontinence problem after the operation. The functions of the tissues exposed to laser beams are not damaged. Sexual function problems do not occur in men. Another advantage is that the possibility of bleeding is very low. While prostate tissues are intervened, the surrounding areas are protected.

It is known that it can be performed safely in all prostates of all sizes. At the same time, a positive improvement in urination is observed. Finally, the advantages of HoLEP surgery also include the recovery period. Hospitalisation takes less time compared to other surgical methods. It offers a more comfortable recovery process to the treated people.

Recovery for a HoLEP surgery

Recovery after Holmium Laser Enucleation of the Prostate (HoLEP) surgery can vary from person to person, but here is a general timeline and some common aspects of the recovery process:

Hospital Stay: Patients typically stay in the hospital for a day or two after the HoLEP procedure. During this time, healthcare providers monitor your condition and manage pain, and you may have a catheter in place to help drain urine from the bladder.

Catheter Removal: The catheter is usually removed within a day or two after surgery, depending on the individual case and the surgeon's recommendations.

Activity Restrictions: While you may be encouraged to move around and walk shortly after the surgery, it’s important to avoid strenuous activities and heavy lifting during the initial recovery period.

Medications: Your healthcare provider may prescribe medications, such as pain relievers or antibiotics, to help manage pain and prevent infection. It’s crucial to take all medications as prescribed.

Follow-up Appointments: You will have follow-up appointments with your healthcare provider to monitor your recovery progress, address any concerns, and discuss the results of the surgery.

Resuming Normal Activities: Most patients can gradually resume normal activities within a few days to a week after the surgery. However, strenuous activities and heavy lifting may need to be avoided for a longer period, as recommended by your healthcare provider.

Urinary Symptoms: It’s normal to experience some urinary symptoms during the initial recovery period, such as temporary urinary urgency, frequency, or burning during urination. These symptoms typically improve over time.

Diet and Hydration: Maintaining a healthy diet and staying well-hydrated are important aspects of the recovery process.

Follow Instructions: Follow all postoperative instructions provided by your healthcare team. This may include any dietary restrictions, prescribed medications, and activity guidelines.

Return to Work: The time it takes to return to work will depend on individual factors, such as the nature of your job and the speed of your recovery. Many people can return to work within a week or two after HoLEP surgery.

It’s essential to communicate regularly with your healthcare provider, report any unusual symptoms or concerns, and attend all scheduled follow-up appointments to ensure a smooth recovery and optimal outcomes. As with any surgical procedure, individual experiences may vary, and your healthcare provider will provide personalized guidance based on your specific situation.