What is HoLEP? Laser Treatment Method for Prostate Enlargement
HoLEP, a laser prostate surgery technique used for benign prostatic hyperplasia (BPH), is a minimally invasive surgical method that removes prostate tissue using laser energy. This approach offers less bleeding, a shorter hospital stay, and a faster recovery compared to traditional methods.
What is the Method Used For?
The surgery is used to alleviate urinary symptoms caused by benign prostatic hyperplasia (BPH). The general symptoms of BPH include:
- Weak urine flow
- Frequent urination
- Difficulty urinating
- Nocturia (waking up at night to urinate)
- Feeling of incomplete bladder emptying
How is the Surgery Performed?
The procedure is performed under general or spinal anesthesia. During the operation, the enlarged prostate tissue is separated from the capsule using a holmium laser and removed through the urinary tract. The tissue is then fragmented into small pieces inside the bladder and removed.
The steps of the procedure are as follows:
- The prostate tissue is carefully separated using the laser.
- The separated tissue is pushed into the bladder.
- The tissue is fragmented using a device called a morcellator.
- The fragmented tissue is removed.
What Are the Advantages of the Surgery?
- With its minimally invasive nature, it is less traumatic compared to traditional surgeries.
- The risk of bleeding is low, and it is safe for those on blood thinners.
- It provides long-lasting effects, with a low recurrence rate.
- The duration of catheter use is short.
- The hospital stay is shorter.
- It is effective even in cases of large prostate volume.
Who is HoLEP Suitable For?
The operation may be suitable for the following patients:
- Those with a prostate larger than 60 cc
- Those experiencing quality of life issues such as frequent urination, urinary incontinence, or nocturia (waking up at night to urinate)
- Those who are required to take blood thinners
- Those who do not respond to other treatments
Suitability for each patient is determined through evaluation by a urology specialist.
What is the Recovery Process After the Surgery?
Post-operation hospital stay typically lasts for 1 day. The catheter is usually removed after 1-2 days. In the first few weeks, frequent urination and burning sensations may occur. Normal daily activities can generally be resumed within a few weeks.
Are There Any Risks of the Surgery?
As with any surgical procedure, HoLEP has some risks:
- Temporary urinary incontinence
- Bladder infection
- Burning sensation during urination
- Rarely, retrograde ejaculation (semen going back into the bladder)
These risks are usually temporary and can be managed with treatment.
What is the Difference Between HoLEP and TURP?
Transurethral Resection of the Prostate (TURP) is a surgical method used to treat BPH. In this procedure, the enlarged prostate tissue is fragmented and removed using an electrical device, through the urinary tract (urethra). The tissue that obstructs urine flow is cleared.
| Feature | HoLEP | TURP |
|---|---|---|
| Energy Type | Holmium Laser | Electric Current |
| Risk of Bleeding | Lower | Moderate |
| Prostate Volume | Effective for Large Volumes | Limited |
| Hospital Stay | Shorter | Slightly Longer |
| Recurrence Rate | Lower | Slightly Higher |
Frequently Asked Questions (FAQ) About HoLEP
1. Is the surgery painful?
Post-operative pain is generally mild and can be controlled with painkillers.
2. Will sexual life be affected after the surgery?
There is no change in sexual desire. However, retrograde ejaculation (semen entering the bladder) may occur.
3. How many days after the surgery can I be discharged?
Most patients are discharged within 24 hours.
4. When can I return to work?
Depending on the physical intensity of the job, most patients can return within 1-2 weeks.
5. When is the catheter removed?
It is typically removed 1-2 days after the surgery.
6. Will another surgery be needed?
The recurrence rate is very low. The effects of the surgery last for many years.
7. Is the risk of urinary incontinence permanent?
It may be temporary. It typically resolves within a few weeks.
8. Is it safe for patients on blood thinners?
Yes, this surgery is a safe option for patients who take blood thinners.
9. Is the surgery suitable for every patient?
No. Prostate size, general health status, and other medical conditions must be evaluated.
Sources:
- Mayo Clinic
- Cleveland Clinic
- European Association of Urology (EAU)
- National Institute for Health and Care Excellence (NICE)
- American Urological Association (AUA)
- Johns Hopkins Medicine
- NHS UK
- Medscape
- Urology Care Foundation
- Mount Sinai Health
- European Urology Journal
- Urology Times
- WebMD
- Harvard Health Publishing
- Journal of Endourology