Holmium Laser Enucleation of the Prostate (HoLEP) is a surgical approach for an enlarged prostate. This minimally invasive procedure uses laser technology to remove excess prostate tissue. It aims to alleviate urinary symptoms caused by prostate enlargement, improving urine flow.
Understanding Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia (BPH) is a common condition where the prostate gland, a small gland located below the bladder and surrounding the urethra, enlarges. This enlargement is a natural part of aging for many men, with about 50% of individuals with a prostate showing signs of BPH by age 60. As the prostate grows, it can press against and narrow the urethra, the tube that carries urine from the bladder out of the body.
This compression often leads to urinary symptoms. Common issues include a frequent or urgent need to urinate, especially at night, difficulty initiating a urine stream, a weak or interrupted flow, and a sensation of incomplete bladder emptying. The impact on daily life can range from mild inconvenience to significant disruptions, sometimes leading to complications such as urinary tract infections, bladder stones, or, in severe cases, kidney damage due to urine backflow. While BPH symptoms can resemble those of prostate cancer, BPH itself is not cancerous and does not increase the risk of developing prostate cancer.
The HoLEP Procedure Explained
The HoLEP procedure is a minimally invasive, endoscopic surgery performed to remove obstructive prostate tissue. The patient is under general anesthesia, and the procedure can range from two to four hours depending on prostate size. The surgeon inserts a resectoscope, a thin, lighted tube with a camera, through the urethra to visualize the prostate gland.
A holmium laser fiber is then passed through the resectoscope. This laser separates, or “enucleates,” the excess prostate tissue from its surrounding capsule, much like peeling an orange. The laser’s pulses allow the surgeon to separate the interior prostate tissue from its outer layer, while also sealing blood vessels to minimize bleeding. After the enlarged tissue is enucleated, it is pushed into the bladder.
Once all the excess tissue is in the bladder, the laser and resectoscope are removed. A morcellator is then inserted through the urethra into the bladder. The morcellator suctions the large pieces of prostate tissue to its tip, where blades cut the tissue into smaller fragments, which are then suctioned out of the body. This process ensures complete removal of the obstructive tissue, which is sent for laboratory analysis to check for abnormalities.
Advantages of HoLEP
HoLEP offers several benefits for individuals seeking treatment for an enlarged prostate. It is effective across a wide range of prostate sizes, providing improvement for both small and large prostates. The procedure is known for its durability, with re-treatment rates typically less than two percent, indicating a lasting solution to urinary symptoms.
The use of the holmium laser during enucleation helps to coagulate blood vessels, reducing blood loss during the procedure. This minimized bleeding makes HoLEP suitable even for patients taking blood-thinning medications, as the risk of transfusion is low. The thorough removal of prostate tissue helps prevent recurrence of symptoms, leading to a long-term positive outcome.
Recovery and Post-Procedure Expectations
Following a HoLEP procedure, patients have a urinary catheter placed to drain urine, which remains for about 24 hours, or sometimes up to a few days. This catheter helps the bladder heal and ensures urine is clear of blood before removal. Most individuals can expect to stay in the hospital for one to two days, with some potentially going home on the same day depending on the surgery time and their overall health.
After the catheter is removed, it is common to experience temporary symptoms. These can include a stinging or burning sensation during urination, increased urinary frequency, and urgency. Blood in the urine is also expected and may be intermittent for up to six weeks as the prostate area heals. Patients are encouraged to drink plenty of fluids to help clear the urine and reduce blood clots.
Full recovery from HoLEP occurs within two to four weeks. Light activities like walking can be resumed almost immediately, but strenuous activities such as heavy lifting or vigorous exercise should be avoided for four to six weeks to allow for proper healing. Pelvic floor exercises may be recommended to help regain bladder control, as temporary urinary leakage can occur, typically resolving within weeks to a few months. A follow-up appointment with the surgeon is scheduled around three months post-procedure to assess outcomes.