Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive surgical procedure designed to alleviate urinary symptoms caused by an enlarged prostate. This technique removes excess prostate tissue that obstructs urine flow. HoLEP utilizes a holmium laser, offering a precise approach to address the condition.
Understanding Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) is the non-cancerous enlargement of the prostate gland, a common condition affecting aging men. The prostate, which surrounds the urethra, can compress this tube as it grows, hindering urine passage. Symptoms include a frequent need to urinate, especially at night, difficulty starting urination, a weak or interrupted urine stream, and a sensation of incomplete bladder emptying.
BPH prevalence increases significantly with age; approximately 50% of men between 51 and 60 years old experience it, rising to about 80% in men over 70. While BPH is common, treatment becomes necessary when symptoms diminish quality of life or lead to complications such as bladder stones, urinary tract infections, kidney damage, or acute urinary retention.
The HoLEP Procedure Explained
The HoLEP procedure is performed endoscopically, meaning no external incisions are made. Under general or spinal anesthesia, a surgeon inserts a resectoscope through the urethra. This instrument contains a camera, allowing the surgeon to view the prostate gland directly.
A holmium laser fiber is then passed through the resectoscope. The laser precisely cuts and separates the enlarged prostate tissue from its surrounding capsule in a process called enucleation. This action effectively “peels” the obstructing tissue away, much like coring an apple. The separated tissue is then pushed into the bladder.
Once in the bladder, the laser is removed from the resectoscope, and a morcellator is inserted. This device suctions the enucleated prostate tissue and grinds it into smaller fragments, which are then removed from the body. This two-step process of enucleation and morcellation ensures comprehensive removal of the obstructive tissue, clearing the urinary pathway.
Preparing for and Recovering from HoLEP
Preparation for HoLEP involves several steps to ensure patient safety and optimize outcomes. Patients typically undergo pre-operative lab work, including blood and urine tests, and may have an electrocardiogram (EKG) or X-rays to assess overall health. Instructions often include fasting for a specified period, usually 8 hours, before surgery to reduce anesthesia risks. Patients taking blood-thinning medications may need to temporarily stop them several days before the procedure under medical supervision, and antibiotics might be prescribed to prevent infection.
Following the HoLEP procedure, patients experience a short hospital stay, often one to two days. A temporary urinary catheter is placed to drain urine and clear any blood, typically remaining for one to three days, though sometimes only overnight. Common post-operative symptoms include blood in the urine, which can persist intermittently for several weeks, and temporary urinary frequency, urgency, or burning during urination. Temporary urinary incontinence is possible but often resolves within a few weeks to three months with pelvic floor exercises.
Patients are encouraged to drink plenty of fluids and are advised to avoid strenuous activities, heavy lifting, and sexual activity for several weeks to allow for healing. While physical recovery may take two to four weeks, some urinary symptoms can take up to three months to settle.
Advantages of HoLEP
HoLEP offers several benefits compared to other surgical treatments for BPH, such as transurethral resection of the prostate (TURP) or open prostatectomy. An advantage is its effectiveness for prostates of any size, including very large ones. The procedure results in less blood loss, often reducing the need for transfusions.
Patients undergoing HoLEP experience shorter hospital stays and quicker recovery times. The holmium laser’s precision leads to a lower rate of re-treatment for recurrent symptoms compared to other methods. HoLEP is a highly effective and durable option for improving urinary flow and relieving BPH symptoms.