Benign Prostatic Hyperplasia, commonly known as BPH, represents a non-cancerous enlargement of the prostate gland that frequently affects aging men. This condition can lead to bothersome lower urinary tract symptoms, such as frequent urination, urgency, and a weakened stream. While various treatments exist, Holmium Laser Enucleation of the Prostate, or HoLEP, has emerged as a modern and highly effective surgical option. Its primary purpose is to alleviate these urinary symptoms by addressing the underlying cause of the obstruction.
What is Holmium Laser Enucleation of the Prostate?
Holmium Laser Enucleation of the Prostate is a minimally invasive surgical procedure that treats benign prostatic hyperplasia. It uses a holmium laser to precisely remove the excess prostate tissue obstructing urine flow. The term “enucleation” refers to separating and removing the enlarged inner portion of the prostate gland from its outer capsule, similar to peeling an orange.
The holmium laser’s unique properties allow for efficient cutting and coagulation, which helps to minimize bleeding during the procedure. This comprehensive removal distinguishes HoLEP from other laser treatments that may only vaporize or incise a portion of the tissue.
How the HoLEP Procedure Works
The HoLEP procedure is performed under general or spinal anesthesia. A surgeon inserts a thin, rigid instrument called a resectoscope, containing a camera and laser fiber, through the urethra and into the bladder. No external incisions are required for this transurethral approach.
Once positioned, the holmium laser separates the enlarged prostate tissue from the surrounding healthy prostate capsule. The surgeon enucleates the obstructive adenoma, pushing the separated tissue into the bladder. This process involves precise laser energy application to achieve a clean plane of dissection.
After the obstructive tissue is enucleated and moved into the bladder, a morcellator is introduced through the resectoscope. The morcellator fragments the tissue into smaller pieces, which are then suctioned out of the bladder. The entire procedure typically takes between 60 to 120 minutes, depending on the size of the prostate gland.
Who is a Candidate for HoLEP?
Candidates for HoLEP are men with moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. Symptoms include a weak urinary stream, frequent nighttime urination, incomplete bladder emptying, or difficulty starting urination. HoLEP may also be considered for men who have developed complications from BPH, such as recurrent urinary tract infections, bladder stones, or bladder damage.
HoLEP is effective across a wide range of prostate sizes. Unlike other surgical techniques limited by prostate volume, HoLEP can treat very large prostates. Men who have not found sufficient relief from medications or prefer a definitive surgical solution are often suitable candidates. Medical evaluation, including a review of symptoms and diagnostic tests, helps determine the most appropriate treatment path for each individual.
What to Expect During and After HoLEP
Prior to HoLEP, patients generally receive instructions regarding medication adjustments, particularly blood thinners, which may need to be temporarily stopped. On the day of the surgery, patients will undergo anesthesia.
Immediately following the procedure, a catheter is typically inserted into the bladder through the urethra to drain urine and clear blood clots. This catheter usually remains in place for one to two days, allowing the urethra to heal and swelling to subside. Patients might experience some mild discomfort or bladder spasms while the catheter is in place.
After catheter removal, patients can expect to notice an immediate improvement in their urinary flow. However, some temporary symptoms, such as burning during urination, frequent urination, or occasional blood in the urine, are common in the initial days or weeks as the bladder recovers. Most individuals can resume light activities within a few days and return to normal physical activity within two to four weeks. Full recovery and stabilization of urinary symptoms typically occur over several months.