HoLep

What is HoLEP?

HoLEP is a prostate surgery which is performed by inserting the Holmium laser probe into the urethra. Although it is a closed method, prostate is totally removed similar to the open prostate surgery. Spinal anesthesia is usually sufficient for this procedure.

HoLEP method is employed for treatment of the benign prostatic hyperplasia.

The benign prostatic hyperplasia is a frequent health problem in men. One of every two men older than 60 is diagnosed with the benign prostatic hyperplasia. The condition is manifested by many complaints, such as frequent urination, and the quality of life decreases. The condition can be managed with medications in early stages. On the other hand, surgical methods are considered when the prostate gland enlarges. The enlargement is a benign condition or in other words, it is not a cancer. However, a patient can have a combination of cancer and benign prostatic hyperplasia. The doctor evaluates the patient from two perspective to make the diagnosis.

The HOLEP is a novel method that uses laser surgery for surgical treatment of the diseases that originate from or involve the prostate gland. Recently, the benign prostatic hyperplasia is commonly treated with HoLEP method. In this treatment, the prostate gland is accessed through the urethra; the procedure is similar to removing the inside of an orange. The HoLEP procedure is a surgical technique that offers treatment outcomes similar to the open surgery even in substantially enlarged prostate glands.

The Prostate Tissue is Totally Removed

The surgery is performed under general or spinal anesthesia (the body part below the waist is numbed). Special instruments with integrated camera are inserted through the urethra. The enlarged prostate tissue is mobilized from the capsule with endoscope and laser and reduced into the urinary bladder. The prostate tissue that is reduced into the urinary bladder is fragmented with another device (morcellator) and removed. A catheter is inserted into the urinary tract at the end of the procedure. The resected prostate tissue is sent to the pathology laboratory to have the specimen checked for cancer. The catheter is usually removed one day after the surgery and the patient is discharged thereafter. However, advanced age and co-morbid conditions may require one-day hospitalization.

Shorter Recovery

Since the prostate tissue is completely removed in the laser resection of the benign prostatic hyperplasia, the risk of recurrence is quite low. Since the laser offers very good hemostasis, it is a relatively safer method for patients who need to take blood thinners (antiaggregant – anticoagulant agents). The HoLEP may also shorten the hospitalization in the surgical management of the benign prostatic hyperplasia.

Patients may continue their routine daily life within one to two day(s). The nerves that regulate the sexual function are located close to the exterior surface of the prostatic capsule. Since the Holmium laser penetrates into the tissue only by 0.4 millimeter, the healthy tissues at deep locations are not affected. Thus, erectile dysfunction is not expected after surgical management of the benign prostatic hyperplasia with the HoLEP.

After Prostate Surgery

The urinary incontinence is rarely observed after the prostate surgery, but the muscles that regulate the continence are relatively better protected in the HoLEP surgeries. Since the penetration depth of the laser used in the HoLEP surgery is 0.4 millimeter, it has very minimal effect on these structures.

In some patient with severely enlarged prostate tissue, temporary urinary incontinence is likely, but it disappears over time. In the surgical resection of the benign prostatic hyperplasia, only the enlarged interior part that compresses the urethra is resected. The exterior part, called the capsule of the prostate gland, is left untouched.

The risk of the prostate cancer applies to the patients, who do not have a cancer in preoperative evaluations that are focused on the prostate cancer. Therefore, patients should be followed up for the risk of cancer even after the HoLEP surgery.

Who are good candidates for the HoLEP?

All patients for whom surgical treatment is considered to treat the prostatic disease can be appropriate candidates for the HoLEP. The technique is independent from the size of the prostate gland or in other words, it can be practiced regardless of the size.

What are the Features of the HoLEP surgery?

Patients do not feel dysuria (pain when urinating) after their catheter is removed, as the method is based on the principle of "resection with laser" instead of "burning with electrical current".

Urinary catheters can be removed within a short time (in 24 hours), and patients can resume the activities of daily life, as the risk of bleeding is low, hospital stay is short and the convalescence is quick.

Since it penetrates into the healthy tissue less than 0.4 mm, it does not harm the nerves that are located around the capsule of the prostate gland and regulate sexual functions. Therefore, postoperative erectile dysfunction is not likely.

As no burn defect occurs in surgically resected tissues, the tissues are more easily examined by pathologists and possible malignancies are less likely to be unnoticed.

The risk of recurrence is very low, as the prostate gland is totally removed.

What are the considerations after the HoLEP surgery?

The patients who are undergone the HoLEP surgery at Prostate Diseases Diagnosis and Treatment Center of Acıbadem Hospitals are given postoperative information form at the hospital. This form addresses some potentially expected issues and other details which require attention.