What is HoLEP?
Holmium laser nucleation of the prostate (HoLEP) is an anatomical surgical procedure that uses laser beam to enucleate the central and transitional zones of the prostate gland along natural tissue planes. BPH usually only develops in these zones of the prostate gland.
HoLEP is a simply invasive procedure that is used to recover the flow of urine. It is used as an alternative to the standard transurethral resection of the prostate (TURP) technique to prevent certain associated complications.
How is the procedure performed?
HoLEP is performed under general anesthesia or spinal anesthesia. The whole surgical procedure takes about 45 to 90 minutes, depending on the size of your enlarged prostate.
Your doctor inserts a narrow telescope-like instrument into your penis and advances it through the urethra. A high-powered laser is passed through this instrument. The BPH tissue in the transitional and central zones of the prostate is carefully separated from its surrounding tissue using the laser along natural tissue planes and pressed into the bladder. A surgical instrument called a ‘morcellator’ is then inserted through the telescope to suction out and remove the excised prostate from the bladder.
You will have a catheter for about 12-24 hours after the operation. Sterile saline fluid may be passed through the catheter to irrigate the bladder of any blood in the urine.
What should I expect after surgery?
Usually patients are discharged the next day after surgery. You may be advise to drink more fluids for a week to help flush blood out of the urine more speedily. You can resume your daily activities within a week. You should notice a much stronger stream and better bladder emptying within days after the operation.
Some studies have shown that patients who underwent HoLEP actually had enhanced erectile function after surgery, but almost all had retrograde ejaculation. All patients experience hematuria for one to two weeks after the procedure, but the need for blood transfusion is low, around 1 percent. Since normal saline irrigation is used for the procedure, there is no risk of hyponatremia, regardless of prostate size. Transient urinary incontinence is common, but permanent incontinence at one year after the procedure occur in approximately 1 to 2 percent of patients, depending on the definition and type of incontinence. This is related to other forms of BPH surgery.
What are the benefits of HoLEP compared to TURP and Green light laser surgery?
•Can treat any size prostate gland, including big prostates > 100cc which would normally need open surgery
•BPH tissue normally forms from the transitional zone and central zones of the prostate, because these are totally removed during HoLEP, the reoperation rate is very low at 2% after 14 years.
•Early, immediate symptom help and fast return to normal activity. The catheter is usually only required overnight, and most patients are discharged the next day.
•Allow tissue preservation for pathologic examination compare to Green light laser prostate ablation. BPH tissue is excised rather than ablated, the removed prostate can be examined for prostate cancer or other abnormalities.
•The low depth of penetration of the holmium laser (0.5-1mm) cause little damage to healthy tissue, and the risk of excessive bleeding and erectile dysfunction associated with traditional surgical approaches is reduced.