Holmium Laser Enucleation of Prostate (HoLEP)

What is Holmium Laser Prostatectomy?

Holmium Laser Prostatectomy is a procedure which uses laser energy to treat an enlarged prostate or benign prostatic hyperplasia (BPH)

What is an Enlarged Prostate or BPH?

Benign (non-cancerous) enlargement of the prostate gland, also known as Benign Prostatic Hyperplasia (BPH for short), almost every man will experience some symptoms of BPH in their lifetime. As the prostate enlarges it cuts off the flow of urine down the urethra and results in varying symptoms. BPH is not usually life threatening but you may have found it to be embarrassing, inconvenient and uncomfortable.

Symptoms of BPH include the need to urinate often, the need to urinate suddenly, difficulty emptying your bladder completely, and difficulty sleeping due to frequent urination.

What is the Prostate?

The prostate is a walnut-shaped gland that is part of the male reproductive system. It is located below the bladder and surrounds the urethra. The urethra is the tube that transports urine from the bladder out of the body. The main function of the prostate is to supply nutrients to the fluid that carries semen.

What are the Treatment options for BPH?

1. Watchful Waiting – If your symptoms are not severe, your doctor may just schedule regular check-ups to monitor your condition.
2. Medical Therapy – Medication or prescription drugs are a common treatment option for BPH. Drugs address the symptoms but do not cure the disease. Symptom relief can cease when you stop taking the drugs. Medication can be costly and some BPH drugs may interfere with other medications you are taking. Potential side effects may include Impotence, dizziness, headaches and fatigue.
3. Non Laser Surgery – Transurethral Resection of the Prostate: TURP is often the surgical procedure doctors choose to use when removing the prostate. While the patient is under general anesthesia a TURP uses an electrical loop which is inserted and used to cut the tissue into small pieces, one at a time. The tissue pieces collect in the bladder and are then flushed out with irrigating fluid. Some bleeding during and after the procedure is common. After the procedure, a catheter is inserted into the bladder and continuously irrigated with fluid to monitor bleeding and prevent catheter obstruction.

   While TURP has been proven effective, some complications exist. The hospital stay is 1-3 days and you may have to return home with a catheter in place. The catheter may be attached to a leg bag and removed several days later. Blood thinning medications may need to be stopped prior to the operation and this can lead to a small increased risk of heart attack and stroke.TURP complications include blood loss and transfusion, impotence, incontinence, infection and retrograde ejaculation (dry climax). Typical recovery time is 4 – 6 weeks.

4. Open prostatectomy – Open surgery is sometimes performed when a transurethral procedure cannot be done. It may also be considered when a prostate is too large to be removed through the urethra. An incision is made in the abdominal wall and the prostate is removed through the incision. Open surgery can involve moderate pain and a hospital stay of several days. Patients usually go home with a catheter. Typical recovery time is longer than TURP.

Holmium Laser Prostatectomy

Holmium laser procedures use laser energy to alleviate BPH symptoms with fewer complications than invasive surgery by ablating or removing enlarged prostate tissue with high-powered laser energy. Holmium laser procedures are generally performed under spinal, epidural or general anesthesia. After receiving anesthesia, your urologist will pass a camera through a tube placed in your urethra, enabling him or her to view the bladder and prostate. The Holmium laser fiber (small flexible tube) is also passed through the same tube.

The prostate is then either ablated or large pieces of prostate are cut out using a very high degree of precision. The prostate pieces are then cut into smaller pieces and then flushed out of the bladder. A catheter is placed and then removed the next day. There is very little if any bleeding during the procedure and the patient experiences very rapid symptom relief.

What are the differences between TURP and Holmium Laser Prostatectomy?

Carefully designed clinical trials have shown that Holmium Laser Prostatectomy is as effective as TURP in improving symptoms. Holmium Laser Prostatectomy removes more obstructing tissue, is associated with less bleeding and has a shorter catheterisation time and hospitalization than TURP. Because saline is used as an irrigant there is almost no risk of dangerous fluid absorption with Holmium Laser Prostatectomy.

What are the disadvantages of Holmium Laser Prostatectomy?

In patients who have large prostates (>100g), there is a greater risk of stress urinary incontinence after surgery because more tissue is removed. However in almost all cases this completely resolves by 6 weeks postoperatively.

Are there any other types of Laser Surgery?

The other common type of Laser Prostatectomy is known as a ‘Greenlight’ Laser Prostatectomy.  Click here for more information about Greenlight laser surgery.

Click here for more information about Holmium Laser Prostatectomy (HoLEP).