HoLEP Laser Enucleation

What is HoLEP Laser Therapy?

HoLEP (Holmium Laser Enucleation of the Prostate) Therapy is an advanced surgical procedure primarily used to treat BPH. HoLEP is considered one of the most effective treatments for BPH, offering long-term relief from symptoms with minimal risk of complications.


How Does HoLEP Laser Therapy Work?

  • Minimally invasive surgery: The surgeon inserts a small telescope-like instrument called a cystoscope through the urethra into the prostate gland, allowing natural orifice surgery with no abdominal incisions.
  • Laser Enucleation: A laser is used to cut and remove the excess prostate tissue that is blocking the urethra, preserving the capsule of the prostate.
  • Tissue Removal: The surgeon uses specialised instruments to remove the enucleated tissue from the prostate, creating a clear passage for urine to flow.


Who is Suitable for Prostate HoLEP Laser Therapy?

  • Men with Benign Prostatic Hyperplasia (BPH)
  • Men with large Prostates
  • Men seeking minimally invasive treatment
  • Men with contraindications to other Treatments
  • Men with medical conditions or factors that make them unsuitable candidates for other treatments such as medications or TURP
  • Men seeking long-term symptom relief
  • Men with urinary retention or complications from BPH
  • Men concerned about sexual function


Advantages of HoLEP Laser Therapy

  • Effective: HoLEP is highly effective in relieving urinary symptoms associated with BPH, with studies showing significant improvement in symptoms and urinary flow rates. It is as durable and effective as TURP, the long-held standard of care for BPH surgery.
  • Minimal Blood Loss: The laser cauterises blood vessels as it removes tissue, leading to minimal bleeding during and after the procedure.
  • Reduced Risk of Complications: Compared to traditional surgical methods like transurethral resection of the prostate (TURP), HoLEP has a lower risk of complications such as bleeding and reintervention rate
  • Quick recovery: HoLEP has a quicker recovery than TURP, with a shorter catheter time and hospital stay. Post-operative recovery is also shorter than TURP.
  • Suitable for Large Prostates: HoLEP is particularly beneficial for men with very large prostates, with no upper prostate size limit for surgery.


Alternative Options to Prostate HoLEP Laser Therapy

Preparation Before Prostate HoLEP Laser Therapy

  • Medical Evaluation: Your urologist will conduct a thorough medical evaluation to assess your overall health, prostate size, urinary symptoms, and any medications you are currently taking.
  • Preoperative Instructions: In the days before the procedure, you may be instructed to stop taking certain medications, such as blood thinners, to reduce the risk of bleeding during surgery. Following any dietary restrictions or fasting instructions your healthcare team provides is essential.
  • Preoperative Tests: Depending on your medical history and overall health, your urologist may order preoperative tests such as blood tests, urine tests, and imaging studies to ensure that you are fit for surgery.
  • Informed Consent: Before the procedure, you will have the opportunity to discuss the risks, benefits, and alternatives of HoLEP with your urologist and provide informed consent.
  • Preparation at Home: You may need to arrange transportation to and from the hospital or surgical centre.


Prostate HoLEP Laser Therapy Procedure

  • Anaesthesia: Prostate HoLEP Laser Therapy is typically performed under general or spinal anaesthesia to ensure comfort and pain-free during the procedure.
  • Surgical Procedure: The urologist inserts a cystoscope, a thin tube with a camera and light, through the urethra into the prostate gland to visualise the surgical site. A holmium laser fibre is then inserted through the cystoscope, and the surgeon uses the laser energy to precisely enucleate and remove excess prostate tissue that is obstructing the flow of urine. The resected tissue is then removed from the prostate using specialised instruments, creating a clear passage for urine to flow.
  • Catheter Placement: At the end of the procedure, a catheter may be inserted into the bladder to drain urine and stop blood clots from building up The catheter is usually removed within 24 to 48 hours after surgery.
  • Monitoring and Recovery: After the procedure, you will be monitored closely in the recovery area until you are fully awake and stable. Your vital signs, including blood pressure, heart rate, and oxygen saturation, will be monitored regularly.

HoLEP Laser Therapy Recovery and Postoperative Care

  • Hospital Stay: Most patients are discharged within 24-48 hours after the procedure.
  • Catheter Removal: After surgery, a catheter is usually placed in the bladder to drain urine for a short period. It is typically removed before discharge.
  • Symptom Relief: Patients may experience significant improvement in urinary symptoms within a few days to weeks after the procedure.
  • Activity Restrictions: Patients are advised to avoid heavy lifting and strenuous activities for a few weeks after surgery to allow the prostate to heal properly and minimise bleeding during the recovery phase.


HoLEP Laser Therapy Prognosis

The prognosis following Prostate HoLEP Laser Therapy is favourable, with most patients experiencing significant improvement in urinary symptoms and quality of life after a successful open channel is created.


HoLEP Laser Therapy Potential Risks and Complications

While HoLEP Laser Therapy is generally safe and effective, there are some potential risks and complications associated with the procedure:

  • Bleeding: This is usually mild and settles itself in the days and weeks after surgery. Some men may pass blood clots or feel unable to empty theire bladder during such bleeding (clot retention).
  • Urinary Tract Infections: There is a small risk of developing a urinary tract infection after the procedure, which is treated with antibiotics.
  • Ejaculatory Dysfunction: HoLEP will cause retrograde ejaculation for the majority of men permanently, where semen flows backwards into the bladder instead of out through the urethra during ejaculation. This does not affect sexual function but will impact fertility.
  • Incontinence: Up to 15% of men may suffer from urine leakage during strenuous activity. This usually lasts up to 3 months and settles itself or with pelvic floor strengthening exercises.
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