Who is Suitable for HoLEP?

Holmium Laser Enucleation of the Prostate (HoLEP) is a highly effective treatment for benign prostatic hyperplasia (BPH), but its suitability depends on several factors. Here's a guide to help determine if HoLEP is a suitable option for an individual:

• Prostate Size: HoLEP suits patients with all prostate sizes. Traditional treatments like TURP typically have an upper size limit of 100cc, whereas HoLEP can be performed on much larger gland sizes with no upper size limit. HoLEP allows for the thorough removal of obstructive tissue, making it ideal for patients with substantial prostate enlargement.
• Symptom Severity: HoLEP is recommended for patients with moderate to severe urinary symptoms due to BPH. Symptoms may include difficulty initiating urination, weak urinary stream, frequent urination (especially at night), urinary urgency, incomplete bladder emptying, or urinary retention. HoLEP provides significant and durable symptom relief, making it suitable for patients with bothersome urinary symptoms affecting their quality of life.
• Failure of Medications: Patients who have failed to achieve adequate symptom relief with medications or who experience intolerable side effects may be candidates for HoLEP. While medications can effectively manage mild to moderate BPH symptoms for some patients, HoLEP offers a definitive treatment option for those who require more substantial relief.
• Desire to Avoid Ongoing Medications: Patients who wish to avoid ongoing medication use may prefer HoLEP. While medications can effectively alleviate symptoms for some patients, they often require long-term use and may be associated with side effects such as dizziness, sexual dysfunction, or orthostatic hypotension. HoLEP provides long-term symptom relief without the need for ongoing medication use.
• Presence of Complications: HoLEP may be recommended for patients with BPH complications such as recurrent urinary tract infections, urinary retention, bladder stones, or renal insufficiency. Thorough removal of obstructive prostate tissue with HoLEP can alleviate these complications and improve overall urinary function.
• Overall Health Status: HoLEP is generally well tolerated by patients with various medical comorbidities, including those with cardiovascular disease, diabetes, or anticoagulant therapy. However, patients should undergo a thorough preoperative evaluation to assess their overall health status and identify any potential contraindications to surgery.
• Patient Preference: Ultimately, the decision to undergo HoLEP should consider patient preferences, values, and treatment goals. Some patients may prefer the definitive and long-lasting relief provided by HoLEP, while others may prioritise less invasive treatment options or wish to avoid surgery altogether. Open communication between the patient and their doctor is essential to ensure that the chosen treatment aligns with their preferences and expectations.

Screening Tests for HoLEP

Before undergoing HoLEP, patients typically undergo screening tests and evaluations to ensure they are suitable candidates for the procedure and to assess their overall health status. These screening tests help the healthcare team make informed decisions about the appropriateness of HoLEP and identify any potential risks or contraindications. Here are some common screening tests for HoLEP:

• Medical History and Physical Examination: The doctor will review the patient's medical history, including any pre-existing medical conditions, medications, allergies, and surgical history. A physical examination may also assess prostate size, urinary symptoms, and overall health status.
• Urinalysis: A urinalysis may be performed to check for signs of urinary tract infection (UTI), such as bacteria, white blood cells, or red blood cells in the urine. To reduce the risk of complications, UTIs should be treated before undergoing elective surgery like HoLEP.
• Blood Tests: Blood tests may assess kidney function, electrolyte levels, and clotting function. These tests help identify any underlying medical conditions that may affect the safety or outcome of the procedure, such as chronic kidney disease or coagulopathy.
• Prostate-Specific Antigen (PSA) Test: PSA is a protein produced by the prostate gland, and elevated levels may indicate prostate enlargement or prostate cancer. While HoLEP is primarily used to treat benign prostatic hyperplasia (BPH), the PSA test helps rule out prostate cancer before proceeding with the procedure.
• Imaging Studies:
• Transrectal Ultrasound (TRUS): TRUS may be performed to assess prostate size, shape, and structure. It helps the doctor plan the HoLEP procedure and identify any abnormalities, such as prostate cancer or prostate abscess.
• Uroflowmetry: Uroflowmetry measures the rate and volume of urine flow during urination. It helps evaluate the severity of urinary obstruction caused by BPH and assesses the patient's suitability for HoLEP.
• Cystoscopy involves inserting a thin tube with a camera into the urethra and bladder to visualise the urinary tract. It helps assess the degree of bladder outlet obstruction, evaluate the size and configuration of the prostate gland, and identify any concurrent bladder abnormalities.
• Cardiac Evaluation: Patients with a history of cardiovascular disease or significant cardiac risk factors may undergo cardiac evaluation, including electrocardiography (ECG) and/or echocardiography, to assess cardiac function and identify any potential risks related to anaesthesia and surgery.
• Medication Review: The doctor will review the patient's current medications, including prescription drugs, over-the-counter medications, and herbal supplements. Certain medications, such as anticoagulants or antiplatelet agents, may need to be adjusted or temporarily discontinued before HoLEP to reduce the risk of bleeding complications.
• Anaesthesia Evaluation: Patients will undergo an anaesthesia evaluation to assess their fitness for anaesthesia and determine the most appropriate anaesthesia technique. This evaluation includes a review of medical history, physical examination, and airway, cardiovascular, and pulmonary function assessment.