Prostate Treatment With the HoLEP Surgical Method

The surgical method called HoLEP surgery is a surgical procedure in which patients with prostate enlargement are treated using the endoscopic method. HoLEP is an abbreviation made up of the first letters of Holmium Laser Enucleation of the Prostate.

HoLEP surgery is a minimally invasive surgical treatment for men who have prostate enlargement, who have urinary symptoms and who have urinary retention, recurrent urinary infections or bleeding because of prostate enlargement. The HoLEP method is applied from inside the urethra. A laser is used to remove the region of the prostate causing the problem.

Patients suitable for the HoLEP method are typically symptomatic because of very large prostates.

The Application of HoLEP Surgery

HoLEP, or by its long name Holmium Laser Enucleation of the Prostate, was developed in New Zealand at the end of the 1990s. It is mostly performed under general anaesthesia. No incision is made in the patient's skin for intervention on the prostate and the intervention is carried out through the urethra.

The holmium laser is used to peel away entirely the core of the prostate causing the obstruction. The HoLEP method provides maximum relief in prostatic obstruction and a man generally needs HoLEP surgery only once in his lifetime.

The prostate growing again after HoLEP surgery is a very low probability.

During the HoLEP application, the urology specialist, using a direct laser, separates the relevant prostate tissue from the capsule in which it is located and leaves it inside the bladder. Then the prostate tissue located inside the bladder is broken up with the aid of a special instrument and, by being aspirated, the inside of the bladder is cleared.

After this operation, in order that no blood clot remains inside the bladder, a sterile catheter is fitted and it is ensured that the inside has been completely cleared.

After the operation a catheter is fitted to the patient. After it is ensured that the bleeding situation has been eliminated, the catheter is removed within 1-2 days.

What Are the Advantages of HoLEP Surgery?

Holmium laser enucleation of the prostate is referred to as the gold method in prostate treatment. This designation is thanks to the advantages the method provides for the patient and the surgeon. The main advantages of the HoLEP surgical method, which offers a rapid recovery process, can be listed as follows:

• It provides less bleeding during the operation and less need for blood transfusion.
• The use of a catheter after the operation is of very short duration. 98% of men who had a catheter before the operation are freed from catheter dependence after HoLEP.
• The length of hospital stay is very short. (After HoLEP surgery 90% of patients can leave hospital without a catheter the day after the operation)
• It provides a serious relief in urinary symptoms.
• It has been proven to improve urine flow rates more effectively than all other endoscopic procedures in BPH treatment.
• After HoLEP surgery the improvement in the average symptom score is in the band of 70-80% and improvements of up to 600% in flow rate have been seen.
• Unlike all other endoscopic procedures for BPH, HoLEP surgery is suitable for a prostate of any size.
• There is a very low rate of complication risk.

Why Is the HoLEP Method Applied?

In situations where the prostate gland has grown to 100 g and more, the HoLEP surgical method, that is enucleation of the prostate with the holmium laser method, is seen as the best treatment option. The reason for this is that with the HoLEP method the narrowing that the prostate gland tissue creates in the urinary channel is successfully eliminated.

This method can be used in prostate enlargement starting at 60 grams. Enucleation of the prostate with the holmium laser method is an open surgical method and is carried out accompanied by general or spinal anaesthesia. After the anaesthesia procedure determined by the anaesthesia specialist is completed, the urology specialist carries out the HoLEP application.

The urology specialist enters endoscopically through the urinary tract using a special instrument called a resectoscope. In this way the patient's enlarged prostate is seen.

As in the laser surgery applications applied in the treatment of prostate enlargement, in the HoLEP method too a faster recovery is achieved. 

When the urinary symptoms in the patient do not show improvement after the HoLEP application, another HoLEP treatment may be necessary again.

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Sexual Life After HoLEP Surgery

After surgery is performed with the HoLEP method in benign prostatic hyperplasia, it is necessary to stay away from sexual activity for approximately 2-3 weeks. Of course this period can vary according to the period the doctor considers appropriate and the patient's response to treatment.

Consult your urology specialist in the event that the following situations are experienced:

• A rise in temperature that does not pass
• Difficulty experienced in urinating
• A burning sensation when urinating
• Bleeding
• Severe pain and colic