HOLEP

Holmium Laser Enucleation of the Prostate (HOLEP)

Procedure

HOLEP – Holmium Laser Enucleation of the prostate is a modern alternative to the TURP – Transurethral Resection of the Prostate procedure for bladder outflow obstruction due to BPH – Benign prostatic hyperplasia. It requires a short period of hospitalization and an anesthetic. A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears.

To whom this procedure is required

HOLEP can be performed on person of any age with urinary outflow obstruction caused by an enlarged prostate.

Why is to choose HOLEP over TURP…?

• There is often less bleeding than after a TURP.
• Discharge is often quicker than after TURP at 1-2 days.
• The chance of recurrence requiring further surgery is very low.
• The PSA generally drops to very low levels after HOLEP operations.
• If the person is on medications to thin the blood such as warfarin, aspirin or clopidogrel than chances of bleeding is quite less in HOLEP than the TURP so no worries of stopping medication as in TURP .

How does it work?

• The aim of HOLEP is to relieve pressure on the tube through which the urine drains (urethra) by anatomically enucleating the majority of excess benign prostate tissue.
• This is done under a general anesthetic with the help of a telescopic camera inserted through the penis.
• The three lobes of the prostate that are cored out intact are pushed into the bladder before being sucked up (Morcellated) by a special instrument inserted through the telescopic camera.
• The pieces are sent for laboratory analysis just in case they might be found to be cancerous.
• A catheter is placed into the bladder to drain the urine while the raw surface heals, then left in place for around 24 hours before being removed on the day of discharge from hospital.
• Sterile saline fluid is also irrigated into the bladder through the catheter to dilute any blood in the urine and prevent clots from forming.
• It is normal to have some blood in the urine after this operation, so it is advisable to drink plenty of water for a few days while it clears. Clots are sometimes passed 10-14 days afterwards; again, this is part of the healing process.

Drawback:

• Apart from this and the risk of infection that accompanies any operation or invasive procedure, the only significant side-effect is the near certainty that normal ejaculation will cease.
• This is because the contraction that occurs during orgasm may not completely block the entrance to the bladder once some tissue has been removed, and the semen will flow back into the bladder (“retrograde” or “dry” ejaculation) rather than out through the penis.
• This is not harmful, but it does mean that future fertility is greatly reduced. The procedure does not generally affect erectile function or continence, although the urinary symptoms may take a few weeks to settle down afterwards.
• Procedure takes long time than TURP.
• Procedure is quit costly than TURP.

Patient Advice:

Patients are advised to take life easily and to avoid heavy lifting for four to five weeks after the surgery.