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HoLEP surgery

What is HoLEP surgery?

HoLEP stands for Holmium Laser Enucleation of the Prostate. It is a surgical procedure used for the treatment of benign prostatic hyperplasia (BPH), a condition characterized by the enlargement of the prostate gland. HoLEP is considered a minimally invasive technique that utilizes a laser to remove excess prostate tissue that is causing urinary obstruction.
During the HoLEP surgery, a small telescope-like instrument called a resectoscope is inserted through the urethra into the prostate. The resectoscope is equipped with a laser fiber that emits a high-powered holmium laser. The laser energy is used to precisely and efficiently vaporize and remove the obstructing prostate tissue. The surgeon enucleates (dissects and removes) the prostate lobes and shreds the tissue into small fragments that can be easily irrigated and flushed out.
HoLEP offers several advantages over traditional surgical methods, such as open prostatectomy or transurethral resection of the prostate (TURP):

  • Effective tissue removal: HoLEP allows for complete removal of the enlarged prostate tissue, providing long-term relief from urinary symptoms associated with BPH.
  • Minimal blood loss: The laser used in HoLEP surgery cauterizes blood vessels as it removes tissue, resulting in minimal bleeding during the procedure.
  • Shorter hospital stay: Compared to open surgery, HoLEP typically requires a shorter hospital stay, usually 1 to 2 days.
  • Quicker recovery: Patients generally experience a quicker recovery time and faster return to normal activities compared to open surgery.
  • Reduced risk of complications: The precise nature of the laser technology used in HoLEP surgery reduces the risk of complications such as urinary incontinence and sexual dysfunction.

HoLEP is considered particularly beneficial for patients with larger prostate glands or those who may have complicating factors such as bladder stones, urinary retention, or recurrent urinary tract infections.

Why and when is HoLEP is recommended?

HoLEP is recommended in cases where benign prostatic hyperplasia (BPH) causes significant urinary symptoms and conservative treatments have not provided adequate relief. BPH is a condition characterized by the non-cancerous enlargement of the prostate gland, which can lead to urinary problems such as frequent urination, weak urine flow, difficulty starting or stopping urination, and incomplete emptying of the bladder.
HoLEP may be recommended for the following reasons:

  • Enlarged Prostate: HoLEP is particularly suitable for patients with larger prostates, typically greater than 40 grams in size. The procedure allows for effective removal of a substantial amount of prostate tissue.
  • Severe Urinary Symptoms: If BPH symptoms significantly affect a person's quality of life, including frequent urination, urinary urgency, nocturia (excessive urination at night), urinary retention, or recurrent urinary tract infections, HoLEP may be recommended to alleviate these symptoms.
  • Failed Conservative Treatments: If medications (such as alpha-blockers or 5-alpha reductase inhibitors) or other non-surgical treatments have not adequately relieved symptoms or have caused intolerable side effects, HoLEP may be considered as an alternative.
  • Complications or Contraindications: HoLEP may be preferred over other surgical treatments when there are certain complications or contraindications. For example, it can be an option for patients who are on blood-thinning medications or have bleeding disorders, as it tends to have lower bleeding risks compared to some other procedures.
  • Concomitant bladder stones or urinary retention: If the patient has bladder stones caused by urinary obstruction from an enlarged prostate or experiences urinary retention (inability to empty the bladder), HoLEP may be recommended. The procedure can address both the prostate enlargement and associated complications.

How does HoLEP differ from other treatment options?

HoLEP (Holmium Laser Enucleation of the Prostate) differs from other treatment options for benign prostatic hyperplasia (BPH) in several ways. Here are some key differences between HoLEP and other common treatment options:

  • Minimally Invasive Nature: HoLEP is a minimally invasive surgical procedure that uses a laser to remove prostate tissue. It is performed through the urethra, without the need for large incisions.
  • Tissue Removal: HoLEP allows for the complete enucleation or separation of the obstructing prostate tissue from the rest of the gland. This means that the surgeon can remove larger amounts of prostate tissue, even in cases of very large prostates. In procedures like TURP or Green Light laser therapy, only the excess tissue blocking the urethra is typically removed, leaving the rest of the prostate intact.
  • Reduced Bleeding: HoLEP has been shown to have lower bleeding risks compared to TURP or open prostatectomy. The holmium laser used in HoLEP has excellent hemostatic properties, allowing for precise cutting and coagulation, which minimizes bleeding during the procedure.
  • Hospital Stay and Recovery Time: HoLEP generally results in shorter hospital stays compared to open prostatectomy. Patients typically spend one to two days in the hospital after HoLEP. Recovery time is generally faster compared to open surgery. Many patients experience a quicker return to normal activities, including work and physical exertion.
  • Long-Term Efficacy: HoLEP has demonstrated excellent long-term effectiveness in relieving urinary symptoms caused by BPH. Studies have shown that HoLEP provides durable symptom relief and improves urinary flow rates comparable to other surgical treatments.


How is life after HoLEP?

Life after HoLEP (Holmium Laser Enucleation of the Prostate) can significantly improve for individuals who have been experiencing bothersome urinary symptoms due to benign prostatic hyperplasia (BPH). Here are some aspects to consider regarding life after HoLEP:


  • Improved Urinary Symptoms: One of the primary goals of HoLEP is to relieve urinary symptoms associated with BPH. Following the procedure, many patients experience a significant improvement in symptoms such as reduced urinary frequency, improved urine flow, decreased urgency, and better bladder emptying. This can lead to a better quality of life and increased comfort during daily activities.
  • Recovery and Healing: Generally, patients can expect some discomfort, mild pain, or urinary symptoms in the immediate postoperative period. However, these typically subside within a few days.
  • Return to Normal Activities: Many patients can resume normal activities relatively quickly after HoLEP, although the exact timeframe can vary. Most individuals can return to work and light activities within a week.
  • Long-Term Benefits: HoLEP has demonstrated excellent long-term efficacy in relieving BPH symptoms. Studies have shown that the procedure provides durable improvement in urinary flow rates and symptom relief. This can lead to long-lasting benefits and a sustained improvement in quality of life for many patients.
  • Sexual Function: HoLEP generally does not have a significant impact on sexual function. Most patients report no adverse effects on erectile function or ejaculation.

Overall, life after HoLEP can bring significant improvements in urinary symptoms and quality of life for individuals with BPH. It is important to have regular follow-up appointments with your urologist to monitor your progress and address any concerns that may arise.

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What is the purpose of HoLEP?

HoLEP is performed to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland that can cause urinary symptoms and obstruction. The procedure aims to remove excess prostate tissue to relieve urinary symptoms and improve urine flow.

How long does the HoLEP procedure take?

The duration of the HoLEP procedure can vary depending on the size of the prostate and the complexity of the case. On average, it may take around 1 to 2 hours.

What is the recovery time after HoLEP?

The recovery time after HoLEP can vary from person to person. Most patients stay in the hospital for 1 to 2 days after the procedure. It may take several weeks to fully recover and return to normal

activities. However, the improvement in urinary symptoms is often noticeable within the first few weeks.

Will I still need to undergo prostate cancer screening after HoLEP?

HoLEP is primarily used to treat BPH, not prostate cancer. If you have a history of prostate cancer or other risk factors, it is important to continue regular prostate cancer screenings, such as prostate-specific antigen (PSA) blood tests and digital rectal examinations (DRE), as recommended by your urologist.

How is HoLEP different from other prostate surgery techniques ?

HoLEP is a minimally invasive surgical technique that uses a holmium laser to remove prostate tissue. It offers advantages such as precise tissue removal, minimal blood loss, shorter hospital stay, faster recovery, and reduced risk of complications compared to traditional open prostatectomy or transurethral resection of the prostate (TURP).

Is anesthesia used during HoLEP?

Yes, anesthesia is used during HoLEP. It can be performed under general anesthesia or spinal anesthesia, depending on the patient and the surgeon's preference.

Are there any risks or complications associated with HoLEP?

As with any surgical procedure, there are potential risks and complications associated with HoLEP. These can include bleeding, urinary tract infection, temporary or permanent urinary incontinence, erectile dysfunction, bladder neck contracture, and urethral stricture. However, the overall risk of complications with HoLEP is generally low.

Will I be able to have sexual intercourse after HoLEP?

HoLEP can have an impact on sexual function, particularly erectile function. Recovery of erectile function varies among individuals and depends on factors such as age, preoperative erectile function, and nerve preservation during surgery. If you experience difficulties with erectile function after HoLEP, there are various treatment options available, including medications, vacuum erection devices, or other interventions. It's advisable to discuss this with your healthcare provider.


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