What is HoLEP (Holmium Laser Enucleation of the Prostate)?
HoLEP is a surgical method using advanced laser technology for the treatment of benign prostatic hyperplasia (BPH). The entire prostate tissue is removed in a closed procedure. It has replaced open surgery for large prostates and is currently considered the gold standard in surgical treatment of the prostate.
How is HoLEP Surgery Performed?
The procedure is performed under general anesthesia or spinal anesthesia. A special instrument with a camera is inserted through the urinary tract. The enlarged prostate tissue is carefully separated from the capsule using a laser and pushed into the bladder. The prostate tissue in the bladder is then fragmented with another device (morcellator) and vacuumed out of the body. Finally, a catheter is placed to complete the procedure.
Why HoLEP?
- It can be safely applied to prostates of any size.
- Even for very large prostates, the procedure is performed without any incisions.
- It is an alternative to open surgery.
- The need for repeat surgery is almost nonexistent.
- It does not harm sexual functions.
- The risk of bleeding is very low, eliminating the need for a blood transfusion.
- It can be performed safely even in patients who must take blood thinners.
- The hospital stay and catheterization period are very short (1 day).
- Patients do not experience a burning sensation while urinating after catheter removal.
Who is HoLEP Recommended For?
HoLEP is a suitable surgical method for anyone who requires prostate surgery. Due to its advantages, it is preferred in cases where other methods cannot be applied. Traditionally, prostates larger than 80 grams are treated with open surgery. However, with HoLEP, prostate size does not matter, making it a highly successful option for large prostates.
If a patient has bladder stones in addition to prostate enlargement, HoLEP can be performed in the same session, and the stones can be broken down with a laser. Additionally, if the patient has a urethral stricture, this can be treated with a laser during the procedure.
It is also a safer option for patients with cardiovascular diseases, those with stents in their heart vessels, those who have undergone bypass surgery, or those taking blood thinners due to vascular occlusions.
Does HoLEP Affect Sexual Function?
Nerves responsible for erection pass around the prostate and may be affected during surgery. Studies have shown that HoLEP affects only 0.4 mm depth of the prostate capsule, meaning that the energy used in the procedure does not damage these nerves. In contrast, the electrical energy used in TUR-P surgery penetrates up to 4 mm in depth.
The common disadvantage of HoLEP, TUR-P, and open prostatectomy is retrograde ejaculation (semen flowing backward) or inability to ejaculate. Since the prostate tissue is completely removed, semen flows into the bladder during orgasm and is later expelled with urine. This condition has no health risks. In conclusion, HoLEP does not cause erectile dysfunction or causes the least harm among all techniques.
What to Expect After Surgery?
After catheter removal and discharge, patients may notice changes in urine color, with minor bleeding at the beginning and end of urination. This is usually temporary. While burning and discomfort during urination are rare with HoLEP, they may occur in some cases, especially in the first few weeks.
Since the prostate is completely removed, some patients, particularly those who have had prolonged catheter use, are immobile, have neurological conditions, or have diabetes, may experience urine dribbling or incontinence. In such cases, exercises and medications are recommended.
Some patients with weakened immune systems or prolonged catheter use may develop infections, but this risk can be minimized with preoperative urine culture and appropriate treatment.
When Can Patients Return to Normal Life?
Most patients can return to their normal daily activities within 2-3 weeks after surgery. Light physical activities are allowed. A fiber-rich diet is recommended to prevent constipation. During the first month, patients should avoid carbonated drinks and spicy foods. Sexual intercourse is not recommended for the first 4-6 weeks. After the first intercourse, blood in urine or semen may occur, but this is harmless. In most cases, semen is expelled into the bladder and later eliminated with urine.
Does the Prostate Grow Back After HoLEP, or Is Repeat Surgery Needed?
Since the prostate tissue is completely removed with a laser, no tissue remains behind. Therefore, there is no risk of prostate regrowth, and the need for repeat surgery is eliminated.
Is the Removed Prostate Tissue Examined by Pathology?
The prostate tissue removed during HoLEP surgery is placed in special containers and sent to the laboratory for pathological examination. Since patients undergo a detailed preoperative evaluation for cancer, pathological results are usually benign. However, if an unexpected result is found, additional treatment is planned accordingly.
Can Prostate Cancer Develop After HoLEP?
In all benign prostate surgeries, only the inner part of the prostate that causes urinary obstruction is removed. The outer capsule of the prostate remains intact, and unfortunately, cancer can develop in this area over time. Even if no cancer is detected before surgery, the risk of prostate cancer increases with age. Therefore, even after HoLEP, patients should continue regular follow-ups if deemed necessary.
Op. Dr. Burak Yavuz KARA
Urology Specialist
