Prostate Problems and Their Impact on Quality of Life

For many men,benign prostatic hyperplasia(BPH) becomes a fact of life as they age. Approximately half of men over the age of 50 and more than 80% of men over the age of 70 experience enlargement of the prostate gland. This condition is usually not cancer; however, when the prostate compresses the urethra, it can lead to problems such as difficulty urinating, frequent urination, waking up at night to urinate, a weak or interrupted urine stream, a feeling that the bladder isn’t fully emptied, and sometimes urinary tract infections.

What makes it even more frustrating is that these symptoms seriously affect a person’s daily life. Frequently getting up to use the restroom at night disrupts sleep patterns, and an inability to hold urine or a sudden urge to urinate can lead to embarrassing situations in social settings.

In this article, we will discuss theHOLEP (Holmium Laser Prostatectomy)technique—the gold standard surgical method for treatingbenign prostatic hyperplasiain recent years—as well as its advantages, potentialside effects, the riskof urinary incontinence, and the entire procedure. I will present all this information in a patient-friendly manner, drawing on the clinical experienceof Prof. Dr. Volkan İzol, a professor of urology specializing in robotic and endoscopic surgery.

What Is Benign Prostatic Hyperplasia?

The prostate is a walnut-sized gland located just below the bladder that surrounds the urethra. As men age, the tissues inside this gland begin to grow under the influence of hormones. This condition is calledbenign prostatic hyperplasia.

This growth is not cancer; however, it narrows the urethra and prevents urine from flowing freely. If left untreated, the bladder muscle will weaken over time, the kidneys may be damaged, and complete obstruction—the inability to urinate—may even develop.

Symptoms typically include the following:

• Frequent urination
• Getting up to use the bathroom more than once during the night
• A weak, intermittent urine stream
• Difficulty starting to urinate
• The sensation of not having fully emptied the bladder
• Occasional urinary incontinence

When these symptoms progress, surgical treatment becomes an option. This is whereHOLEP offers a modern, safe, and permanent solution.

What Is HOLEP?

HOLEP (Holmium Laser Enucleation of the Prostate) is the most advanced endoscopic laser technique used in the surgical treatment of benign prostatic hyperplasia.

In this procedure, the surgeon enters through the urethra and uses a holmium laser to detach (enucleate) the enlarged inner tissue of the prostate from the capsule; this tissue is then drawn into the bladder, where it is fragmented using a device called a morcellator and removed from the body.

In other words, the procedure of “cleaning out the inside of the prostate”—which is typically performed during open surgery or a TUR-P—is done with a laser this time. As a result, all of the enlarged tissue is removed.

As Prof. Dr. Volkan İzolhas emphasized, the HOLEP method has become the gold standard, particularly for enlarged prostates, because it can be performed regardless of prostate size and minimizes the risk of bleeding.

The Benefits of HOLEP

1. Minimally Invasive and Bloodless Approach
   Because the holmium laser cuts through tissue with great precision, bleeding is minimal. Even in patients taking blood thinners (anticoagulants), surgery can often be performed without interrupting treatment.
2. Effective Even for Large Prostates
   It can be safely performed even on very large prostates, such as those weighing 100–200 grams. In this regard, it has largely replaced open prostate surgery.
3. Permanent Solution
   Since the enlarged tissue is completely removed, the risk of regrowth is extremely low. The likelihood of needing a repeat surgery is much lower than with TUR-P.
4. Shorter Hospital Stay
   Usually, a one-night hospital stay is sufficient. The catheter is also typically removed within 24 hours.
5. Faster Recovery
   Patients can usually return to their normal social lives within one week.
6. Tissue Is Sent for Pathology
   The removed prostate tissue is examined to determine whether there is any hidden prostate cancer.

How Is HOLEP Performed?

The surgery is performed under general or spinal anesthesia. No incision is made in the abdomen during the procedure; the entire procedure is performed through the urethra.

• First, the urethra is entered to view the interior of the prostate.
• It is carefully separated from the prostate capsule using a holmium laser.
• All the enlarged tissue is placed inside the bladder.
• It is then broken up with a morcellator and removed.
• The catheter is inserted and is usually removed 1 day later.

This ensures that the tissue is removed in an anatomically correct manner and that a pathological examination can be performed without any loss of tissue.

The Recovery Process After HOLEP

Patients are usually able to get out of bed on the first day after surgery; on the second day, the catheter is removed and they are discharged.

The following are considered normal during the recovery process:

• A slight burning sensation when urinating during the first few weeks
• Occasionally, small clots
• Temporary urinary incontinence (especially when coughing or laughing)
• Frequent urge to urinate

These symptoms usually improve significantly within 4 to 6 weeks.Prof. Dr. Volkan İzol advises his patients to drink plenty of fluids, avoid strenuous exercise, and be patient during this period.

Side Effects and the Risk of Urinary Incontinence

As with any surgery, HOLEP may have someside effects:

• Temporary Urinary Incontinence:In most patients, it resolves completely within 1 to 3 months.
• Retrograde Ejaculation:This is when semen flows into the bladder. Sexual pleasure is not lost, but the semen does not come out.
• Temporary Burning Sensation or Blood in the Urine:This is common during the first few weeks.
• Rare Urethral Stricture:Occurs in 1–2% of cases.

The risk of permanent urinary incontinence is less than 1% when the procedure is performed by an experienced surgeon. For this reason, the surgeon’s experience is of the utmost importance.

Does HOLEP Cause Erectile Dysfunction?

One of the questions patients ask most often is:
“Will I experience erectile dysfunction after prostate surgery?”

This concern is perfectly natural because sexual health is one of the most important aspects of quality of life. HOLEP is an extremely safe method in this regard:

• It does not damage the nerves responsible for erections:The holmium laser used during HOLEP only separates the enlarged prostate tissue from the capsule. Since the nerves responsible for erections run along the outer capsule of the prostate, these nerves are not affected.
• Scientific studies provide reassurance:Numerous clinical studies have shown that erectile function is preserved following HOLEP and that this procedure yields better results compared to other methods, such as TUR-P.
• Sexual function generally improves:Ease of urination, an end to nighttime urination, and increased self-confidence all have a positive psychological impact on sexual performance.

Prof. Dr. Volkan İzol clearly explains the following to his patients on this subject:

“HOLEP surgery does not cause erectile dysfunction. On the contrary, once their urinary symptoms are resolved, patients feel more energetic and confident.”

The only change is that a large portion of the semen flows into the bladder (retrograde ejaculation). This condition should be evaluated in young patients who are planning to have children. However, it does not have a negative effect on sexual pleasure or orgasm.

Frequently Asked Questions

How is sex life affected after HOLEP?
Sexual desire and erections are generally not affected. However, the manner of ejaculation changes (semen is ejaculated backward).

Is the surgery painful?
No, since the procedure is minimally invasive and performed with a laser, significant pain is not expected.

Will it grow back?
The removed tissue does not regrow; therefore, the likelihood of needing another surgery is very low.

When can I return to my normal life?
You can usually return to your daily routine within one week.

Prof. Dr. Volkan İzol’s Clinical Experience

Prof. Dr. Volkan İzol, who has been providing services in all areas of modern urology in Adana for many years, has particular expertise in minimally invasive and laser surgeries.
In his own words:

“The HOLEP procedure is currently the most effective and safest surgical treatment for benign prostatic hyperplasia. With an experienced team and the appropriate technological infrastructure, patients can recover in a very short time.”

This ensures thatprostate treatmentis performed in accordance with scientific standards while prioritizing patient comfort.

Conclusion

HOLEP is a modern, safe, and permanent surgical solution for benign prostatic hyperplasia.
Minimal bleeding, high tissue removal capacity, and an extremely low risk of recurrence have made this method the first choice today.

When performed by an experienced urologist such as Prof. Dr. Volkan İzol, both the complication rate decreases and the patient’s quality of life improves rapidly.

If you have been experiencing prostate symptoms for a long time, have not responded to medication, or suffer from recurrent urinary tract infections,HOLEPmay be a suitable option for you.