HoLEP
Benign Prostatic Hyperplasia (BPH)
BPH is a condition in which the prostate, which enlarges with age, blocks the bladder outlet and obstructs urine flow. Symptoms become more common and bothersome as men get older.
Surgical treatment is required if at least one of the following conditions is present. The goal of surgery is to remove the tissue that is blocking the urinary tract.
Symptoms that persist despite medication
Presence of bladder stones
Persistent bleeding caused by the prostate
Development of kidney failure due to an enlarged prostate
Recurrent inability to urinate, requiring catheterization
Recurrent urinary tract infections
What Are the Surgical Options for Benign Prostatic Hyperplasia (BPH)?
Surgical treatment for an enlarged prostate involves removing the part of the prostate that has grown and is blocking the urinary tract. There are several methods available for this procedure. With technological advancements, many different techniques have been developed. The key is to determine which method will provide the best outcome for each patient.
TURP – Transurethral Resection of the Prostate
Plasmakinetic – Transurethral Bipolar Enucleation
HoLEP – Holmium Laser Enucleation of the Prostate
ThuLEP – Thulium Laser Enucleation of the Prostate
Greenlight – Laser Vaporization of the Prostate
Water Vapor Therapy (Steam Therapy)
Open Surgery
What Is HoLEP (Laser Prostate Surgery)?
HoLEP is a minimally invasive (closed) prostate surgery technique. It involves using a laser to separate and remove the enlarged inner tissue of the prostate (adenoma) from its capsule.
Why the HoLEP Method?
According to the 2023 European Urology Guidelines, HoLEP is more well-established, has the highest level of evidence, and is strongly recommended compared to other laser techniques such as ThuLEP or KTP.
Thanks to its excellent results, HoLEP has become increasingly popular and widely used today, and it is considered the gold standard treatment of the 21st century.
How Is Prostate Surgery Performed Using HoLEP?
HoLEP prostate surgery can be performed under spinal anesthesia (numbing from the waist down). In this procedure, the enlarged prostate tissue is accessed through the natural urinary tract and separated from its capsule. The tissue that has been pushed into the bladder is then broken into small pieces with a special instrument and removed. A special laser device and laser probe are used throughout the operation.
What Are the Advantages of the HoLEP Method?
No risk of prostate tissue regrowth (recurrence)
Safe for patients taking blood thinners
Low risk of bleeding
No burning sensation (dysuria) during urination
No expectation of erectile dysfunction
Catheters are removed very quickly
Tissue specimens can be obtained for pathology
Short hospital stay
What Are the Risks of the HoLEP Method?
The risks associated with HoLEP surgery are quite rare, but may include:
Bleeding
Infection
Need to switch to open surgery
Risks associated with anesthesia
Does the HoLEP Method Affect Sexual Function?
There are nerves around the prostate capsule that are responsible for regulating sexual function. Since the holmium laser’s effect on tissue is limited to just 0.4 mm, the deeper healthy tissues are not affected by the procedure. Therefore, erectile dysfunction is not expected after HoLEP prostate surgery.
Is Urinary Incontinence Possible After HoLEP Surgery?
Since HoLEP surgery is the technique that best preserves the sphincter muscles (which control urination), urinary incontinence generally does not occur.
However, if the sphincter has become weakened or sluggish due to a previous inability to urinate or because of a very large prostate, minor leakage may occur during the adaptation phase after the prostate is completely removed via HoLEP.
These minor leaks usually improve with medication and exercises—sometimes within a few days, and sometimes within 3 months. In rare cases, the recovery period may be longer.
Conclusion
With advances in laser technology and the support of scientific research, HoLEP surgery has become an effective treatment method that can be safely performed on prostates of all sizes, with minimal side effects. As with any surgery, the experience of the surgeon and the medical team plays a crucial role in the success of HoLEP procedures.
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