HOLEP (Holmium Laser) Treatment for Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH)

This condition occurs when the prostate, which enlarges with age, blocks the outlet of the bladder and impedes urine flow. Symptoms become more common and more bothersome in many men as they age.Surgical treatment is necessary if at least one of the conditions listed below is present. The goal of surgical treatment is to remove the tissue blocking the urinary tract.

• Symptoms that do not improve despite medical treatment
• Presence of bladder stones
• Persistent bleeding originating from the prostate
• When kidney failure develops due to an enlarged prostate
• Recurrent inability to urinate and the need for catheterization
• Presence of recurrent urinary tract infections

What are the surgical options for benign prostatic hyperplasia?

Surgical treatment for an enlarged prostate involves removing the portion of the prostate that has grown and is blocking the urinary tract; there are many methods for this procedure: In line with technological advancements, many different methods have been developed, and the key is to determine which method will yield the best results for each individual patient.

• TURP - Transurethral Resection of the Prostate
• Plasmakinetik - Transurethral Bipolar Enucleation
• HoLEP - Holmium Laser Enucleation of the Prostate
• ThuLEP - Thulium Laser Enucleation of the Prostate
• Greenlight - Laser Vaporization of the Prostate
• Steam method
• Open Surgery

What Is HoLEP (Laser Prostate Surgery)?

HoLEP is a minimally invasive prostate surgery technique; it involves using a laser to separate the enlarged prostate tissue (adenoma) from its capsule and remove it.

Why the HoLEP method?

According to the 2023 European Urology Guidelines, it is a method that is better known than other laser techniques such as ThuLEP or KTP, has the highest level of evidence, and is strongly recommended.

Thanks to the excellent results it has yielded, HoLEP—which is becoming increasingly popular and widely used today—is considered the gold standard of treatment for the 21st century.

How is surgery for an enlarged prostate performed using HoLEP?

HoLEP surgery for an enlarged prostate is a procedure for which spinal anesthesia (numbing the lower body) is sufficient. In this procedure, the enlarged prostate tissue is separated from its capsule by accessing it through the normal urinary tract. The prostate tissue, which is pushed into the bladder, is broken down into small pieces using a special instrument and then removed. A laser probe is used with a special laser device during this procedure.

What Are the Advantages of the HoLEP Method?

· There is no risk of prostate cancer recurrence

· It is safe for patients taking blood thinners

· The risk of bleeding is low

· There is no burning sensation when urinating (dysuria)

· Erectile dysfunction is not expected

· The probes are removed very quickly

· It is possible to collect specimens for pathology

· The hospital stay is short.

What Are the Risks of the HoLEP Procedure?

Risks associated with HoLEP surgery are quite rare:
• Bleeding
• Infection
• Need to switch to open surgery
• Anesthesia-related risks

Does the HoLEP procedure have any adverse effects on sexual function?

There are nerves around the prostate capsule that regulate sexual function. Since the holmium laser’s effect on tissue is only 0.4 mm deep, the healthy tissue located deeper within the prostate is not affected by the procedure. As a result, patients are not expected to experience erectile dysfunction followingprostate enlargement surgery using HoLEP.

Can urinary incontinence occur after a HoLEP procedure?

Since HOLEP surgery is the method that best preserves the muscles that control urination—known as the sphincter—urinary incontinence does not occur.

However, if the patient has sphincter weakness—whether due to a previous inability to urinate or an excessively enlarged prostate—minor leakage may occur during the sphincter’s adaptation and recovery process following HOLEP surgery, since the entire prostate is removed during the procedure.

These episodes usually resolve with medication and exercise—sometimes within a few days, sometimes within 3 months. Rarely, they may last even longer.

Conclusion

With the advancement of laser technologies today, and in light of scientific research, HoLEP surgery is an effective treatment method that can be safely performed on prostates of all sizes and is associated with minimal side effects. As with any surgery, the experience of the surgeon and the surgical team plays a crucial role in the success of HoLEP surgery.

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Prof. Dr. Volkan İzol, Urological Diseases, Urological Treatments, Adana Urology, Adana Urology Specialist, Adana Urologist

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