Holmium laser enucleation of the prostate – otherwise more simply known as holmium laser prostate surgery or abbreviated as HoLEP – is a minimally invasive procedure to treat benign prostatic hyperplasia (BPH) – an enlarged prostate – which is common in older men and can restrict the flow of urine to the urethra.
It is a very effective way to operate on symptoms quickly and efficiently, and the procedure greatly reduces recovery time and postoperative complications.
The procedure employs a laser to remove enlarged prostate tissue that is impeding urine flow, meaning that no incisions need to be made. It averts any metabolic complications associated with a transurethral resection of the prostate (TURP) procedure and is far less invasive.
Holmium laser enucleation of the prostate also helps preserve tissue that is removed, which may be necessary to help diagnose prostate cancer.
The prostate gland is a part of the male reproductive system. Its main role is to produce the fluid that carries and protects sperm. It is located in the lower abdomen in men only.
As men get older the prostate can enlarge, which can restrict the flow of urine to the urethra. This will lead to poor flow or the inability to completely void the bladder of urine. It may also increase the frequency and urgency of urination – this can be particularly uncomfortable at night where multiple trips to the bathroom may be needed.
The aim of HoLEP is to remove the blockage to relieve these symptoms. This is done by inserting an instrument called a resectoscope into the eye of the penis and through the urethra to get a visual of the prostate tissue and the lining of the bladder.
From here a high powered holmium laser is used to cut away the obtrusive tissue. An instrument called a morcellator is the used to cut the resected prostate tissue into smaller pieces. The tissue is then removed via the rectoscope.
After the procedure, a catheter is inserted into the urethra in order to drain any urine, this may remain in place for a day or two after surgery.
Before the procedure patients are usually given a general anaesthetic. Spinal anaesthesia is also possible. Your anaesthetist and urologist will discuss this with you.
After the procedure patients are usually required to stay in hospital for one or two days. During this time a catheter is necessary because the swelling caused by the procedure blocks the flow of urine. This is required for a day or two or until the swelling goes down.
Once the catheter has been removed, the patient can go home. Full recovery should only take 1-2 weeks. During this time, patients are advised to rest and avoid heavy lifting and strenuous activity.
Holmium laser enucleation of the prostate is far less invasive than open or laparoscopic surgery and has many benefits including a shorter stay in hospital, less bleeding, lower chance of metabolic complications. However, as with any surgery, there are some risks, such as bleeding and urinary tract infection (UTI).
A common side effect is a burning or stinging sensation, and frequent urination, for a short period after the procedure. Other possible side effects include retrograde ejaculation, which is quite common, and erectile dysfunction, incontinence and urethral stricture (narrowing of the urethra), which are rare.
While he is primarily a urological cancer surgeon, Dr Arianayagam also sees patients with more general urological problems and often practices laser prostate surgery.