HoLEP Procedure

Prostate enlargement is something that occurs in men as they age. Affected men may experience symptoms such as issues with urination, dribbling, and urgency. The HoLEP procedure is a minimally invasive treatment for benign prostate enlargement that can reduce the size of the prostate. This procedure, which requires specialized training, is offered here at Advanced Urology Institute at Titus for your benefit and can improve your well-being by relieving symptoms associated with prostate enlargement. Dr. Walsh was expertly trained on the HoLEP technique in Cambridge, England with Dr. Tev Aho, who one of the most experienced urologists for this procedure.

Candidates for HoLEP

HoLEP is a procedure for men who have enlarged prostates. Men whose prostates are over 60 ml in size are particularly good candidates, as are men taking blood thinners such as aspirin, warfarin, or clopidogrel. As life expectancy rises, men in their 60s or older are increasingly likely to experience prostate enlargement and desire relief from its associated symptoms. Prostate enlargement, also known as benign prostatic hyperplasia (BPH), may cause symptoms that usually involve problems with urination, including urgency, leakage, frequent urination, and a hesitant, weak, interrupted stream. The HoLEP procedure can effectively treat BPH and help men experience relief from these symptoms.

The HoLEP Procedure

HoLEP is short for holmium laser enucleation of the prostate. Using a holmium laser, Dr. Walsh can perform a minimally invasive treatment for BPH by enucleating most of the excess benign prostate tissue. In other words, Dr. Walsh can remove the enlarged tissue from inside the prostate without cutting into it. The HoLEP procedure lasts an average of 45 minutes to two hours, depending on the size of the prostate.

First, the patient is placed under general anesthesia or given a spinal anesthetic to numb everything from the waist down. Next, Dr. Walsh inserts a telescopic camera through the penis and uses the holmium laser to separate the prostate gland tissue from the prostate capsule. The holmium laser enucleates three prostate lobes (cored out intact), leaving only the capsule. Finally, the excised tissue is pushed into the bladder and then ground up and sucked out via a special tool. The tissue is later sent to a laboratory to test for cancer.

After the Procedure

After the HoLEP procedure, a catheter is placed into the bladder for about 24 hours to drain urine until it is clear of blood from the prostate area. Patients should drink lots of water and fluids over the following weeks to help clear the urine and stop bleeding. Saline may be irrigated through the bladder to dilute any blood and prevent clots. The catheter may be left in for one week but is typically removed one day after the procedure, at which point the patient is discharged home.

Most men feel tired after the HoLEP procedure but are surprised by how comfortable they feel during recovery. Some minor discomfort may occur for a few days, as well as urgency and frequency to urinate. Patients may need a recovery period of up to two weeks to rest before returning to work. Patients may experience some intermittent bleeding for up to six weeks after the procedure. Most patients can resume sex after three to four weeks but are advised to take it easy and avoid heavy lifting or straining for four weeks.

Risks and Side Effects

As with all surgeries, the HoLEP procedure is not without risks and side effects. The most common side effects are temporary mild burning, frequency of urination, and urgency. Dr. Walsh may prescribe antibiotics if needed or if an infection occurs. Occasionally, men experience urinary incontinence, which typically resolves within six weeks and can be improved with pelvic floor exercises (taught before the surgery). A pad can be worn if needed, but the need for pads after three months is rare (less than two percent of patients who undergo this procedure).

Some patients may be unable to pass urine after the procedure due to temporary swelling and will require a catheter until the swelling resolves and the bladder regains its normal function. This temporary catheter is usually successfully removed just one day after surgery. As discussed above, intermittent bleeding can continue for several weeks after the procedure. Rarely, patients may experience sudden difficulty passing urine, severe bleeding, or passage of clots that may require rehospitalization. Very rarely, repeat treatment or additional surgery may need to be performed if prostate regrowth, persistent incontinence, retained tissue fragments in the bladder, and/or perforation of the bladder occurs.

It is possible for patients to experience weaker or, rarely, no erections afterward, but the removal of your prostate should not negatively affect your ability to have an erection if you are having normal erections before the procedure. After prostate surgery, it is common for men to no longer be able to ejaculate semen during orgasm because the semen will tend to travel back into the bladder. This change is not uncomfortable or harmful but can have a significant impact on fertility if you hope to father children in the future. Most men report that orgasms continue to be pleasurable.

The Advantages of HoLEP in Treating Benign Prostatic Hyperplasia

Men who experience symptoms associated with BPH will usually need treatment at some point. The FDA has approved certain types of drug therapy to halt or reverse prostate growth; however, unfortunately, drug treatment is not effective in every case. Surgery may be recommended as a long-term solution, but not every patient will be a good candidate for surgery. Transurethral resection of the prostate (TURP), the most commonly used surgical treatment for BPH, can result in complications and risks that may require multiple days in the hospital and a four- to six-week recovery. Laser ablation treatments provide quick relief of symptoms, but they can cause temporary prostate swelling that leads to a number of problems. Their long-term durability is also unknown, and repeat surgery may be required at a later point.

The HoLEP procedure is consistently superior compared to other treatments for benign prostate enlargement. HoLEP can treat any size prostate gland and is so effective that retreatment rates are less than two percent. It leads to fast symptom relief with limited swelling and minimal to no pain when voiding. Patients can often be discharged from the hospital the next day and may quickly return to normal activities. The procedure allows the excised prostate tissue to be examined for cancer cells, which is not possible with laser ablation. The potential complications are fewer, with little tissue damage and a reduction in the risk of excessive bleeding and erectile dysfunction. HoLEP can help men of any age by relieving enlarged prostate symptoms and improving their quality of life.

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