HoLEP Procedure
Prostate enlargement is a health problem that can occur in men and cause bothersome symptoms. Various medical treatment options are available for prostate enlargement. While some treatment options may be insufficient, others may cause serious side effects. HoLEP is a surgical operation performed on patients with benign prostatic enlargement that does not require an incision (closed) and has few side effects.
What Is HoLEP?
The prostate is a gland located just below the bladder in men and is responsible for secretion. Non-cancerous growths that occur in the prostate gland are called benign prostatic hyperplasia (BPH). Minimally invasive options are available for BPH that cannot be treated with other methods. HoLEP is one of these options. HoLEP is one of the applicable options for treating symptoms that do not improve with medication. During HoLEP, prostate treatment is carried out using a holmium laser. Holmium laser prostate surgery involves breaking up the enlarged prostate gland with a laser and removing it from the body. The procedure uses a holmium laser device to remove excess prostate tissue that may cause obstruction of the urethra.
Who Is Suitable for HoLEP Surgery?
Holmium laser enucleation of the prostate is not a treatment used in every patient with prostate enlargement. If the enlarged prostate tissue affects the person's health or causes serious symptoms, treatment options are evaluated. Treatment options include various lifestyle changes and medications. However, in some people these options may not provide benefit. In this case, the symptoms are relieved by removing the enlarged prostate tissue with HoLEP. The signs that indicate prostate enlargement needs to be treated are:
Frequent urination
Increased urinary frequency at night
Weak urinary flow
Inability to completely empty the bladder
For HoLEP surgery, it is also important that the person first undergoes the necessary checks. It is important that the doctor evaluates the medical history and then performs a physical examination. A rectal examination may also be performed during the physical examination. It is important that other tests are performed before deciding on surgery. Tests may be performed to determine whether all urine has been expelled from the bladder after urination. Blood tests may also be used to examine whether the cause of prostate enlargement is cancer. PSA, checked in the blood test, can give an idea about this. If high levels are seen in these results, the patient may be referred for a prostate biopsy. In addition, imaging techniques are used to observe the size of the prostate. An ultrasound performed transrectally helps determine its size. The size of the prostate is also a determinant of the HoLEP surgery duration. Depending on the patient's symptoms, urethral strictures may be examined with cystoscopy, or urodynamic tests may be performed to assess bladder function quality.
How Long Does the Surgery Take and What Is the Length of Hospital Stay?
HoLEP is a procedure performed under general anesthesia. To carry out the procedure, the patient who receives anesthesia is placed supine with the legs raised. A device called a resectoscope is inserted through the urinary tract. With the camera it contains, this device allows the surgeon to visualize the prostate during the surgery. With the same device, the laser unit is brought to the prostate. Excess prostate tissue is broken into pieces with this laser. The separated pieces collect in the bladder, and by minimizing bleeding with the laser, the cut vessels are sealed. The laser is removed from the resectoscope and a device called a morcellator is placed to remove the prostate excess that has accumulated in the bladder. This device draws in the prostate tissue accumulated in the bladder and allows it to be removed from the body. When the entire procedure is completed, all devices are removed and a urinary catheter is inserted in their place. The procedure takes approximately 60-90 minutes. This duration may vary depending on the amount of excess prostate tissue. An increase in prostate tissue may prolong the surgery time, as the amount of tissue to be removed also increases. The length of hospital stay after surgery is about 1-2 nights. However, depending on the patient's condition, this period may extend to several days.
Does the Surgery Have Side Effects?
As with every operation, side effects may also occur after HoLEP. To minimize possible complications after surgery, certain precautions may be taken before the operation. These precautions include stopping blood-thinning medications before surgery so that bleeding does not increase. Blood may be seen in the urine for a few weeks after surgery. This blood is generally not a sign of a serious condition and indicates that the healing process is not yet complete. However, it may still need to be checked by the surgeon who performed the operation. Given the risk of infection after surgery, the necessary antibiotics are prescribed. Urinary incontinence may be encountered for a period before and after surgery. To resolve such problems, the doctor may recommend physical exercises. Also, various medications may need to be prescribed for a period for any discharge that may occur. Some side effects can be prevented by the surgeon's expertise, and others can be eliminated with post-operative care. The most common side effects are:
Burning sensation during urination
Blood in the urine
Urinary incontinence
No fluid during sexual activity
Rarely, erectile dysfunction
Development of scar tissue
Injury to the prostatic capsule
Bladder injury
Infection
Bleeding
Recovery Process After HoLEP?
The recovery process after the HoLEP procedure varies from person to person. In particular, a return to work for employed individuals may take a few weeks. For people who do heavy physical work, this period may be somewhat longer. During the recovery process, it is important for the person not to perform strenuous physical activities, not to miss check-ups, and to take the prescribed medications in order to speed up the process. During recovery, light activities such as short walks may be beneficial when done under the doctor's supervision. It is natural to have some bleeding after surgery. This typically improves within approximately 12 hours. However, if the person experiences a complication such as excessive bleeding, intervention may be required. Also, a catheter may need to be used to clear the blood from the urine after surgery. With the help of the catheter, bloody urine is removed from the body until the morning after surgery.
When the urinary catheter is removed after surgery, the patient may be discharged without a catheter if they can urinate 2-3 times a day. However, in cases where urination is not possible, the catheter is kept in place for a while longer.
Urination may be painful for a few days during the recovery period. If necessary, painkillers may be prescribed by the doctor. Fluid intake is very important during this period so that urine output does not decrease. For this reason, daily water consumption must be carefully monitored. Improvement of symptoms that appeared before surgery may take several months after the operation. Also, it is necessary to wait for the period stated by the doctor before resuming sexual intercourse. Following the doctor's recommendations during this period is of great importance for healing to occur.
Frequently Asked Questions:
Laser treatments such as HoLEP are among the minimally invasive options. In addition to being minimally invasive, it is a method that allows the removal of substantial amounts of prostate tissue from the body. Apart from this, other surgical options are also available. With TURP or open prostatectomy, hospital stays may be longer and removal of the catheter may take time. With the HoLEP method, these periods can be shorter. At the same time, removal of the prostate with HoLEP allows blood vessels to be quickly sealed during the procedure using a laser. This is associated with less bleeding. Because it is performed without any incision, the recovery process is faster and can be easier to go through. Since it does not involve a surgical incision, symptoms such as pain are experienced less. The HoLEP operation is a procedure applied to eliminate or reduce symptoms arising from prostate enlargement. It may be preferred due to problems related to urinary outflow and issues occurring in the urinary system. Situations in which it can particularly be preferred are:
Use of blood-thinning medication
Risks associated with undergoing transurethral resection of the prostate (TURP)
Prostate larger than 80 grams
Failure to achieve results with medications used for prostate enlargement treatment, or medications not being suitable for use by the patient
Necessity of catheter use due to urinary retention
Symptoms related to severe prostate enlargement, such as blood in the urine (hematuria), bladder stones, kidney failure, or recurrent urinary tract infections
The surgery allows the removal of all excess tissue in the prostate. The procedure performed helps relieve prostate obstruction and usually does not need to be repeated. The HoLEP performed may prevent problems related to prostate enlargement for the rest of the person's life. Since HoLEP is a minimally invasive operation, it has a short hospital stay. However, this process may vary due to the patient's health condition or side effects that may be observed. If no problems occur, the person may be discharged after an average of 1 night. If the person's health condition is not suitable for discharge the next day, or if there are problems related to urination that need to be monitored, this period may extend to several days. Prostate enlargement treatments are procedures that must be performed by doctors and surgeons who specialize in the field. Innovative methods in this area require not only innovative equipment but also surgeons who specialize in the field. For information about current approaches to prostate enlargement treatment and the HoLEP method, you can contact us.
