HoLEP

Holmium: YAG laser enucleation of the prostate (HoLEP) is a minimally invasive surgical method used for the treatment of benign prostatic hyperplasia (BPH).

The method has shown to be extremely effective for many patients with BPH, including those with significant prostate enlargement or those whose previous treatments have failed. The capability of HoLEP to manage different prostate sizes makes it a suitable solution for a broad spectrum of patients, and this method can help reduce the symptoms related to BPH with a lower risk of complications. As a result, HoLEP replaced the previous standards: open adenectomy and transurethral resection of the prostate (TURP).

The patient will undergo a general examination before HoLEP is recommended. This enables the physician to assess the patient’s overall health and their medical history. The decision to perform HoLEP will depend on the patient’s symptoms and treatment goals.

The duration of the procedure depends on the size of the prostate and is 1-2 hours on average. This procedure ensures an extremely low level of blood loss compared to conventional methods, i.e. open adenectomy and TURP. At the end of the procedure, the enucleated adenoma temporarily deposited in the urinary bladder is fragmented using a morcellator and removed through the urethra. The specificity of this method is the laser separation of the adenoma from the prostatic capsule and the temporary deposition of the enucleated adenoma in the urinary bladder. If the patient is taking anticoagulants, they need to be discontinued 48 hours before the procedure and replaced with low-molecular-weight heparin.

HoLEP does not have an adverse effect on potency. By removing the tissue, the external sphincter loses support, which can result in transient difficulties with urinary retention in the form of stress and urge incontinence. Weakness of the sphincter, i.e. a phase of adaptation to the new situation, may last up to 6 weeks in some patients, after which the symptoms completely withdraw. A temporary adverse effect of HoLEP is retrograde ejaculation. It is a condition in which the semen, due to a newly formed lower pressure in the urinary bladder, goes backwards into the urinary bladder instead of exiting directly through the urethra, and it is excreted from the bladder via urine. Besides the off-white colour of urine, retrograde ejaculation does not have any adverse effects on the patient’s health.

The efficiency of this method has been confirmed by numerous international studies. National, European and U.S. professional associations recommend it as the method of choice for the treatment of BPH.