What is holmium laser enucleation of the prostate (HoLEP)?

Holmium laser enucleation of the prostate (HoLEP) is a form of laser surgery that can be done for benign prostatic hyperplasia (BPH), It is also Known as Holmium Laser Prostate Surgery. BPH causes your prostate to become bigger (enlarged prostate), pushing against your urethra and stopping pee from flowing freely. HoLEP is a less invasive method in which a laser beam is used to shave off the blocking tissue of your prostate.

HoLEP was created in the 1990s as a more efficient and possibly less expensive surgery for urinary blockage caused by BPH. HoLEP provides quicker recovery periods and does not involve any cuts (incisions).

What is treated with Holmium Laser Prostate Surgery (HoLEP)?

The holmium laser is a surgical laser used to remove the swollen prostate tissue that's stopping the flow of urine. The most frequent reason for urinary blockage (stalled urine) is BPH. BPH makes your prostate grow large, squishing up against your urethra and preventing urine from exiting your bladder.

The following are some common symptoms of BPH:

Difficulty urinating.
Weakened urine stream.
Having a stream of urine that begins and ends a lot.
Burning during urination.
Having to urinate very often.
Urgently urinating or leaking urine because you cannot get to the bathroom in time.

How common is HoLEP surgery?

BPH affects over 60% of men aged 60 or older. As you get older, the chances of developing BPH increase. Over time, BPH symptoms can also worsen. Not all people with BPH require surgery. Most people respond well to medication and other treatments. However, if your symptoms are bothersome or you're at risk for complications such as urinary tract infections (UTIs) and bladder stones, your doctor may suggest HoLEP.

Is Holmium Laser Prostate Surgery a big surgery?

HoLEP is less invasive and has a lower risk of complications than other surgeries to address the same condition. However, like most surgeries, there are risks. Discuss your concerns regarding the procedure and your recovery with your doctor.

What happens before HoLEP surgery?

Your doctor will ask you about your medical history and conduct a physical exam to determine the severity of your condition. This might include a prostate exam and an assessment of how much pee is left in your bladder after you urinate. Lab tests might include blood tests, such as the PSA (prostate-specific antigen) test and urinalysis.

Certain other tests might occur before HoLEP surgery and include:

Tests that measure the amount and flow of your urine.
Imaging tests such as a transrectal ultrasound or CT scan (computed tomography scan) to assist your physician in measuring the size of your prostate.
Cystoscopy (examining the inside of your urethra, prostate, and bladder with a scope) to check your bladder and prostate for cancer, infection, or obstruction.
A urodynamics test to assess how your bladder is functioning and whether the removal of the prostate tissue might reduce symptoms. This is a diagnostic procedure with a catheter in your bladder and some pressure sensors.

Inform your doctor about the medications you are taking. Your doctor may request that you avoid taking certain medications within 10 days of surgery. You will not be permitted to drink or eat anything after midnight before your operation.

How is a holmium laser enucleation of the prostate (HoLEP) procedure done?

HoLEP is done under general anesthesia (you're asleep during the surgery). If for some reason you can't have general anesthesia, you might receive a spinal anesthetic to numb you from your waist down. Your healthcare professional may also administer an antibiotic injection to minimize your chance of getting infected.

HoLEP surgery typically proceeds like this:

After you're asleep, your healthcare team puts you on your back and elevates your legs.
Your doctor passes a surgical tool named a resectoscope inside your urethra. The resectoscope contains a camera so that your doctor can see your prostate gland.
Your doctor passes a laser inside the resectoscope. It pulses bursts of laser light inside your prostate to slice through the tissue that's obstructing the flow of pee (a process called enucleation). Then they close off the blood vessels using the laser.
They remove the laser from the resectoscope and insert a morcellator in its place. The morcellator suctions out the left behind prostate tissue in your bladder and eliminates it from your body. Your surgeon will send off tissue samples of your prostate to the lab to look for abnormalities such as prostate cancer.
After removing the tissue, your doctor removes the resectoscope and installs a urinary catheter.

How long is surgery?

HoLEP surgery should last one to three hours, depending on your condition.

What happens after you have HoLEP surgery?

Most individuals return home after a few hours in the recovery room. However, some might be required to remain in the hospital if there are concerns regarding bleeding or other complications.

The following are some of the things you can expect following HoLEP surgery:

A healthcare provider will flush fluid through the catheter to clear blood from your urine after the surgery. You'll be allowed to go home as long as the pee is a clear pink or red color. You’ll go home with a catheter.
Your health care provider takes your catheter out the day after surgery unless you're bleeding a lot (this is uncommon) or there's another issue. If you can urinate two to three times after the catheter has come out, you may be discharged home and urinate normally. If you cannot urinate after removing your catheter, your provider will reinsert it and take it out a few days later.
Initially, urinating can hurt and be more frequent than normal. Medications will improve symptoms. Be prepared to have blood in your urine for several weeks. It will depend on your activity level and how much you drink. Your doctor will want you to drink a lot of fluids after the catheter is removed. This fluid clears your urine of blood more easily.
Symptoms like more frequent peeing, feeling an urgent need to pee and needing to pee during the night can take a few months to get better. This is because your bladder needs to learn to function without the prostate tissue and muscle control of the pelvis may be poor after surgery.
Burning sensations for several weeks after surgery are normal. You may take over-the-counter (OTC) pain medication for pain.
It is normal to have some light bleeding from your prostate for a couple of weeks and even a couple of months.

Your doctor will follow up after surgery to track your healing and rerun tests, such as the urinary flow rate and bladder scan. These measurements determine the success of the surgery and potential complications.

Your doctor may also suggest performing pelvic floor exercises (Kegel exercises) as soon as the day following surgery to enhance urinary incontinence symptoms. Kegel exercises can reduce leakage caused by stress maneuvers like coughing, sneezing, or lifting.

What are the side effects of holmium laser enucleation of the prostate (HoLEP)?

The most frequent side effects are:

Burning and bleeding while peeing temporarily. It's also normal to have blood in your urine up to three months after surgery. This is probably just because you're not fully over surgery.
You might have to wear pads in your underpants for a couple of days as you might not be able to hold pee. This usually gets better after a few weeks. The chance of leaking pee over the long term is low. Your risk for long-term incontinence is based on several factors such as age, size of the prostate, symptoms and other illnesses.
Retrograde ejaculation or "backwards or dry ejaculation." In 75% of instances, you will not notice any fluid during ejaculation or intercourse after surgery.
Absence of semen at orgasm. Erection is generally not a problem.

What percentage of the prostate is taken out in HoLEP?

How much of your prostate is taken out by your surgeon is based on how big the blockage is or how much your prostate is compressing your urethra. Usually, your surgeon will take out 50% to 60% of the entire prostate size.

What are the benefits of HoLEP?

HoLEP is a safe and effective procedure with a quick recovery compared to similar surgical procedures. Although there are many procedures to treat BPH, HoLEP offers the following advantages:

Surgeons can remove a large amount of prostate tissue without any incisions on the skin.
HoLEP is excellent in treating large prostates but can be effective for any size prostate.
Minimal or no hospital stay.
Decreased risk of bleeding and blood transfusions.
Less chance of requiring repeat procedures.

What are the complications and risks of holmium laser enucleation of the prostate (HoLEP)?

Like all surgeries, there are some risks involved in HoLEP. Some of the most frequent risks are:

Damage to your prostate, urethra, bladder or ureters.
Urinary incontinence for more than three months.
Infection of your bladder, testicles or kidneys.
Risks of anesthesia such as blood clots, heart attack or aspiration.
Requirement of blood transfusion secondary to excessive bleeding.
Requiring a catheter for more than 24 hours (extended catheterization).

A small percentage, around 5% to 15%, of men are informed that they have prostate cancer following HoLEP. It doesn't impact your future ability to be treated for prostate cancer if you don't have it or get it later. Fewer than 2% of men develop future urinary obstruction symptoms and need another operation.

What is the recovery time?

You can begin to walk and drive on the day after surgery. You should not do strenuous activities (run, lift heavy loads, etc.) for at least two weeks and straddle activities (ride a bike, lawnmower, motorcycle, etc.) for six weeks. The majority of individuals can return to work in one or two weeks. Individuals with highly physically demanding jobs might require longer. You shouldn't lift anything greater than 10 pounds for at least two weeks.

When should I call my doctor?

Your doctor will inform you about what to anticipate during your recovery. Some symptoms are normal and anticipated in your recovery. After HoLEP surgery, you should call your doctor if you:

Pass blood clots or urinate bright red blood that resembles tomato soup.
Experience fevers above 101 degrees Fahrenheit (38 degrees Celsius).
Have pain that does not go away with medicine.
Cannot urinate.

Why choose Tender Palm Super-Speciality Hospital for Holmium Laser Enucleation of the Prostate (HoLEP) Surgery in Lucknow, India?

Tender Palm Super-Speciality Hospital is one of the best hospitals for Holmium Laser Prostate Surgery in Lucknow, India. Our experienced Urologists uses advanced technology, and provides patient-focused care, the hospital ensures safer procedures, quicker recovery, and improved long-term outcomes.