HoLEP
The Procedure: What to Expect
1. Preparation: The procedure is typically performed under general anaesthesia.
2. Enucleation: The surgeon inserts equipment (resectoscope) through the urethra. The laser fibre is then passed through the resectoscope, and this is used to “core out” the obstructing prostatic tissue, much like peeling an orange from the inside.
3. Morcellation: The detached (enucleated) prostate tissue is moved to the bladder. An equipment called a morcellator is then used to safely suction the tissue out.
4. Pathology: Because the tissue is removed rather than burned away, it can be sent to a lab to be screened for prostate cancer.
Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive surgical procedure used to treat an enlarged prostate. It is performed endoscopically through the urethra, so there are no cuts on the skin.
HoLEP uses a high-powered laser to precisely trim (enucleate) the obstructive portion of the prostate, thereby improving urine flow and bladder emptying.
Once the prostate tissue is enucleated, it is pushed into the bladder and finely shredded (morcellated) for removal. The prostatic tissue removed is then sent off to the lab for analysis to exclude prostate cancer.
As men grow older, the prostate tends to enlarge. This is called BPH (Benign Prostatic Hyperplasia). As the prostate gets bigger, it compresses on the urethra—the “pipe” you pee through—making it hard to pass urine. Untreated, this could result in urine retention, urine infections, bladder stones, kidney failure and other complications.
Compared to other procedures for treating BPH, HoLEP is versatile and efficient:
- Treats Any Prostate Size: HoLEP is effective regardless of prostate size.
- Reduced Bleeding: The Holmium laser is precise and seals blood vessels as it cuts through the prostate, significantly minimising blood loss.
- Faster Recovery: Most patients experience shorter hospital stays and can have their urinary catheter removed sooner than with conventional surgery.
- Low Retreatment Rate: Because the entire obstructing portion (adenoma) of the gland is removed, the chances of the prostate growing back and requiring a second surgery are extremely low.
Recovery and Results
Most patients notice an immediate improvement in urine flow following the procedure.
Common benefits include:
1. A stronger, more consistent urinary stream.
2. Complete emptying of the bladder.
3. Reduced frequency, urgency and nocturia
(If these symptoms were due to irritation from an enlarged prostate.
Some temporary side effects, such as mild burning when urinating or light bleeding in the urine, are normal during the first few weeks of healing. For further information about HoLEP, please refer to the BAUS leaflet