Benign prostate enlargement is the most important cause of difficulty urinating, occurring in more than 40 percent of men over the age of 60. Moreover, the condition may worsen with increasing age. Surgery may come to the agenda in patients whose problems persist despite drug treatments, and it is also considered the first option in the group with severe urination problems.

HoLEP is a method that can be applied to all patients with benign prostate enlargement requiring surgical intervention. There is no prostate size restriction for HoLEP surgery. Any size prostate can be treated endoscopically (closed) with this method. Since all parts of the prostate that may obstruct the flow of urine can be removed with the HoLEP technique, it is an important option, especially for the treatment of severely enlarged patients.

What is HoLEP (Holmium Laser Prostate Enucleation)?

Holmium Laser Prostate Surgery is a minimally invasive, i.e. closed surgery treatment method used to solve the problem of prostate enlargement. Urinary problems due to prostate enlargement, which seriously affects the lives of men, can also be treated without any incision.

Holmium Laser Enucleation of Prostate (HoLEP) is an endoscopic (minimally invasive) surgical method used in the treatment of men with urinary problems due to benign prostate enlargement of any degree (mild, moderate, and severe urinary complaints), urinary retention, i.e. the inability to urinate despite a full bladder, recurrent urinary tract infection due to prostate enlargement, or bleeding in the urine due to prostate enlargement. The most important gains of HoLEP that make it a preferred method for patients and physicians are the minimal risk of bleeding after the procedure and a much faster recovery with a shorter hospitalization period.  In addition, the HoLEP method does not melt the adenoma tissue (prostate tissue that grows and obstructs the urinary tract) as in some other lasers but removes it completely.

How Does HoLEP Work?

The place of holmium laser technology, which is widely used in urological surgery, in the HoLEP method is based on the principle of removing the prostate tissue that prevents urine flow completely from the inside of the prostate.

HoLEP Operation

• How to Prepare the Patient Before HoLEP Operation?

• Before surgery, the patient is evaluated in detail and a physical examination is performed to reveal the patient's condition.
• Urine and blood tests are performed.
• With the help of ultrasound, the enlargement of the prostate gland is clearly revealed.
• The patient is evaluated by an anesthesiologist before the HoLEP operation. The procedure is performed under general or epidural anesthesia, depending on the patient's condition.

• What To Do During HoLEP Operation?

• The patient lies on their back during the HoLEP operation.
• First, a special endoscopic instrument is inserted into the lower urinary tract. A preliminary assessment is made by looking at the entire lower urinary tract and bladder.
• Using a laser, the enlarged prostate lobes (adenomas) are incised and enucleated bloodlessly. Enucleation means that the enlarged prostate lobe is removed from the prostate capsule in one large piece using a laser. The prostate lobes, which are separated from the prostate in one piece, are taken into the bladder.
• The working element of the laser is removed and the large prostate lobes in the bladder are sucked out of the bladder completely in small pieces with a special device called a morcellator.
• After the tissues in the bladder are completely removed, the operation is terminated by placing a foley catheter (catheter) into the bladder.

• What is the Process After HoLEP?

• After HoLEP surgery, the patient is taken to his room and is observed until the next day and catheterized.
• At the end of HoLEP surgery, after the anesthesia effect wears off, food and drink can be started to be given orally.
• In small prostates, the catheter can be withdrawn after 12 hours, but usually, waited for 24 hours and the catheter is withdrawn the next day. If the urine color is not clear enough, the catheter may be left in for one more day.
• In the early period after HoLEP surgery, there may be blood at the end of urine, urine may be slightly red, this condition improves by drinking plenty of water.

What is Prostate Enlargement?

Benign prostatic hypertrophy, or "Benign Prostatic Hypertrophy - (BPH)" as it is called in the medical literature, is a major health problem affecting many men over the age of 50. The term "benign" means innocent. This refers to whether the enlargement is due to prostate cancer. The most common symptom of benign prostate enlargement is difficulty urinating. This complaint tends to increase with age. The symptoms of an enlarged prostate can be treated with medication or surgery.

• Why Does Prostate Enlargement Occur?

There is more than one reason for benign prostate enlargement. The main reason is the excessive response of the prostate to the male hormone. The second factor is genetic predisposition. People with a family history of prostate enlargement are 4 times more likely to have this problem than normal. Environmental factors are also important.

• What Problems Does Prostate Enlargement Cause?

As the prostate grows, it presses on and squeezes the urethra (the lower urinary tract after the bladder). The bladder wall thickens. In untreated benign prostate enlargement, urination problems persist. In later stages, recurrent urinary tract infections, bleeding in the urine, kidney dysfunction, and bladder stones may also develop. 

Prostate Enlargement Treatment

In mild and moderate cases of benign prostate enlargement, medication can be used in the first stage. Those with advanced problems often do not benefit sufficiently from medication. In these cases, surgical treatment should come to mind first. In addition, if the function of the kidneys has started to deteriorate, there is a potential for prostate-induced kidney disease, recurrent infections, bleeding in the urinary tract, stones in the bladder, or small pockets called diverticula, direct surgical intervention should be performed instead of drug treatment.

HoLEP Surgery | Frequently Asked Questions

• Which Diseases Are Treated with HoLEP?

HoLEP is a method independent of prostate size. Therefore, it can be performed in both large and small prostate sizes. All patients who are considering surgery for prostate disease can be considered suitable candidates for HoLEP.

• When Can I Be Discharged After HoLEP Surgery?

In the HoLEP method, which can be safely used in the treatment of prostate enlargement of all sizes, the surgery is performed by entering the urinary canal with an endoscope. Since no incision is made, the patient can return to daily life very quickly.

• How is HoLEP Different from Other Closed Surgeries?

Open surgical intervention in prostate treatment is almost completely abandoned today. It is generally not practiced except in limited cases.
In closed surgical interventions such as classical TUR, plasmakinetic TUR and greenlight laser methods, residual tissue is left behind due to incomplete removal of the adenoma and the patient may not be able to urinate completely. The residual tissue may grow over time and cause bleeding and urination problems to recur. However, since all the tissue is removed in the HoLEP method, there is no risk of recurrence of the disease.

• Is Urinary Incontinence a Concern After HoLEP Surgery?

After the operation, the urine color is clear, sometimes if there is a slight discoloration in the urine, continuous washing from the catheter can be performed. The catheter inserted after the operation can be withdrawn after 12 to 24 hours. After the catheter is removed, the patient is discharged if he urinates 2-3 times comfortably. Since the structure called the sphincter, which provides urinary retention, remains outside the area intervened with HoLEP surgery, problems such as urinary incontinence are not experienced after the procedure.

• Does HoLEP Surgery Affect Sexual Life?

The depth of tissue affected by the laser energy used in HoLEP surgery is very small. Therefore, it does not affect the nerves that run outside the prostate and provides erection (hardening). Therefore, there are no problems such as sexual dysfunction after the procedure.

• Is There a Risk of Recurrence of Postoperative Prostate Enlargement?

There is no risk of recurrence of the disease as all of the prostate tissue except the capsule is removed.

• Is There an Age Limit for HoLEP?

There is no age limit for HoLEP used in patients with benign prostate enlargement.