Holmium Laser Enucleation of the Prostate (HOLEP) is a minimally invasive surgical procedure designed to treat an enlarged prostate, known as benign prostatic hyperplasia (BPH). This technique uses advanced laser technology to remove excess prostate tissue that blocks the flow of urine. HOLEP creates a wide channel for urine to pass, offering a durable and effective solution for bothersome urinary symptoms. The procedure is performed entirely through the urethra, requiring no external incisions.
The Mechanism of HOLEP
The HOLEP procedure begins after the patient is under general anesthesia. A surgeon inserts a thin, lighted tube called a resectoscope through the urethra to reach the prostate gland. A specialized Holmium:YAG laser fiber is then passed through this scope. This laser is used to meticulously separate the enlarged inner portion of the prostate gland from its outer shell, known as the surgical capsule.
This separation process is called enucleation. The laser’s energy cuts the tissue and simultaneously seals the blood vessels, which helps to minimize blood loss during the procedure. Once the obstructive tissue is fully detached, it is pushed entirely into the bladder in large pieces.
The surgeon then removes the resectoscope and inserts a second instrument called a morcellator. This device is designed to suction the large pieces of prostate tissue into its tip, where rotating blades cut the tissue into smaller fragments. These small pieces are then suctioned out of the body through the urethra, and the removed tissue is sent for pathological analysis.
Who is a Candidate for HOLEP
HOLEP is a highly effective treatment for patients suffering from BPH that has not responded adequately to medication. It is particularly well-suited for patients with a large prostate gland, as the procedure can remove tissue of virtually any size, offering a significant advantage over some other minimally invasive options. HOLEP’s complete enucleation technique makes it size-independent, unlike other procedures limited to smaller prostates.
A major benefit of HOLEP is its suitability for patients who must continue taking antiplatelet or anticoagulant medications, such as blood thinners. Because the Holmium laser is highly effective at sealing blood vessels, the risk of significant bleeding is lower compared to some traditional prostate surgeries. This capability allows patients with cardiovascular issues to safely undergo the procedure without having to stop medications that prevent serious events like stroke or heart attack.
Preparation and Recovery
Preparation for a HOLEP procedure involves steps to ensure patient safety and optimal outcomes. Patients will typically undergo pre-operative lab work, including blood tests and a urine culture, and their medical history will be reviewed to assess any pre-existing conditions. It is important to follow the surgeon’s instructions regarding fasting and the temporary adjustment or cessation of certain medications in the days leading up to the surgery.
Following the procedure, a urinary catheter is placed to drain the bladder and reduce swelling. This catheter usually remains in place for a brief period, often being removed within 24 to 48 hours. The hospital stay for most patients is short, with many being discharged the day after the procedure.
During the initial recovery phase, patients may notice temporary urinary symptoms, including urgency, frequency, or a mild burning sensation during urination. It is common to see blood in the urine, which is expected as the treated area heals, and this symptom can come and go for up to six weeks. Most patients can resume light activities within one to two weeks and experience substantial improvement in urinary flow within the first month. Full recovery, with the resolution of all temporary irritative symptoms, typically occurs within two to three months.