What is HoLEP? Prostate Surgery with the HoLEP Method

  1. What is HoLEP (Prostate Enucleation with Holmium Laser)

It is a surgical method in which advanced laser technology is used in the treatment of benign prostate enlargement (BPH). It is a closed procedure that can clean and remove all of the prostate tissue.

  1. How is HoLEP Surgery Performed?

It is performed under general anesthesia or by numbing the waist down. It is entered through the urinary canal with special instruments with cameras. The enlarged prostate tissue is carefully separated from the capsule by laser and thrown into the bladder. The prostate tissue thrown into the bladder is broken up with another device (morcellator) and vacuumed and taken out of the body. Afterwards, the probe is inserted and the process is terminated. The removed prostate tissue is sent to pathology to investigate the possible presence of cancer.

  1. How many days is the hospital stay after HoLEP?

Generally, we remove the catheter and discharge the patient the day after the surgery. However, we monitor our elderly patients with additional diseases for 1 more day and discharge them without any problems.

  1. Does HoLEP surgery harm sexuality?

Nerves that pass around the prostate and provide erection in men may be adversely affected during surgery. When compared in terms of energy used, HoLEP has been shown to act on the prostate capsule to a depth of only 0.4 mm. In other words, the energy used to separate the prostate tissue does not damage the nerves that provide hardening. The electrical energy used in TUR-P surgery can be spread to a depth of 4 mm. In terms of sexual functions, HoLEP and other TURP/ How to prepare for HoLEP?

After prostate examination, urine flow rate test, ultrasonography, urinalysis, blood test (PSA), suitable patients are treated.

  1. Will there be bleeding in the HoLEP surgery?

Prostate tissue is an organ with a lot of blood, and usually the operation is bloody. Usually, before open and TUR operations, blood preparation is made against the risk of bleeding and blood transfusion is given to the patient when necessary.

Will there be urinary incontinence after the surgery?

Urinary incontinence is rarely seen in some patients after prostate surgery. The main reason for this is damage to the valves that hold the urine. Since the laser used in HOLEP surgery acts at a depth of 0.4 mm, it has little effect on these structures. Urinary incontinence usually does not occur if HoLEP surgery is performed carefully. However, in some patients in whom large prostate tissue is removed, the temporary urinary incontinence seen at first improves over time.

  1. What awaits patients after surgery?

Changes in urine color are seen in patients discharged after catheter removal. There may be minor bleeding at the beginning and end of urination. This situation is mostly temporary. Burning and pain during urination, although very rare in the HoLEP method, are among the complaints we encounter. It is usually temporary and is common in the first weeks. As we mentioned above, since the prostate is completely removed, some patients may experience dripping and inability to control urination, especially in the first weeks. Generally, we see it more frequently in patients who have long-term catheterization, who are immobile, who have neurological disease or diabetes. Patients with ongoing complaints are started on exercise and drug therapy for this. In some patients who remain on the probe for a long time and whose immune system is weakened, there may be a little inflammation. We can minimize this risk with prior urine culture and treatment.

  1. When to return to normal life?

Our patients can return to their normal lives 2-3 months after the operation. They can do non-heavy physical exercises. It is recommended to take plenty of fiber foods as a diet and not to be constipated. We recommend that they stay away from acidic drinks and spicy foods, especially in the first month. Sexual intercourse is not recommended for the first 4-6 weeks after surgery. Bleeding in the urine and semen may occur after the first intercourse. In most cases, semen flows back into the bladder and is then excreted in the urine. It is not harmful to health.

  1. Is the prostate enlarged again after HoLEP or is surgery required in the following years?

Since the prostate tissue is completely separated and removed from the capsule by laser, no fragments are left behind. Since there is no prostate tissue left behind, patients do not need surgery again.

  1. Is prostate tissue removed after HoLEP examined by pathology?

Prostate tissue removed in HoLEP surgery is placed in necessary containers and sent to the laboratory for pathological examination. In general, since patients are evaluated in detail for cancer before surgery, no bad results come from the pathology. However, if there is a contrary result, additional treatment is applied accordingly.

  1. Can prostate cancer develop after HOLEP?

In all benign prostate surgeries; Only the inner part of the prostate that grows and presses on the urinary canal is removed. The outer part of the prostate, which we call the capsule, remains, and unfortunately, cancer may develop from this part in the future. There is a possibility of developing prostate cancer with increasing age in patients who are evaluated for prostate cancer before surgery and cancer cannot be detected. Therefore, even after HoLEP, patients deemed necessary in terms of cancer risk should be followed up.

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