Holmium Laser Enucleation of the Prostate (HoLEP)

ABOUT HoLEP

What is HoLEP?

HoLEP is a minimally invasive operation to remove prostate tissue which is blocking the flow of urine from the bladder. It is also known as a “laser prostatectomy”.

Why is HoLEP required?

HoLEP is a surgical treatment for urinary symptoms which are due to enlargement of the prostate.

 

These symptoms may include:

• Waking through the night to urinate.
• Needing to pass urine frequently throughout the day.
• Having to pass urine urgently.
• Reduced urine flow.
• Difficulty starting urination.
• Stop-start flow.
• Dribbling after passing urine.
• A feeling of incomplete bladder emptying.

 

HoLEP is a good option for you if you have a large prostate (usually >80grams), and:

 

• You do not want to take or are unable to take medications for prostate enlargement (such as prazosin, tamsulosin, silodosin, dutasteride or finasteride); or
• Medications are no longer working; or
• You are catheter dependent due to urinary retention; or
• You have complications of your enlarged prostate including blood in the urine (haematuria), bladder stones, kidney failure or recurrent urinary tract infections; or
• You take blood thinning medication which makes other prostate surgery high risk. HoLEP is a treatment for benign prostate enlargement. It is not a treatment for prostate cancer.

 

Prostate Enlargement

Prostate enlargement, also called benign prostatic hyperplasia (BPH), is a non-cancerous growth of the prostate gland that commonly occurs in men as they age. The prostate surrounds the urethra, so when it enlarges, it can press against the urethra and block urine flow.
PATIENT JOURNEY

What does HoLEP involve?

HoLEP is performed under a general anaesthetic, through a telescope introduced into your bladder through your urethra.

 

There are no incisions involved in the procedure.

 

A laser is used to core out the obstructing part of the prostate (adenoma) leaving the outer zone of the prostate behind (much like coring out the flesh of an orange and leaving the outer rind behind).

 

A morcellator is then used to chew up the prostate tissue so it can be removed via the urethra. A tissue sample is sent to pathology to be tested for prostate cancer.

 

What does HoLEP involve?

A catheter will be left in your bladder at the end of the procedure with irrigating fluid to wash out any blood overnight.

 

The catheter is removed the day after surgery and you will have a “trial of void” which tests your ability to urinate

What is the recovery after HoLEP?

HoLEP usually requires a one-night stay in hospital.

 

You can return to sedentary work approximately 4-5 days after the operation.

 

You may have discomfort when urinating and blood in the urine intermittently for a couple of weeks after the procedure.

 

Some patients experience transient urinary incontinence (leakage of urine). This usually resolves within three months with pelvic floor muscle exercises. We strongly recommend seeing a pelvic floor physiotherapist to learn pelvic floor muscle exercises prior to your HoLEP and doing these exercises once your catheter has been removed.

 

Most men (>80%) will experience retrograde ejaculation (ejaculate going into the bladder during orgasm) after HoLEP. This means you will no longer be able to father children naturally.

What are the benefits of HoLEP?

HoLEP has some benefits over other surgical treatments for prostate enlargement.

 

These benefits include:

• HoLEP allows for the treatment of large prostates (>80 grams) through a minimally invasive technique, avoiding the need for incisions.
• The catheter is usually removed 1-2 days after the procedure, before you are discharged home (compared to 5-10 days with open or robotic procedures).
• The hospital stay after HoLEP is shorter than transurethral resection of the prostate (TURP) or simple prostatectomy (open or robotic).
• There is a lower risk of bleeding or blood transfusion compared to a TURP.
• The need for further treatment for prostate enlargement is very low (<4% at 10 years compared to 12-15% for TURP at 10 years).
• There is no risk of ‘TUR Syndrome’ which is an uncommon but serious complication associated with TURP.
• If you have stones in the bladder, these can be destroyed with the holmium laser at the same time as the HoLEP procedure.

OUR TEAM

The following doctors in our practice perform HoLEP:

Dr Anojan Navaratnam

Dr Anojan Navaratnam

Urologist

Book an appointment

Book an appointment to discuss this procedure with one of our doctors.