Holmium Laser Enucleation of the Prostate
One thing that most men can anticipate as they get older is to have issues with an enlarged prostate gland. Benign prostatic hyperplasia (BPH) is the clinical term for an enlarged prostate. BPH causes many uncomfortable or irritating symptoms involving the male urinary system, such as decreased urine flow and frequent need to urinate.
Dr. Shridharani uses a form of laser surgery known as holmium laser enucleation of the prostate to treat BPH. Here’s some more information on this helpful treatment.
What is holmium laser enucleation of the prostate?
An enlarged prostate is a common condition of aging men. The prostate grows and it begins to push on the urethra. This decreases the urine flow, leading to frequent need to urinate, inability to urinate, difficulty in starting urination, or loss of bladder control. This is not prostate cancer; it is simply an enlarged prostate, BPH.
Surgery has been used to help with this problem, options such as laser vaporization and transurethral resection of the prostate. But in the mid-1990s holmium laser enucleation of the prostate (HoLEP) was developed. In these procedures, laser energy is used to cut and remove the enlarged areas of the prostate.
How does HoLEP work?
The holmium laser used by Dr. Shridharani is a surgical laser. Over the past 20+ years, this laser has shown itself to be very effective when used for urological surgery. In this particular procedure, HoLEP, the laser energy simply cuts away the prostate tissue that is pushing on the urethra and blocking the flow of urine.
Who is a good candidate for the HoLEP procedure?
You probably know if you’re a good candidate for the HoLEP procedure. You’re having difficulty passing urine. BPH occurs in over 40 percent of men over the age of 60. Symptoms usually worsen with age. There are some options for treating BPH without surgery, but when those treatments aren’t effective, surgery is usually necessary to avoid problems with urine retention and bladder stones. If you have an enlarged prostate that is pressing on your urethra, odds are you’re a good candidate for HoLEP.
Certain patients may not be eligible for HoLEP:
- Patients with bleeding problems
- If the patient has had certain types of prior prostate treatments
- If the patient cannot lie on his back with the legs raised (the position required for HoLEP)
What happens during the HoLEP procedure?
Patients are placed under general anesthesia for these procedures. The patient is placed on his back with his legs raised during the procedure. A surgical instrument called a resectoscope is inserted through the urethra. This instrument has a camera that allows Dr. Shridharani to view the internal structure of the prostate gland. This allows him to see and plan the incision locations.
Next, the laser is inserted into the resectoscope. The laser energy is then used to “enucleate” the enlarged prostate tissue. The laser vaporizes the incision line, instantly sealing the blood vessels. Tissue that is removed goes into the bladder.
The laser is then removed from the resectoscope and is replaced by a morcellator. This device suctions away the tissue that was deposited in the bladder.
When this is complete, the resectoscope is removed and a urinary catheter is put in place.
How is HOLEP different than laser ablation?
Laser ablation fully vaporizes the tissue. It is useful for small areas that need to be removed. But when the prostate has a larger amount of tissue pressing on the urethra, it’s not realistic to be able to ablate all of it. That’s where the holmium laser can simply cut it away.
What is recovery like after HoLEP treatment?
After your HoLEP treatment, you’ll be admitted to the hospital overnight for observation and catheter care. Some bleeding from the prostate is to be expected, but this clears in 12 hours for most patients. Fluid will be flushed through the catheter to clear blood from the urine after your surgery.
The morning after your surgery, the catheter is removed. If you are able to urinate well at least two to three times, you are cleared to go home without the catheter. If you are unable to urinate, the catheter is replaced and it will stay in for one week.
It is normal for it to be painful when urinating at first. You’ll also need to urinate more frequently. In a few days, these issues should improve. You’re encouraged to drink plenty of fluids once the catheter is removed; this helps clear the urine of blood.
It can take several months for symptoms such as frequency, urgency, and waking at night to urinate to permanently improve. This is because the bladder must adjust to the removal of the prostate tissue and muscle control in the pelvic area can be weakened by the surgery.
What are the Side Effects with HoLEP?
The side effects are these:
- Temporary burning and bleeding during urination — Blood may be in your urine for weeks.
- Urinary incontinence — All patients should expect this immediately after surgery. They should plan on wearing pads for a period of days or possibly weeks.
- Backwards ejaculation — In three quarters of patients, they will not see any fluid during ejaculation during sexual activity after surgery.
What Are the Risks with HoLEP?
- Injury to the urethra or development of scar tissue
- Injury to the bladder or ureteral orifices
- Bladder, testes, or kidney infection
- Return of urinary obstruction
- Need for transfusion due to bleeding
- Failure to relieve all symptoms
- Need for prolonged catheterization
- “Dr Shridharani performed the HoLEP Procedure on me April of 2018. I was treated with nothing but respect and given answers to all my questions. I have had no problems and two weeks after the surgery I am doing fanstastic. I would recommend Dr. Shridharani for this procedure wirh a high level of confidence. My after surgery results were very postive and more than expected. Thank you so much Dr. Shridharani for an excellent job well done.” – Bill C.
- “I needed prostate surgery. I’ve been shown genuine concern for my well-being before, during, and still after the surgery. A special group of professionals in this clinic.“- Steve W.