Holmium Laser Enucleation of the Prostate (HoLEP)

Indications

Standard indications for BPH treatment are similar for all of the treatments outlined.

Traditional absolute indications for surgical therapy include recurrent urinary retention, recurrent urinary tract infections, recurrent prostatic bleeding, bladder stones, renal failure secondary to bladder outlet restriction. Relative indications include intolerance of medications and poor quality of life secondary to lower urinary tract symptoms.

Patients who desire a less invasive alternative than open, simple prostatectomy may choose this option for very large glands, but this requires someone who is very proficient at this difficult to learn technique.

Testing

You made need the following tests prior to HoLEP:

• Cystoscopy
• Uroflow
• Prostate Ultrasound
• Urodynamics (Less common)
• Urinalysis

Procedure

Enucleative procedures. Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy.

With holmium laser enucleation of prostate (HoLEP), the surgeon places a resectoscope through the penis into the urethra. The laser vaporizes the prostate tissue.

After the Procedure

For most men, symptoms improve after treatment. Infection, bleeding, incontinence , and erectile dysfunction may occur after some treatments. In some cases, scar tissue may form. There may be complications after surgery. Some men need further or new treatment.

Results

In large published trials there was no need for transfusion and no TUR syndrome. 

At 2 years there were no significant differences in AUA symptom score, quality of life scores, peak flow rates, or complications. 

TURP had a longer catheterization times and hospital stays. 

Gilling PJ, Kennett KM, Fraundorfer MR. Holmium laser resection v transurethral resection of the prostate: results of a randomized trial with 2 years of follow-up. J Endourology. 2000;14, 757-760.

Complications

Side effects vary with the type of treatment you choose. Most side effects are temporary. It may take a while for sexual function to return fully. Most experts agree that if you were able to have an erection shortly before surgery, you will probably be able to after surgery. Most men find little or no difference in orgasm. They may have retrograde ejaculation. This is when semen enters the bladder rather than being sent out. For most men, side effects lessen with time. But there may be long term side effects for some men for some.