Surgical removal of benign prostate enlargement can basically be performed in three different ways. These are resection (removal by cutting), vaporization (vaporization) and enucleation (removal of the adenoma by stripping the adenoma from the capsule).
Different energy sources can be used in resection techniques, for example unipolar and plasmokinetic-bipolar TURP or HoLPR using laser energy. Vaporization can also be performed with laser or electrical energy (PVP). Enucleation, especially in large prostates (>80 g), is classically performed with an open surgical technique, but in recent years, it has been performed in a closed way using laser or bipolar electrical energy.
Holmium yttrium-aluminum-garnet (HoYAG) is a laser with a wavelength of 2140 nm. Both cutting, cauterization and vaporization can be performed with energy that can go down to a depth of 3-4 mm. It is usually applied using 2-2.5 J and 80-120 W laser energy with 20-50 Hz. During HoLEP, the prostate adenoma is entered from the penis with the help of an endoscopic device, the prostate adenoma is scraped from the capsule with a 550-mM laser probe and thrown into the bladder in 2-3 pieces, and the adenoma is separated into small pieces and taken out of the body with a device with fragmentation and vacuum feature called morcellator in the bladder. This surgery technique is called HoLEP.
What are the Advantages of the HoLEP Method?
Compared to other surgical techniques;
HoLEP is safer regardless of the size of the prostate, blood thinning therapy and history of previous TURP;
It is safer.
It is more effective.
The catheter is withdrawn in a shorter time
Shorter hospital stay.
It has fewer complications.
Requires fewer re-interventions.
In summary, HoLEP is at least as effective as TURP, open prostatectomy and other laser treatments, with fewer complications and shorter hospital stay. In the 21st century, it is becoming the gold standard treatment.
What are the results of HoLEP?
HoLEP is an operation that takes an average of 90 to 150 minutes depending on the size of the prostate. After HoLEP surgery performed by a specialist doctor, the patient stays in the hospital with a catheter for 1-2 days on average. Usually, the catheter is withdrawn on the 2nd day and the person is sent home.
HoLEP complications:
Bleeding requiring blood transfusion during HoLEP is much less common than open prostatectomy and TURP. HoLEP can also be safely performed in patients on blood thinners.
There is no inability to urinate after HoLEP (if bladder function is normal).
Since the prostate is completely removed, people may experience dripping or inability to control urine, especially in the first weeks. This situation varies from person to person. It is more common in people who are catheterized for a long time, do not move, have neurological diseases or diabetes. Pelvic floor exercises are especially recommended to prevent these complaints. In some patients, drug treatments can be started if the complaints do not go away.
Urinary tract infection, urethral stricture and bladder neck contracture were found to be 0.7%, 2% and 1.1%, respectively, compared to TURP. Urethral or bladder neck stricture is more common in < 50 g prostates, in patients with long preoperative catheterization and in patients with long operation time.
The most feared complication is the risk of bladder perforation during the morcellation procedure. It has become quite rare with the improved technique.
Regardless of the size of the prostate, the urination rate increases, less residual urine remains after voiding and the urination quality score improves. For 6 to 12 weeks, mild urinary burning and frequent urination may be observed. Results remain similar after 5-10 years.
In the HoLEP method, holmium laser energy penetrates the prostate capsule to a depth of 0.4 mm. In other words, the energy used to separate the prostate tissue does not damage the nerves that provide hardening.
The person can return to normal life approximately 1-2 weeks after the procedure. If they have a physically heavy work tempo, they should return to work life after at least 2 weeks. In addition, they can do physical exercises that are not heavy. They should also consume plenty of fiber foods as a diet. Especially for the first 1 month, they should avoid acidic drinks, hot or spicy foods.