HoLEP enables endoscopic resection of the prostate through the urethra, even for prostates over 80 cubic centimeters in size.

This prostate-removal method replaces invasive surgery that requires an incision in the lower abdomen, and offers a variety of advantages, including relatively quick and easy recovery and next-day discharge without a catheter.

 

About HoLEP surgery

Holmium laser enucleation of the prostate is an innovative prostatectomy procedure in which the surgeon removes the enlarged prostate endoscopically (inserting an endoscope – a long, thin tube – into the body). The surgeon inserts the endoscope, which contains optical fiber, through the urethra, and uses a laser to excise any size prostate.

This method has many advantages, making it the European standard for removal of prostates over 80 cubic centimeters. The procedure greatly shortens surgery recovery time, and patients can be discharged home the day after surgery without a catheter. The degree of bleeding in surgery is considered low for this minimally invasive procedure.

HOLEP surgery has two main stages:

  1. The surgeon uses the laser to cut out the tissue and a morcellator to cut up and remove the large tissue masses. The small pieces are pulled out of the body and sent for microscopic examination by a pathologist.
  2. The surgeon positions a catheter in the bladder to flush blood clots from the surgical area.

HoLEP is an alternative to open surgery, which requires a large incision in the abdomen and other risks.

For whom is HoLEP surgery suitable?

Men who need prostate surgery due to benign enlargement of the prostate are good candidates for HoLEP, especially as a less invasive alternative to open surgery.

To date, there have been various solutions for treating an enlarged prostate, especially in cases of small or medium enlargement, from medication and surgical solutions such as transurethral resection of the prostate (TURP). But, for highly enlarged prostates, surgeons would refer patients for invasive open surgery, conducted by opening the abdomen.

Benign prostatic hyperplasia (BPH) is most common in men over the age of 60. Not every case of an enlarged prostate requires surgical intervention. Only when men experience dysfunction, such as urinary problems, infections, bleeding, or kidney failure, will doctors recommend resection of the enlarged prostate.

 

Advantages of the surgery

  • Prevents the need to open up the abdomen using invasive surgery
  • Reduces blood loss
  • Minimizes the hospital stay – usually limited to only one night
  • Quickens recovery and the return to routine
  • Eliminates the need for a catheter upon discharge home

What is important to know before surgery?

As with any surgery related to anesthesia, patients need to prepare to undergo the procedure successfully. These preparations include fasting for several hours, stopping or changing blood-thinning medication, etc. Patients should consult their surgeon and/or anesthesiologist during the pre-surgery appointment to receive specific instructions for surgery.

Recovery and rehabilitation

One of the biggest benefits of HoLEP surgery is the relatively quick recovery. In most cases, the patient is discharged home the day after surgery, after the catheter has been removed. Getting back to routine is also considered quick, but in the days immediately following surgery, patients may experience pain, discomfort, bleeding or burning along the urethra. However, patients should have no problems with urination or sexual intercourse.

What are the potential risks?

HoLEP surgery involves risks; this is not different from other medical procedures. The Lev Naot surgeon will explain the risks in detail, which can be, even if unlikely: bleeding that will sometimes require surgery, urinary tract or testicular infection, urinary incontinence during varying degrees of exertion, complete incontinence (very rare), perforation of the bladder that may require surgery, or loss of erectile function.

Possible late complications include narrowing of the bladder neck or urethra that requires surgery or expansion to correct the narrowing.

The surgery does not treat or prevent the development of prostate cancer, so if prostate cancer is discovered, further treatment may be required. Usually, after undergoing this surgery, men no longer ejaculate during orgasm, but this does not affect the man’s feeling or satisfaction in most cases.