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Laser Prostate Surgery (HoLEP)

Holmium laser enucleation of the prostate (HoLEP) is a type of laser surgery used to treat obstruction (blockage) of urine flow as a result of benign prostatic hyperplasia (BPH). In men with BPH, the prostate gland is not cancerous but has become enlarged. An enlarged prostate can result in a number of urinary tract symptoms such as frequent urination, inability to urinate, difficulty in starting urination, or loss of bladder control.

HoLEP was developed in the 1990s as a more effective and potentially less costly surgery for urinary obstruction due to BPH, as compared to other surgical options such as laser vaporization and transurethral resection of the prostate.

 

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What are the advantages of holmium laser enucleation of the prostate (HoLEP)?

Use of HoLEP in many different parts of the world has shown it to be a safe and effective procedure. Although there are many types of BPH surgeries available, HoLEP offers a unique advantage in being able to remove a large amount of tissue without any incisions on the body, even in very large prostates, while decreasing the risk of bleeding and providing tissue for pathology (to look for cancer). This decreases the need for blood transfusions during surgery, minimizes the time of stay in the hospital to one or two days, and reduces the risk of needing repeat treatment.

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What are the risks or potential complications of holmium laser enucleation of the prostate (HoLEP)?

  • Injury to the urethra or development of scar tissue at a later date.
  • Injury to the capsule of the prostate (typically treated with longer catheterization).
  • Injury to the bladder or ureteral orifices (where urine from the kidneys  drains out).
  • Infection of the bladder, testes or kidneys.
  • Return of urinary obstruction at a later date requiring another operation  (1 to 2 percent).
  • Need for transfusion or reoperation due to bleeding.
  • Failure to relieve all symptoms and/or need for prolonged  catheterization after surgery.
  • Five to 15 percent of patients are found to have previously  undiagnosed prostate cancer in their prostate specimen. Prostate cancer  can be treated after HoLEP.
  • Standard risks of anesthesia including blood clots, heart attacks, etc.
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Who needs to have holmium laser enucleation of the prostate (HoLEP)?

BPH occurs in more than 40 percent of men over the age of 60 and is a leading cause of urination symptoms, including difficulty in passing urine. As men age, the symptoms of this condition can worsen. Although many cases of urinary obstruction from BPH can be treated without surgery, patients who do not benefit from such medical treatments may eventually need surgery to avoid or deal with long-term problems such as retention of urine, urinary tract infections, and bladder stones. Patients who are appropriate for HoLEP are typically symptomatic due to very large prostates.

Patients may not be candidates for HoLEP if:

  • They have bleeding problems.
  • They have had certain types of prior prostate treatments.
  • They cannot lie on their back with their legs raised. This position is necessary for the procedure.

Source :- https://my.clevelandclinic.org/health/treatments/17917-holmium-laser-enucleation-of-the-prostate-holep

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