Holmium Laser Enucleation of the Prostate or HoLEP is a form of laser used to remove blocking tissue from the prostate gland in patients with prostatic symptoms. It is used when medications have not been effective, or are causing side effects. It can be used as the first treatment in patients with severe symptoms, or those in retention of urine.
HoLEP has been used for over 15 years worldwide, and over 10 years in the United Kingdom. It is a NICE approved treatment. This article aims to answer some of the common questions patients ask regarding the treatment, and the clinical experience of users around the world.
Male patients with lower urinary tract symptoms. This includes a slow stream, dribbling on the trousers after passing urine, having to wait for the urine to come out, and also to agree a degree, those who get up at night to pass urine and those going frequently and urgently during the day. Your urologist will make the final determination as to whether you are a candidate.
The laser is used as a ‘laser scalpel’ to cut out from within the blocking prostatic tissue. This is dropped into the bladder, and these pieces are chopped up and removed. A catheter is placed overnight. Most of the prostatic tissue is removed and it is an extremely efficient way of removing blockages. All patients having surgery on the prostate gland may have up to 6 weeks’ worth of bladder symptoms afterwards, but as they settle, initial symptoms are usually found to be a lot better.
The procedure is called enucleation because, unlike other laser techniques which burn the prostate tissue away, the laser is used like a knife, cutting out the tissue via the water pipe. There are no cuts in the skin and because of the way it works, there is little problem with bleeding. Unlike the old TURP operation, Patients usually go home same day or the next day. The rate of problems with erections after this operation is extremely low.
There is evidence to suggest that the procedure will last as long as an open operation with good results, still, at 15 years.
The evidence is that the operation is as effective as open operating at 15 years, and this true in all prostate sizes. There is a low rate (1%) of a scar in the waterpipe, which is the commonest further operation needed. In a proportion of patients the bladder can slowly fail to squeeze as well as one gets older, and so bladder function testing (Urodynamics) would be offered to check this if symptoms came back.
If the effects wear off, the commonest but still rare issue is a stricture. Your urologist will reassess the water pipe and sort out the problem. Occasionally, regrowth of the prostate gland can get in the way and need further treatment. Alternative treatments include medication, open surgery and some of the newer techniques to either staple or stem treat the prostate gland. HoLEP is the only treatment licensed approved by NICE for prostates which are over 100ml.
If you are taking tamsulosin you will be able to stop this. You can stop finasteride or dutasteride if you wish, but it may prevent further problems which your urologist will discuss with you.
Mr Chris Blick
Mr Chris Blick is a Consultant Urological Surgeon who has a subspeciality interest in urological cancers, particularly laparoscopic and robotic renal and bladder surgeryRead more
Mr Philip Charlesworth
Mr Philip Charlesworth is a Consultant Urologist at Berkshire Independent Hospital in ReadingRead more
Mr Steve Foley
Mr Steve Foley is a Consultant Urologist at Berkshire Independent Hospital in ReadingRead more
Mr Paul Hadway
Mr Paul Hadway is a Consultant Urological Surgeon in Berkshire, Reading who specialises in urological conditionsRead more
Mr Adam Jones
Mr Adam Jones is a Consultant Urologist in Berkshire, Reading who specialises in laparoscopic and robotic surgery for benign and malignant urology conditionsRead more
Mr Sunil Kumar
Mr Sunil Kumar is a Consultant Urological Surgeon at Berkshire Independent Hospital in Berkshire who specialises in urological conditionsRead more
Miss Johanna Thomas
Miss Johanna Thomas Consultant is a Consultant Urologist at Berkshire Independent Hospital in ReadingRead more
Mr Shafi Wardak
Mr Shafi Wardak is a Consultant Urological Surgeon in ReadingRead more
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