Have you been diagnosed with benign prostatic hyperplasia (BPH)? Are you looking for treatment options? If so, HoLEP (Holmium Laser Enucleation of the Prostate) surgery may be the solution for you. Kelli Gross, MD, a urologist at University of Utah Health, can help you make the best choice among treatment options based on your diagnosis, health history, and symptoms.
What is HoLEP?
During HoLEP surgery, a urologist targets and removes enlarged prostate tissues without making an incision to relieve pressure and eliminate or reduce symptoms of BPH.
Common symptoms of an enlarged prostate include:
- An urgent or frequent need to urinate,
- Difficulty starting to urinate,
- A weak urine stream resulting in frequent stopping and starting during urination,
- Increased urination at night that disrupts sleep,
- Inability to empty the bladder,
- Small amounts of blood in urine, or
- Urinary retention resulting in the inability to urinate at all.
What are the benefits of HoLEP?
According to Dr. Gross, HoLEP has one of the lowest retreatment rates, and its highest long-term success rate is tied with simple prostatectomy. Patients also can benefit from the removal of a large amount of tissue with a reduced risk of bleeding and a decrease in the need for blood transfusions during surgery. The tissue that the surgeon extracts can be used for post-surgical examination for cancer by a pathologist.
What are the risks of HoLEP?
HoLEP has a low rate of complications; your urologist will discuss the following issues with you before surgery.
- Incontinence—You may experience short-term incontinence for a few weeks or months. "Long-term incontinence can be an issue in 1-4% of men and can be a higher risk in men with larger prostate size, preoperative incontinence or severe urgency, neurologic disease, and a long-term indwelling catheter," Dr. Gross says. "It is similar to the rates of long-term incontinence with a simple prostatectomy."
- Retrograde ejaculation—If you experience this condition, also known as "dry orgasm," semen will go into your bladder during sexual climax instead of through your penis.
- Anejaculation—A condition where you have no semen ejaculation during sexual climax.
- Temporary burning or bleeding during urination for a few weeks or months after surgery is normal and is an indication that your body is still healing.
- Urinary tract infection (UTI).
- Damage to the bladder or ureteral orifice.
- Prolonged need for a catheter after surgery.
- Scar tissue around the surgery.
- "Failure of the procedure to help with symptoms," Dr. Gross says.
What happens after HoLEP surgery?
You will probably go home after a few hours of monitoring. If you are at higher risk for complications, you may need to stay for one night or more. Your surgeon may place a catheter temporarily in your bladder to drain urine.
For the first few days after you leave the hospital, you will need to be attentive if your catheter is not draining. This could be a sign of a blood clot in the bladder. Also, be aware that although blood in the urine is normal, the volume of blood should generally become less over time.
For a smoother recovery:
- Drink plenty of fluids.
- Rest for one to two weeks.
- Avoid heavy lifting or strenuous physical activity for two to three weeks, or longer if instructed by your doctor.
- "Slowly ramp up activity in the weeks after surgery as long as urine is clear," Dr. Gross says. And "do Kegel exercises."
"People typically notice an improvement in [urine] flow immediately," Dr. Gross concludes. "The first few months can take a while for things like burning with urination, incontinence, and urgency to resolve, though some people notice results quicker."
She recommends HoLEP for patients with very large prostates who aren't good candidates for other minimally invasive surgeries to resolve their BPH symptoms.