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Holmium Laser Enucleation of the Prostate (HoLEP)

Urology

Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive surgery used to treat obstructive benign prostatic hyperplasia (BPH), resulting in moderate to severe lower urinary tract symptoms. This procedure utilizes a holmium laser to remove enlarged prostate tissue precisely and is performed through the urethra, eliminating the need for external incisions. Its short- to medium-term efficacy is comparable to open resection surgery but with higher safety.

Technology

Holmium Laser Enucleation of the Prostate (HoLEP) utilizes a holmium laser (Ho: YAG) with a wavelength of 2,140 nanometers. This pulsed solid-state laser is absorbed by water and water-containing tissues. This laser's tissue coagulation necrosis depth is 3-4 millimetres, effectively controlling bleeding. Through surgery, it can alleviate urethral obstruction and lower urinary tract symptoms caused by benign prostatic hyperplasia.

Procedure

Here are the steps of the HoLEP surgery:

Anaesthesia: Patients typically receive general anaesthesia or spinal anaesthesia.
Instrumentation insertion: The surgery employs a ureteroscope inserted into the patient's body through the urethra.
Laser application: The holmium laser emitter is introduced into the bladder and aimed at the prostate. The laser emits a high-energy beam, precisely removing the overgrown prostate tissue.
Tissue removal: The laser vaporizes and removes the prostate tissue while simultaneously coagulating the surrounding small blood vessels, effectively controlling bleeding during the procedure.
Tissue fragmentation: The excised prostate tissue is fragmented into small pieces and then expelled through the urethra. It typically requires the use of a specialized instrument called a morcellator.
Examination and cleaning: After the prostate tissue is completely removed, the surgeon examines the surgical area to ensure there is no residual tissue or excessive bleeding. Additional laser treatment may be performed if necessary to provide adequate hemostasis.
Placement of a catheter: Following the surgery, a catheter is usually temporarily placed to facilitate urine flow and promote healing of the treatment area.
Recovery: HoLEP surgery typically requires a brief hospital stay for recovery. The catheter is removed after a few days, and patients can return home for rest following evaluation by their doctor.

Advantages

As an advanced minimally invasive surgery, Holmium Laser Enucleation of the Prostate (HoLEP) offers several significant advantages:

Efficient tissue removal: HoLEP can wholly and accurately remove prostate hyperplasia tissue, even in cases of very large prostates.
Minimal bleeding: The holmium laser can coagulate blood vessels cut during surgery, significantly reducing intraoperative bleeding and enhancing surgical safety.
Quick recovery: Due to the small surgical incision, patients typically experience shorter recovery times than traditional surgery, with many returning to normal activities shortly after surgery.
Low recurrence rate: HoLEP has a lower symptom recurrence rate than other prostate reduction surgeries, providing long-term efficacy.
Suitable for all sizes of the prostate: Unlike some procedures that are only suitable for specific prostate sizes, HoLEP can effectively treat prostates of various sizes. Reduced impact on sexual function: HoLEP surgery carries a lower risk of sexual dysfunction, particularly issues related to ejaculation.
Short hospital stay: Due to rapid postoperative recovery, most patients can be discharged within one to two days after surgery. Suitable for high-risk patients: For patients with cardiovascular disease or other health issues, HoLEP is an ideal surgical option due to its low bleeding risk and high safety.

In summary, HoLEP surgery provides a treatment option with good efficacy and low risk and has a minimal impact on overall recovery and quality of life for patients.