If BPH is your diagnosis, HoLEP may be your ideal treatment option.
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.
What is HoLEP?
HoLEP is a minimally invasive treatment for an enlarged prostate. Holmium laser is used to remove prostate tissue that is blocking urine flow through the urinary pathway or urethra, a condition known as benign prostatic hyperplasia (BPH). The prostate tissue is then cut into easily removable fragments and sent for examination.
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 starting and stopping during urination
- Increased urination at night that disrupts sleep
- Inability to empty the bladder
- Urinary retention resulting in the inability to urinate at all
HoLEP animation
What are the benefits of HoLEP?
HoLEP is similar to open prostate surgery (simple prostatectomy) but requires no incisions. It can be an option for men with a very enlarged prostate.
HoLEP removes the entire portion of the prostate that can block urine flow and it has one of the lowest retreatment rates among all BPH treatments. Patients also can benefit from the removal of a large amount of tissue with a reduced risk of bleeding and a decreased need for blood transfusions during surgery. HoLEP is also one of the few procedures recommended for patients on blood thinning medications. The tissue that the surgeon extracts can be examined in the laboratory for other conditions, including prostate cancer.
As with other types of prostate laser surgery, HoLEP can offer faster recovery and symptom relief compared with traditional prostate surgery such as transurethral resection of prostate (TURP). It is also one of the most effective treatment for men with urinary retention.
HoLEP May Be Your Ideal Treatment Option
Minimally invasive
prostate surgery
Reduced risk
of bleeding
Shorter
hospitalisation
Lowest chance of
recurrence requiring
further surgery
Patients on blood
thinners can be
operated on safely
Any size or shape
of prostate can be
operated on safely
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 (either urge or stress) for a few weeks or months. Long term incontinence is rare
- 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.
- 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 urethra
- Scar tissue around the surgery
- Failure for resolution of all urinary symptoms
Alternative treatment options
While there are a growing number of options for the management of BPH, all of the procedures have a similar goal: to open up the urethra and the affected area of the prostate to enable men to empty their bladders more completely. “But each method achieves it differently and may work better or worse in certain circumstances, and each one comes with its own set of potential side effects and risks, including urinary and sexual function risks.”
This chart highlights several newer treatments and their potential benefits and possible side effects. We will endeavour to tailor treatment plans to the patients’ goals, needs and concerns.
| Burgeoning Options for BPH Treatment | Urolift | Rezum | Greenlight PVP | HoLEP | TURP | Simple Prostatectomy |
|---|---|---|---|---|---|---|
| Small Prostate | ||||||
| Large Prostate | ||||||
| Median Lobe | ||||||
| Anticoagulation | ||||||
| Ejaculation | ||||||
| Blood Transfusion | ||||||
| Dysuria | ||||||
| Durability | ||||||
| Pathology available |
HoLEP Procedure
This operation involves the removal of obstructing prostate tissue using a laser, followed by temporary insertion of a catheter to help the bladder drain normally. The procedure is usually carried out under a general anaesthetic (you are asleep). On average, the procedure takes 60-180 minutes, depending on the size of your prostate, and necessitates an over-night stay with a catheter in place.
HoLEP is suitable for any man with a blockage of his urinary system due to an enlarged prostate.
There are fixed priced quotes available on request. Please contact us on +65 6553 5066
You have been diagnosed with urinary outflow obstruction (trouble passing urine) caused by an enlarged prostate or in urinary retention. HoLEP is a treatment recommended for men with large prostates and is probably safer for men on medications to thin the blood such as warfarin, aspirin or clopidogrel.
Alternative treatment options include: medication; use of a catheter to bypass the obstruction; observation; conventional transurethral resection (TURP) surgery, or an open operation. There are some newer alternatives such as Rezum, Urolift and Prostate Artery Embolisation (PAE). You could discuss suitability of procedure options with the consultant during your appointment.
If you are taking the blood-thinning agent clopidogrel on a regular basis, you must stop 7 days before your admission for the procedure as this drug can cause increased bleeding after prostate surgery. You can resume taking clopidogrel safely about 10 days after you get home. If you are taking warfarin or aspirin to thin your blood, you should ensure that the Urology staff are aware of this well in advance of your admission.
There will some health checks including pre-operative blood tests, ECG and chest X-ray which may be done during the clinic visit for anaesthetic purposes.
You will usually be admitted on the day of your surgery. You will be asked not to eat or drink for 6 hours before surgery. After admission, you will be seen by members of the medical team which may include the consultant, anaesthetist and nursing staff.
At some stage during the admission process, you will be asked to confirm the consent for the HoLEP surgery you have given previously as well as to confirm your identity. Do let the staff know if there are any questions or concerns about the surgery.
Immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you feel pleasantly sleepy.
A full general anaesthetic will be used. You can discuss any anaesthetic related concerns with the anaesthetist prior to the procedure. In addition, you will usually be given an injectable antibiotic before the procedure, after checking for any drug allergies.
Once you are asleep, a laser is used to separate the obstructing prostate tissue from its surrounding capsule and to push it in large chunks into the bladder. An instrument is then used through a telescope device to remove the prostate tissue from the bladder. A catheter is normally left to drain the bladder at the end of the procedure.
- There is always some bleeding from the prostate area after the operation. The urine is usually clear of blood within a few days, although some patients lose more blood for longer. It is very rare to require a blood transfusion after laser surgery.
- You should drink as much fluid as possible in the first 12 hours after the operation because this helps to clear the urine of any blood more quickly. Sometimes, fluid is flushed through the catheter to clear the urine of blood.
- You will be able to eat and drink on the same day as the operation when you feel able to.
- The catheter is generally removed on the morning after surgery. At first, it may be painful to pass your urine and it may come more frequently than normal. Any initial discomfort can be relieved by painkillers such as Paracetamol and the frequency usually improves within a few days.
- Some of your symptoms, especially frequency, urgency and getting up at night to pass urine, may not improve for several months because these are often due to bladder over-activity (which takes time to resolve after prostate surgery) rather than prostate blockage. Since a large portion of prostate tissue is removed with the laser technique, there may be some temporary loss of urinary control until your pelvic floor muscles strengthen and recover. You will be taught pelvic floor exercises following surgery to help achieve this.
- It is not unusual for your urine to turn bloody again for the first 24-48 hours after catheter removal. Some blood may be visible in the urine even several weeks after surgery but this is not usually a problem.
- Let your nurse know if you are unable to pass urine and feel as if your bladder is full after the catheter is removed. Some patients, particularly those with small prostate glands, are unable to pass urine at all after the operation, due to temporary swelling of the prostate area. If this should happen, we normally insert a catheter again to allow the swelling to resolve and the bladder to regain its function.
As with any other medical procedure there is a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure. The side effects you might experience include:
Common (greater than 1 in 10)
- Temporary mild burning, bleeding and increased frequency of urination after the procedure.
- No semen is produced during an orgasm in approximately 95% of men if the prostate is fully enucleated.
Treatment may not relieve all the urinary symptoms.
- Loss of urinary control (incontinence) which reduces within 6 weeks (5%). This can usually be improved with pelvic floor exercises.
Occasional (between 1 in 10 and 1 in 50)
- Failure to pass urine after surgery, requiring a new catheter.
- Bleeding, requiring a return to theatre and/or blood transfusion (less than 1%).
Rare (less than 1 in 50)
- Finding unsuspected cancer in the removed tissue which may need further treatment.
- Retained tissue fragments floating in the bladder which may require a second telescopic procedure for their removal.
About 1 man in 5 experiences bleeding some 10-14 days after getting home. This is due to scabs separating from the cavity of the prostate. Increasing your fluid intake should stop this bleeding quickly but, if it does not, you should contact the Urology practice during working hours or the hospital 24 hour A&E service out of hours. In the event of severe bleeding, passage of clots or sudden difficulty in passing urine, you may need to be readmitted into hospital.