Role of HoLEP in Prostate Cancer

Table of Contents

Holmium Laser Enucleation of the prostate (HoLEP)

HoLEP which stands for Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to the standard Transurethral Resection of the Prostate (TURP) procedure for bladder outflow obstruction. It is a surgical intervention that removes obstructive BPH (Benign Prostatic Hyperplasia) tissue via enucleation and morcellation. BPH is a medical condition of mostly older men. HoLEP can be performed on men of any age with urinary outflow obstruction caused by an enlarged prostate. It is particularly indicated in men with large prostates and men on medications to thin the blood such as warfarin, aspirin, or clopidogrel. The treatment requires a short period of hospitalization and an anesthetic. A catheter (a tube that drains the bladder) is also needed for one to two days until the urine clears. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.

The treatment of HoLEP is often less bleeding than after a TURP
Discharge is often quicker i.e. within one to two days
The chance of recurrence requiring further surgery is very low
Unlike greenlight laser operations, large quantities of prostate tissue are sent for pathological analysis
The PSA (Prostate-Specific Antigen) generally drops to very low levels after HoLEP operation

Treatment

HoLEP is performed transurethrally, using a holmium laser to separate the plane between the prostate gland tissue and the prostate capsule. This procedure allows complete resection of all adenomatous tissue, minimizing the need for future re-treatment. The treatment of HoLEP relieves pressure on the tube through which the urine drains (urethra) by anatomically enucleating the majority of excess benign prostate tissue. This is done under a general anaesthetic with the help of a telescopic camera inserted through the penis. The three lobes of the prostate that are cored out intact are pushed into the bladder before being sucked up (morcellated) by a special instrument inserted through the telescopic camera. The pieces are sent for laboratory analysis just in case they might be found to be cancerous. A catheter is placed into the bladder to drain the urine while the raw surface heals, then left in place for around twenty four hours before being removed on the day of discharge from hospital. Sterile saline fluid is also irrigated into the bladder through the catheter to dilute any blood in the urine and prevent the formation of clots.