Prostate Surgery With HoLEP Method

HoLEP (Holmium Laser Prostatic Enucleation) is a minimally invasive surgical method used in the treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia is a health condition frequently seen especially in older men and can significantly reduce quality of life. This condition may lead to symptoms such as inability to completely empty the bladder, frequent urination, and waking up at night to urinate. Compared to traditional surgeries, HoLEP offers a more comfortable process and provides patients with a permanent and effective treatment option.

What Is HoLEP (Holmium Laser Prostatic Enucleation)?

HoLEP is a minimally invasive (laparoscopic) surgical procedure used to treat benign prostatic hyperplasia (BPH). While medication is often used in the early stages of BPH, surgical treatment becomes necessary as the prostate size increases. Because HoLEP is a minimally invasive surgery utilizing cutting-edge technology, it is frequently used today.

In this method, the enlarged prostate is completely removed using an advanced holmium laser. This eliminates the tissue obstructing urine flow. The HoLEP method offers an effective and permanent treatment option, especially for large prostates.

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In Which Diseases Is HoLEP Applied?

HoLEP is primarily used in cases of benign prostatic hyperplasia (BPH). With age, the prostate enlarges and compresses the urethra. This can lead to symptoms such as waking up at night to urinate, frequent urination, and interruptions in urine flow. The HoLEP method eliminates these urinary problems by completely removing the enlarged prostate tissue.

Who Is HoLEP Suitable For?

HoLEP is an ideal method especially for male patients with prostate volume greater than 80 cc, but it can be safely used in the treatment of prostate enlargement of all sizes.

In addition, HoLEP can be safely applied to patients who have bladder stones in addition to prostate enlargement, and to patients with a history of cardiovascular disease, stent placement, or bypass surgery.

In What Situations Is HoLEP Surgery Recommended?

HoLEP surgery is primarily used in the treatment of benign prostatic hyperplasia (BPH). The HoLEP method may be preferred in the following situations:

• Patients experiencing symptoms such as frequent nighttime urination, interruptions in urine flow, difficulty urinating, and inability to completely empty the bladder.
• Those who do not benefit from drug treatment or who cannot use drug treatment
• Patients with recurrent urinary tract infections due to prostate enlargement
• Patients experiencing kidney failure and stone formation due to prostate enlargement.

These symptoms significantly affect the patient's quality of life, and if other treatment methods have not been effective, HoLEP surgery offers a safe and permanent solution.

How To Prepare For HoLEP?

Preparation before HoLEP surgery is extremely important. The patient's condition is thoroughly assessed through pre-operative examinations and tests. The tests and examinations performed during the HoLEP preparation process include:

Prostate Examination

A prostate examination is a physical examination performed manually. During the examination, the size of the prostate, the surrounding tissues, and its surface are checked. If cancer is suspected, the firmness of the prostate or the presence of nodules is also evaluated.

Urine Flow Rate Test

Urine flow rate testing, also known as uroflowmetry, is performed using a special device called a uroflowmeter. The test records the urine flow rate, urination time, and flow rate during urination. This allows the extent to which the prostate is obstructing the urinary tract to be determined.

Kidney And Bladder Ultrasonography

Ultrasonography (USG) is an imaging method performed through the abdomen. This method is used to check prostate volume, the amount of urine remaining in the bladder, and the kidneys. It allows for the assessment of the severity of any obstruction and whether long-standing urinary problems have spread to the kidneys.

Urinalysis

A urine test is performed using a simple urine sample taken from the patient. The urine is examined for inflammation, blood, or any other abnormalities. Some patients may have a urinary tract infection (UTI). In this case, surgery may not be recommended until the infection is treated.

Blood Psa Test

Prostate-specific antigen (PSA) is a protein secreted in the prostate. This value, which is particularly evaluated during blood tests, may raise suspicion of cancer if it is high.

What Are The Characteristics Of A 150-Watt Holmium Laser?

While a 60-watt laser is sufficient for HoLEP surgery, a 150-watt laser allows for faster removal of prostate tissue. This enables the following:

• The surgery time is significantly shortened.
• Bleeding is controlled more effectively.
• It does not damage surrounding tissues; it only targets the tissue itself.
• It can be used not only for HoLEP but also in the treatment of urethral stricture, bladder stones, and ureteral stones.

The 150-watt holmium laser stands out as an advanced option in surgery. Its high performance and advantages make it frequently used in urological surgery today.

How Is HoLEP Surgery Performed?

HoLEP surgery is performed under general or spinal (lower back) anesthesia. Because HoLEP is a minimally invasive procedure, a small incision is made in the urethra. A small instrument with a camera at its tip (endoscope) is inserted through this incision. The enlarged prostate tissue is removed with a Holmium laser and pushed into the bladder to be collected there.

The prostate tissue removed from the bladder is broken into pieces using a device called a morcellator and then removed by vacuuming. This completes the surgery. A catheter is inserted temporarily after the operation. The removed prostate tissue can be sent for biopsy if cancer is suspected.

What Are The Advantages Of Prostate Surgery With The HoLEP Method?

HoLEP prostate surgery has several advantages over traditional surgery. These advantages include the following:

• Because a 150-watt laser is used, prostate tissue is removed more quickly. This significantly reduces the procedure time, especially in cases of large prostate enlargements.
• Because a closed procedure is used, the risk of bleeding is lower.
• Hospital stay is short.
• It can be used successfully even in cases of very large prostate enlargements.
• No stitches or scars will form on the skin.
• It does not impair sexual function.
• The risk of prostate enlargement recurring is very low.

What Are The Risks Of HoLEP Surgery?

Like any surgical procedure, HoLEP surgery carries risks, but these are quite rare; most are temporary or manageable.

• Temporary burning and bleeding may occur during urination after surgery.
• Urinary incontinence may occur during the first few days.
• Blood in the urine can occur, although rarely.
• Because a urinary catheter is used temporarily, there may be a delay in urination.

How Is Follow-Up Performed After HoLEP?

Follow-up after HoLEP is crucial for the patient's recovery. The patient typically stays in the hospital for one or two days after surgery. During this time, a urinary catheter is inserted to monitor for risks and bleeding in the urine. After the catheter is removed, pelvic floor exercises are recommended to improve bladder control.

The patient is called for follow-up appointments at 6 weeks and 6 months post-surgery. During these follow-up appointments, the doctor will order tests such as PSA testing and uroflowmetry, and will make a further assessment based on the test results.

How Long Does The Recovery Process Take After HoLEP Surgery?

The recovery process after HoLEP surgery is quite fast and comfortable. This process may vary depending on the patient's condition, other illnesses, and overall health. All postoperative checks and observations are completed within 1–2 days, and the patient is discharged.

Home rest is very important; generally, 10 days of rest at home is preferred. The time it takes for the patient to return to work varies depending on their job. For patients with physically demanding jobs, the rest period may be extended with the doctor's approval. Heavy lifting and strenuous sports should be avoided in the first few weeks. Light walks, plenty of fluids, and rest are recommended.

What Precautions Should Be Taken After HoLEP Surgery?

To ensure a smooth recovery after HoLEP surgery, patients need to pay attention to certain things. These include drinking plenty of fluids to help cleanse the bladder, avoiding strenuous physical activity, resting, and taking light walks.

In the first few days after surgery, blood in the urine, burning and stinging during urination may occur, but these symptoms are temporary. Additionally, some patients may experience difficulty controlling urination (temporary urinary incontinence) in the first few weeks. This usually resolves within a few weeks. The frequency of these symptoms can be affected by underlying health conditions such as diabetes or kidney disease. Therefore, postoperative check-ups are very important.

Frequently Asked Questions About HoLEP Surgery

How Long Does Prostate Surgery Take Using The HoLEP Method?

The duration of the surgery varies depending on the size of the prostate and the patient's existing medical conditions.

How Long Do Patients Stay In The Hospital After HoLEP Surgery?

Generally, a hospital stay of 1–2 days is sufficient. Some patients can be discharged within 24 hours.

Can Prostate Problems Recur After HoLEP Surgery?

Because the prostate tissue is completely removed, the risk of the prostate growing back is very low.

Does Holep Surgery Negatively Affect Sex Life?

Sexual function is usually preserved after surgery. It is generally recommended to wait 6 weeks before resuming sexual intercourse.

When Can We Return To Normal Life After HoLEP?

While light daily activities can be resumed within the first week, the return to work varies depending on the patient's occupation.

Besides HoLEP, What Other Minimally Invasive Surgical Techniques Are Available Using Lasers?

The da Vinci® robotic surgical system, Greenlight laser, and steam (Rezum) treatments are also available. The choice of treatment will be determined after consultation.

What Is The Best Surgical Method For Prostate Problems?

This varies depending on the patient's condition, but HoLEP surgery is considered the gold standard for large prostate volumes.

Is The Patient Sedated During HoLEP Surgery?

Yes. The surgery is performed under general or spinal (lower back) anesthesia.

Can Urinary Incontinence Occur After HoLEP Surgery?

Urinary incontinence may occur in the first few weeks, but this usually resolves quickly with pelvic floor exercises.

How Much Does HoLEP Surgery Cost?

The price of HoLEP surgery varies depending on the surgeon's level of expertise and other factors related to the patient's medical condition. To receive more information about HoLEP surgery, simply fill out the contact form. Our expert team will contact you as soon as possible.