What is Holep Surgery? What Does Holep Surgery Do?

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HOLEP surgery, which represents the abbreviation of the words Holmium Laser Enucleation Of The Prostate, is the process of removing the occlusive part of the prostate by leaving the capsule part of the prostate in cases of benign prostatic enlargement (BPH) and related inability to urinate or difficulty urinating.


Compared to other methods, it is similar to the open surgical removal of the obstructing part of the prostate.

It is a very successful method because all the occlusive and benign prostate tissue is removed and covered with a holmium laser.

The most important advantage compared to open surgery is that it can be entered through the urinary tract and there is no external incision and it has a similar successful result with open surgery.

The Holmium laser system has both cutting and burning features. It does the cutting job with its breakthrough laser feature.

The 2.1 micron pulse of light occurs sequentially and cuts through tissue like a drill. Low watts are used for crushing stone, while higher watts are used for cutting tissue.

In recent years, it has been increasingly used to remove the occlusive part of the prostate in benign prostate enlargement.

With a device with an optical system, namely a camera, which we call a resectoscope, the urine is entered through the external canal, the prostate and then the urinary bladder are reached.

After observing the bladder (urinary bladder) and the right, left and middle occlusive parts of the prostate with the camera system, the capsule of the prostate is left and the occlusive parts are cut as a whole with the HOLEP method and thrown into the urinary bladder.

Then, these prostate tissues, which are cut from the urinary tract, are cleaned with a device we call a morsalator.

After a thorough control of bleeding, the probe is placed and the procedure is terminated.

In open prostate surgery, the occlusive part of the prostate is entered and removed from the urinary bladder through a surgical incision made in the umbilicus.

In classical TUR surgeries and other laser methods (such as green light, red light), the occlusive parts of the prostate are removed in small pieces by entering through the external urinary tract and there is a high probability of remaining obstructive tissue.

Especially in large prostates, the risk of residual (residual) tissue is high and this causes obstruction in the prostate again.

The most important advantage of the HOLEP method is that there is no residual tissue and the risk of recurrence is very low.

Although the same procedure is performed with open surgery, it is also an important advantage to have any incision scars outside.

In addition, the risk of bleeding is very low. It is very important in terms of not causing hardening disorder due to the absence of high heat effect on the cut area.

As a result, HOLEP surgery is an effective and successful method that is increasingly used in urinary tract obstruction due to benign prostatic enlargement (BPH).

Does HoLEP Affect Sex Life?

The passage of nerves that provide erection around the prostate in men may cause damage to these nerves during prostate surgeries. However, in operations performed with the HoLEP method, there is no possibility of damaging the nerves in question. In the HoLEP method, the electrical energy affects 0.4 mm, which means that the electrical energy remains well above the nerves.

Problems that can be experienced here are problems such as back ejaculation (retrograde ejaculation) or inability to ejaculate. In such cases, the prostate tissue is completely cleaned and this place is emptied. Therefore, during orgasm, semen escapes into the bladder and is excreted with urine. This situation does not cause any harm in terms of health and does not adversely affect the hardening. Therefore, patients can continue their sexual lives. In operations performed by inexperienced surgeons, it is possible to damage the nerves that provide the erection. Therefore, choosing a specialist and experienced surgeon is of great importance.

How Many Days Do You Stay in the Hospital After HoLEP?

The duration of HoLEP operations varies according to the size of the prostate. The procedure takes 1 hour for some patients and 3 hours for some patients. After HoLEP, it is recommended that patients stay in the hospital for 1 day for control and be discharged the next day. However, the hospital stay of patients with comorbidities or advanced age may be extended for a few more days. if the catheter was applied to the patients, the catheter is taken the next day. However, the catheters of patients who use blood thinners or who have stenosis in the urethra may stay for a few more days.

After the patients are discharged, the first check-up is usually in the 3rd or 4th week. If patients experience complaints such as burning or infection, then appropriate drug therapy is started to eliminate these problems. If the complaints of the patients have ceased after the drug treatment, the next controls are carried out at the 3rd, 6th and 12th months. If there are no complaints in the following years, it is not necessary to go to the control. It usually takes 2 to 3 months for patients to return to their normal lives. It is recommended to consume plenty of fiber foods and avoid acidic and spicy drinks and foods in the first month after the operation. It is necessary to wait up to 6 weeks to start sexual life.

What are the Advantages of HoLEP Surgery?

The advantages it provides to patients have made HoLEP treatment the most preferred treatment method in benign prostate enlargement. The main advantage is that it can be applied regardless of prostate size. It is also extremely unlikely that prostate enlargement will recur after HoLEP treatment. The bleeding rate is minimal and therefore blood transfusions are unnecessary. Other advantages that patients can obtain in HoLEP treatment, which has an extremely rapid recovery process, are as follows:

  • HoLEP can be applied without any incision even in cases where prostate enlargement is advanced,
  • The probability of a second operation being required is almost zero,
  • Sexual functions are not damaged,
  • Even if blood thinners are used, there is no harm in applying HoLEP,
  • The hospital stay is only a few days,
  • There is no burning when urinating after the catheter is taken,
  • The time to return to normal life is very short.

In order to obtain all these advantages without any problems, the operation should be performed by a specialist and experienced surgeon.


Does Bleeding Occur in HoLEP Surgery?

HoLEP surgery can be performed with both general and spinal anesthesia. The operation is performed by entering the external urinary canal of the penis with a camera. During the intervention on the prostate tissue, the border points of the enlarged prostate tissue and the capsule are cut first. During this cutting process, all of the vessels in the tissue are sealed with laser and bleeding occurs very little after this sealing process.

Bleeding is usually very high in benign prostate enlargement surgeries performed with open surgery method. Because prostate tissue is a very bloody organ. The risk of bleeding is quite high in open operations and surgeries such as TURP. Therefore, blood preparation is made before the operation and blood transfusion is given to the patient in case of bleeding. However, this is not the case in the HoLEP method. The laser technology used in this method does not cause bleeding or very little bleeding is seen. Therefore, no blood preparation is required before the operation.

Does Urinary Incontinence Occur After HoLEP?

Especially after open prostate surgery, some patients may experience problems such as urinary incontinence. This is usually caused by the valves holding the urine from being damaged during the operation. However, the probability of these valves being damaged during the HoLEP operation is extremely low. Because the laser used during the HoLEP operation only acts up to a depth of 0.4 mm. Therefore, even if problems such as urinary incontinence are observed in the postoperative period, these problems will resolve spontaneously over time. The likelihood of urinary incontinence is higher in cases where large prostate tissues are removed. However, after the operations performed carefully by specialist and experienced surgeons, the possibility of urinary incontinence is almost negligible.

Does the Prostate Grow Again After HoLEP?

The oldest method used in the treatment of benign prostate is open prostate surgery. In this operation, which is preferred in cases where the prostate is very large, the prostate adenoma pressing on the urinary canal is removed. If this operation is done carefully and well, it is possible to completely remove the adenoma and prostate enlargement will not recur. If prostate surgery is not done well and a piece is left inside, there is always the possibility of recurrence of prostate enlargement.

In operations such as TUR or TUR-P, it is entered through the urinary canal to remove the prostate adenoma and the operation is performed closed. In cases where the prostate tissue is very large, the TUR technique does not allow the entire prostate tissue to be removed. Therefore, there is always the possibility of recurrence of prostate enlargement and a second surgery may be required in the future. In the HoLEP method, the prostate tissue is completely removed by separating it from the prostate capsule, which is the membrane surrounding the prostate. Therefore, the possibility of recurrence of prostate enlargement is eliminated.

What are the Differences Between HoLEP and ThuLEP?

Both HoLep and ThuLEP are two different operations performed with a laser. While Thulium laser is used in ThuLEP surgery, Holmium laser is used in HoLEP surgery. In both procedures, there is separation and removal of the prostate adenoma from the outer capsule. Holmium laser application started to be used in the treatment of benign prostate enlargement 20 years ago, and Thulium laser was used for the first time in 2010. While the laser reaches a depth of 0.4 mm in the HoLEP treatment, a depth of 0.25 mm is reached in the ThuLEP treatment.

Although the cutting feature of the Thulium laser is more effective than the Holmium laser, there is no proven superiority of these two methods to each other. While the Thulium laser reduces bleeding by creating charring in the tissue, the Holmium laser makes explosive pulses with long wavelengths and allows the capsule and prostate tissue to be separated from each other. The operation time in ThuLEP surgery is 7-8 minutes shorter than in HoLEP surgery. However, there is no difference between the results obtained after the operation.

Prof. Dr. Abdullah ArmağanUrology Specialist

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