All you need to know about Holmium laser prostate treatment

Holmium laser (HoLEP) is an extremely commonly performed endoscopic procedure that effectively treats various prostate-affecting conditions, such as hypertophy of the prostate as well as benign prostatic hyperplasia, but to mention a few. 

We recently spoke to highly experienced and exceptionally well-regarded consultant urologist, Mr Aniruddha Chakravarti, in order to find out how exactly the prostate-treating Holmium laser procedure is performed, how effective and safe it is, and what patients can expect following the surgical intervention.

What exactly is Holmium laser?

So, firstly, you need a basic element to stimulate laser energy. The basic element used here is Holmium, which is an element by itself. It is mixed with something called YAG (yttrium aluminium garnet). This Holmium YAG is then stimulated to get the desired laser energy that we use. It is very precise, has a large wavelength, and a small degree of penetration. It is a pulsed laser, so it has a mechanical effect also. 

How effective is it when it comes to treating prostate-affecting conditions?

It is used to treat benign hyperplasia of the prostate. One in three men above the age of 50 and one in two men above the age of 80 will have benign enlargement of the prostate. When we get to this situation, when we have an overgrown part of the prostate gland and the adenoma is compressing the outflow of the bladder, there then forms a natural plane between the adenoma and what we call a capsule. 

If you can enucleate the adenoma in its natural plane, then you will certainly have the best outcome because it is atonomical enucleation in its natural plane. This undoes the process which unfortunately happens naturally, and achieves a freedom from obstruction of the bladder outflow. 

This is done very effectively with the Holmium laser due to its precision, its minimal penetration, and, mainly, its pulsed nature. The pulsed nature significantly aids the enucleation process.

What does the procedure involve exactly?

It involves putting a telescope through the waterpipe (through the natural channel). Through the telescope, a very fine laser is passed, which delivers the laser energy at its tip, which is very precise. We then use the laser energy to open up the plane between the adenoma and the capsule, and to enucleate that adenoma in its natural plane. 

How safe is it and what should patients do before undergoing the procedure?

It is a very safe procedure. It involves irrigating the bladder with Normal Saline. If this fluid is observed by the body, no ill-effects are observed. The laser energy effectively enucleates the prostate, and at the same time, we can stop the bleeding. 

We can also alter the energy of the laser. Therefore, it is a very effective enucleation that involves little-to-no bleeding. It is safe because we are using natural fluid (Normal Saline). Also, due to the fact that it has very little penetration, the procedure has less of a negative affect on the nerves that surround the prostate, which are responsible for our sexual function and continence. It has the lowest reintervention rate (it typically lasts up to 20 years) when compared to similar procedures. 

Is it painful? What is recovery time like?

It is not painful at all. The operation is usually performed under general anaesthetic. The patient will not experience post-operative pain, and a catheter will typically be inserted for about 24 hours, sometimes 48. The amount of bleeding through the catheter after surgery is usually very minimal. 

Apart from strenous activity, no other activity is restricted. The recovery time is usually about three weeks, during which the patient can be up and about and active, with no food or drink restriction. They can resume all physical activity after three weeks. 

If you are considering undergoing Holmium laser prostate treatment, make sure you make an appointment with leading expert consultant urologist, Mr Aniruddha Chakravarti, by visiting his Top Doctors profile.