HoLEP: all you need to know

The HoLEP procedure, or holmium laser enucleation of the prostate, involves using a laser to remove enlarged prostate tissue, relieving urinary blockage and improving urine flow. Consultant urologist Mr Mohamed Asad Saleemi explains more about the procedure, its side effects and the recovery process. 

What is the HoLEP procedure, and how is it performed?

The HoLEP procedure, short for holmium laser enucleation of the prostate, is performed under general anaesthesia. A resector scope is inserted into the urethra, allowing passage of a thin laser fiber, approximately half a millimetre wide. This fibre is used to remove the inner part of the prostate, which enlarges benignly in men, causing pressure on the urethra and potentially leading to urinary blockages.

The procedure essentially widens the urethra, relieving pressure on the bladder. Success rates, based on data from about 2000 patients, indicate a 99% chance of patients being able to pass urine spontaneously after the catheter removal. The removed prostate tissue is extracted using a morcellator for further analysis. Typically, patients have a catheter overnight, and most can pass urine within 24 hours post-catheter removal, with a 99% success rate within the first two weeks if not initially successful.

What should I expect during recovery after HoLEP surgery?

After the surgery, it takes several weeks for the bladder to readjust. The bladder needs time to recover its normal function after being catheterised. This process can last anywhere from 6 to 12 weeks. Initially, patients may experience increased urination frequency and notice slight pink-coloured urine due to traces of blood for about 10 days. Patients are advised to avoid heavy lifting or straining and to drink up to three litres of fluids daily for the first three weeks. Some urinary leakage, especially during movement or heavy lifting, may occur initially but usually improves with time.

Pelvic floor exercises are recommended to help regain bladder control, and patients may need to use pads for a few weeks post-surgery. Burning sensations during urination can persist for up to six weeks, but overall recovery is typically smooth. Many patients report minimal pain after surgery, particularly during the procedure due to anaesthesia. These are common experiences patients may encounter during recovery.

Are there any risks or side effects associated with HOLEP?

The main risks of whole-up surgery include both general anaesthesia risks, which are standard for any operation, and specific risks associated with the procedure itself. Patients undergo thorough preoperative assessments, including medical checks, blood tests, and ECG, to mitigate these risks. Regarding the surgery, there is a minimal risk, less than 0.5%, of requiring a blood transfusion, which is significantly lower than previous treatments.

How does HoLEP compare to other treatments for BPH (Benign Prostatic Hyperplasia)?

In our unit, we firmly believe that HoLEP surgery reigns supreme. Referred to as "HoLEP is king," this procedure offers the best outcomes for patients suffering from urinary retention. Compared to previous methods like TRP, which involved using an electric hot wire to remove the prostate, HoLEP surgery stands out for its superior effectiveness and lower complication rates. TRP, despite advancements, still falls short in comparison.

HoLEP surgery minimises the need for blood transfusions and ensures thorough removal of the prostate, reducing the likelihood of future surgeries. Over a 10-year period, the risk of requiring additional procedures after HoLEP surgery is only 1%, whereas it is 20% after TRP. This highlights the durability and lasting benefits of HoLEP surgery, making it the preferred choice for patients seeking long-term relief from urinary symptoms.

Will HoLEP affect my sexual function or cause incontinence?

Regarding other side effects of the HoLEP procedure, issues concerning ejaculation and erectile dysfunction are comparable. Additionally, alternative minimally invasive techniques exist, such as Rezum, aquablation, and UroLift, which may be suitable for younger men with smaller prostates who prioritise preserving sexual function. While these procedures show effectiveness in the short to medium term, long-term data compared to HoLEP or TRP is limited. Therefore, the choice of procedure depends on individual patient needs and circumstances upon initial consultation.

If you would like to book a consultation with Mr Saleemi, simply visit his Top Doctors profile today.