What is HoLEP (Prostate Enucleation with Holmium Laser)
It is a surgical method using advanced laser technology in the treatment of benign prostate hyperplasia (BPH). It is a closed procedure that can clean and remove all of the prostate tissue.
How is HoLEP Surgery Performed?
It is performed under general anesthesia or anesthesia from the waist down. It is entered through the urinary tract with special instruments equipped with cameras. The growing prostate tissue is carefully separated from the capsule by laser and thrown into the bladder. The prostate tissue thrown into the bladder is broken up with another tool (morcellator) and vacuumed and taken out of the body. Then, the procedure is terminated by inserting a catheter. The removed prostate tissue is sent to pathology to investigate the presence of possible cancer.
How many days will you stay in the hospital after HOLEP?
Generally, we remove the patient's catheter and discharge the patient on the day after surgery. However, we monitor our older patients and patients with additional diseases for 1 more day and discharge them without any problems.
Does Holep surgery harm sexuality?
The nerves that provide erection may be negatively affected during surgery. When compared in terms of energy used, HoLEP has been shown to only affect the prostate capsule to a depth of 0.4 mm. In other words, the energy used to separate the prostate tissue does not damage the nerves that enable erection. The electrical energy used in TUR-P surgery can spread to a depth of 4 mm. How to prepare for HoLEP and other TURP/HoLEP in terms of sexual functions?
Prostate examination, Urine flow rate test, Ultrasonography, Urine analysis, Blood test (PSA) are performed on suitable patients. .
Is there any bleeding in HoLEP surgery?
Prostate tissue is an organ that receives a lot of blood and the surgery is usually bloody. Mostly before open and TUR surgeries, blood preparation is made against the risk of bleeding and blood transfusion is given to the patient when necessary.
Can urinary incontinence occur after surgery?
Rarely, some patients may experience Urinary incontinence also occurs. The main reason for this is damage to the valves that hold urine. Since the laser used in HOLEP surgery affects a depth of 0.4 mm, it has little effect on these structures. If HoLEP surgery is performed carefully, urinary incontinence usually does not occur. However, temporary urinary incontinence, which is seen initially in some patients where large prostate tissue has been removed, improves over time.
What awaits patients after the surgery? changes in color are observed. There may be minor bleeding at the beginning and end of urination. This situation is mostly temporary. Although burning and pain while urinating are very rare in the HoLEP method, they are among the complaints we encounter. It is usually temporary and occurs frequently in the first weeks. As we mentioned above, since the prostate is completely removed, some patients may experience dribbling and inability to control urine, especially in the first weeks. Generally, we see it more frequently in people who remain catheterized for a long time, who are immobile, and who have neurological disease or diabetes. Patients whose complaints continue are started on exercise and medication. Some patients who have been catheterized for a long time and whose immune system is weakened may experience a small amount of inflammation. We can minimize this risk with prior urine culture and treatment.
When can we return to normal life?
Our patients can return to their normal lives 2-3 months after the surgery. They can do light physical exercises. It is recommended to consume plenty of fiber in the diet and avoid constipation. We recommend that they stay away from acidic drinks and hot spicy foods, especially in the first month. Sexual intercourse is not recommended for the first 4-6 weeks after surgery. Bleeding in urine and semen may occur after the first intercourse. In most cases, semen leaks back into the bladder and is then excreted with urine. This has no harm to health.
After HoLEP, will the prostate grow again or will surgery be required in the following years?
Since the prostate tissue is completely separated and removed from the capsule by laser, no pieces are left behind. Since there is no prostate tissue left behind, patients do not need surgery again.
Protection removed after Holep Is the prostate tissue examined by pathology?
The prostate tissue removed during the HoLEP surgery is placed in the necessary containers and sent to the laboratory for pathological examination. In general, since patients are evaluated in detail for cancer before surgery, there is no bad outcome from pathology. However, if an opposite result occurs, additional treatment is applied accordingly.
Can prostate cancer develop after HOLEP?
In all benign prostate surgeries; Only the inner part of the prostate that grows and puts pressure on the urinary tract is removed. The outer part of the prostate, which we call the capsule, remains, and unfortunately, cancer may develop in this part in the future. In patients who are evaluated for prostate cancer before surgery and no cancer is detected, there is a possibility of developing prostate cancer as they get older. Therefore, patients deemed necessary in terms of cancer risk should be followed, even after HoLEP.
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