ADVANTAGES OF HoLEP OVER OPEN SURGERY
1. Surgical incision
It is performed through the urethra without requiring a surgical incision (same approach as TUR of the prostate) over the abdominal wall. In contrast, open adenotomy requires an incision over the abdominal wall and bladder until the prostate is reached.
2. Surgical bleeding
The holmium laser has an excellent coagulation capacity. For this reason, bleeding during surgery is minimal. This means that patients can go home within hours of surgery and the risk of blood transfusion is very low. The bleeding that occurs with TUR or open adenotomy is greater than with enucleation. For this reason, the duration of bladder lavage and hospital stay is longer with these techniques. For the same reason, these techniques have a higher risk of requiring a blood transfusion (adenomectomy up to 25%) or needing a reoperation due to bleeding.
3. Probe stay and hospital stay
The permanence of the catheter and hospital stay after HoLEP is usually in the order of 1 to 2 days. On the other hand, both the length of catheter and the length of hospital stay after TUR-P or open adenotomy is longer.
4. Treatment of bladder stones
Patients undergoing a surgical procedure to treat BPH may have stones or lithiasis in the bladder. As the holmium laser is an excellent lithotripter, simultaneous fragmentation and removal of bladder stones is possible during laser prostatectomy. In contrast, bladder lithiasis cannot be fragmented with the electricity used in prostate TUR.
5. Medium and long term functional outcomes
Enucleation is an established and well-established surgical technique. Numerous studies have shown that the clinical improvement achieved after enucleation remains stable in the medium and long term. This long-term clinical stability is similar to that of conventional surgery.
HoLEP: Prostate laser enucleation surgery
What is it?
Holmium laser enucleation of the prostate (HOLEP) is a surgical technique for the treatment of benign prostatic hyperplasia. It is currently recognised and recommended by the main European and American urological guidelines.
However, due to its technological requirements and high technical complexity, it is only performed in highly specialised centres.
It is considered the best technique for benign prostatic hyperplasia because it is a minimally invasive technique (no incisions) with an early recovery (hospitalisation of less than 24 hours) that combines the comfort of the transurethral approach with the safety of laser technology.
Prostatic enucleation can be performed on any size prostate, making it the only technique that can be only technique able to operate on any size prostate.
Why don't all urologists perform this type of technique?
The two main reasons why prostatic enucleation is not currently performed, despite being the best technique in the world, are as follows:
- The high technological requirements, which are not available to all centres, such as state-of-the-art lasers.
- It is technically demanding as it is one of the most difficult urological operations to perform safely and effectively in all cases. Many centres have the holmium laser device to treat urinary lithiasis, but do not perform HoLEP because they do not have a urologist trained in it: "There are many machines, but few experts".
It also requires a highly qualified team. Not only the urologist is important, but also the anaesthetist, nurses and assistants who, in turn, must be familiar with the process. It is a team surgery and for the surgeon to achieve the best results it is necessary to work in a coordinated way.
What does the technique consist of?
The prostate enucleation technique consists of separating the prostate capsule (the external part, "the skin of the orange") from the prostate adenoma, which is the area of the prostate that makes urination difficult (the internal part, "the segments of the orange").
Once these two structures have been separated, the adenoma is removed in small fragments using an instrument, the morcellator, which allows the prostate adenoma (the segments) to be aspirated and fragmented into small pieces and extracted through the bladder.
Once this tissue has been removed, it is sent to the pathologist for analysis.
What problem does this treatment solve / What type of patient is ideal?
Urinary problems derived from the obstruction produced by the prostate in prostates larger than 50 grams or patients taking anticoagulant therapy: Eliquis, Sintrom, Aspirin, Heparin...
Areas to be treated
What does the Pre-operative consist of?
Blood tests, urine analysis, electrocardiogram and visit to the anaesthesiologist.
What is the approximate duration of the procedure?
60-90 min depending on the size of the prostate.
If you use any specific equipment in this intervention, please mention it...
Greenlight Green Laser Generator 120 or 180W
Depends on the patient and the prostate
Does it require anaesthesia, what type?
Spinal or general depending on each patient and at the discretion of the anaesthesiologist.
Does it require admission or is it ambulatory?
1 day of hospitalisation.
How should the patient be cared for after the operation?
Discharge without catheter in most cases (98%) to return home.
Rest for 4 days at home.
Approximate recovery time
2 weeks for normal activity.
Does it leave scars?
Scarless, it is operated through the urethra.
What results should the patient expect?
Urinating without difficulty with a stronger and more pleasurable stream. Frequency of urination may take some time to reduce.
Mention other complementary treatments (if applicable)
Post-operative medication is sometimes necessary to reduce urinary discomfort.
Other facts about this surgical procedure that are important to note
After surgery, the patient's erection and sexual pleasure will not be affected, but he will not expel semen at orgasm: RETROGRADED EYACULATION.