Treatment of Benign Prostatic Hyperplasia With the Holep Method

Treatment of Benign Prostatic Hyperplasia with the HoLEP Method

One of the most common conditions in men as they age is benign prostatic hyperplasia. With advancing technologies, the HOLEP method, which uses laser technology, has replaced classic prostate surgeries. HOLEP surgeries performed without incisions stand out in this field because they allow patients to return to daily life much sooner.

In the Urology Department of Daviva Health Group, diagnosis and treatment processes for prostate health are carried out meticulously within the framework of current protocols, with our technological infrastructure and experienced team.

What Is HOLEP?

Holmium Laser Enucleation of the Prostate, or HOLEP, is a minimally invasive treatment method for benign prostatic hyperplasia. In this procedure, a holmium laser is used to remove the inner part of the prostate gland. While traditional prostate surgery involves incisions in the skin, the HoLEP method does not require an incision. Performing prostate surgery without an incision also brings many advantages.

In Which Cases Is HOLEP Used?

HOLEP is used in the treatment of benign prostatic enlargement. No matter how large the prostate is, HOLEP is one of the most effective treatment methods for complaints caused by benign prostatic enlargement.

The HOLEP method can be used for complaints caused by prostate enlargement.

• Urinary tract obstruction
• Prostate-related bleeding
• Burning sensation during urination
• Inability to urinate
• Frequent urination
• Incomplete emptying of the bladder
• Recurrent urinary tract infections

Because the HOLEP method cleans the inner prostate tissue with a laser, it is not used in the treatment of prostate cancer.

How Is HoLEP Surgery Performed?

• HOLEP surgery is usually performed under general anesthesia.
• After anesthesia, a narrow endoscopy tube called a resectoscope is inserted into the urethra through the tip of the penis.
• Thanks to the resectoscope, which has a camera at its tip, the prostate gland can also be visualized.
• To treat the enlarged prostate tissue, a holmium laser is passed through the resectoscope.
• The holmium laser sends pulsed laser beams to the prostate to cut the tissue blocking urine flow.
• The laser beams separate the prostate tissue from the surrounding capsule, almost like separating the inside of an avocado or kiwi from its outer skin.
• The tissue cut and removed with the laser falls into the bladder.
• Then the tissue is broken into smaller pieces with a special instrument, and these pieces are suctioned out of the bladder.
• The outer capsule of the prostate and nearby nerves responsible for sexual function are preserved.
• The removed tissue pieces are sent to pathology to check whether there are signs of prostate cancer.
• After the tissue removal is completed, the resectoscope is removed and a urinary catheter is placed in its place.

What Are the Advantages of HOLEP?

• One of the biggest advantages of the HOLEP method is that no incision is made during surgery.
• The fact that HOLEP is performed without an incision is also reflected in the recovery time. Compared with other prostate surgeries, patients can recover much sooner and return to social life.
• It is effective for benign prostatic enlargement of all sizes, including very large prostate enlargements.
• Because bleeding during surgery is very limited, a blood transfusion may not be necessary. It can be safely performed even in patients using blood thinners.
• Since the prostate tissue is peeled away from the capsule and removed, the risk of recurrence is very low.
• It is a method that minimizes the risk of damage to sexual function.

**What Are the Disadvantages and Risks of the HOLEP Method? **

The biggest disadvantage of HOLEP surgery is not for patients but for doctors. The technique used is quite difficult for the surgeon. However, successful results are achieved with surgeries performed by surgeons specialized in HOLEP.

Apart from that, the disadvantages and risks of the HOLEP method can be listed as follows.

• Benign prostatic hyperplasia surgery performed with the HOLEP method takes longer than classic prostate surgeries.
• Retrograde ejaculation risk exists in the HOLEP method, as in other prostate surgeries. After surgery, semen may flow into the bladder instead of exiting outward. This does not affect sexual pleasure. However, patients who want to have children naturally should discuss this with their doctor.
• The risk of erectile dysfunction, commonly known as impotence or erection problems, exists in all prostate surgeries. Although this risk is lower in the HOLEP method compared with other methods, it should still be taken into consideration.
• After HOLEP surgery, urinary leakage after the catheter is removed is common. However, this condition improves within a few weeks without any intervention.
• During recovery, temporary burning, frequent urination, or blood in the urine may occur for a few weeks.
• Although rare, there are risks such as bladder perforation or damage to the ureteral orifice.

Therefore, it is important that the HOLEP method be performed in fully equipped centers by urology doctors and teams specialized in this field.

What Is the Recovery Process Like After HOLEP Surgery?

Because HOLEP surgery is a surgical method that does not require an incision, recovery and return to social life are quick.

First Week After Surgery

• After HOLEP surgery, you need to stay in the hospital for 1 or 2 days.
• After surgery, a three-way catheter is used to wash the bladder. This catheter is removed within the first 1-2 days.
• Blood in the urine is normal. This will resolve on its own within a few weeks.
• During the first week, you may experience urinary urgency, frequent urination, and a burning sensation.
• It is important to take short walks during the first week after surgery. However, strenuous activities and prolonged sitting should be avoided.
• Do not forget to drink plenty of water during this period.

First Month After Surgery

• People who work in jobs that do not require physical activity can return to work 2 weeks after HOLEP surgery.
• Heavy lifting should be avoided during this period.
• Make sure you do not become constipated. Eating accordingly is important.
• It should be remembered that it is still too early for sexual intercourse.

Second Month After Surgery

• Within 6-8 weeks, most patients experience a significant improvement in urine flow.
• Small urine leaks may occur during coughing or sneezing. However, overall urinary incontinence begins to decrease during this period.
• After 2 months, urinary incontinence is completely brought under control.

What Should Be Considered During Recovery After HOLEP?

• Drink plenty of water. In particular, 2-2.5 liters of water per day should be consumed to help cleanse the bladder and prevent clotting.
• Light walks can be taken. However, avoid heavy lifting, straining, or cycling for at least 2 weeks.
• Urinary incontinence is among the common complaints after prostate surgery. In order to overcome this problem quickly, it is important to do Kegel exercises regularly.
• Do not take any medication without asking, except for the painkillers recommended by your doctor.
• Excessive straining may cause bleeding. Constipation is a condition that increases intra-abdominal pressure. To avoid constipation, choose high-fiber foods.
• During recovery, stay away from coffee, alcohol, or carbonated drinks to help resolve urinary problems more quickly.
• If you experience symptoms such as excessive bleeding, inability to urinate, or fever after surgery, contact your doctor immediately.

Frequently Asked Questions About HOLEP

How Long Does HoLEP Surgery Take?

The duration of HOLEP surgery may vary depending on the size of the prostate tissue to be removed and the structure of the tissue. Surgeries in which a small amount of prostate tissue is removed take less time. In general, considering these factors, HOLEP surgeries may take between 1 and 3 hours.

When Can I Be Discharged After Surgery?

After HOLEP surgery, you may usually need to stay in the hospital for 1 or 2 days. The main criterion for discharge from the hospital is that the patient becomes stable.

• If postoperative pain is under control
• If urination is possible
• If general values are normal, the patient is discharged.

When Does Sexual Activity Resume After HOLEP?

As with any surgery, recovery after HOLEP may vary from person to person. In order to resume sexual activity, the surgical wounds and the removed prostate tissue need to heal. This usually takes 4-6 weeks.

Although the recovery period varies from person to person, sexual activity can usually be resumed 4-6 weeks after surgery. During this period, complete healing of the tissues should be awaited. You should consult your urology doctor before resuming sexual activity.

Can Prostate Enlargement Recur After HOLEP?

HoLEP surgery is considered a permanent treatment for benign prostatic enlargement. During the procedure, the prostate tissue that could grow again is cleaned out almost completely. However, in 1% of cases, a second surgery may be required within 10 years.

Is Urinary Incontinence After HOLEP Permanent?

After HOLEP surgery, urinary incontinence may be seen in 10–20% of patients. However, this is usually temporary. Permanent urinary incontinence is seen in very few patients. Thanks to Kegel exercises performed after surgery, urinary incontinence returns to normal in most patients within about 3 months.

When Can I Return to Social Life and Work After HOLEP Surgery?

This may vary from person to person and also depends on the patient's social life and job. Those with more stable desk jobs can return to social life and work within 2-4 weeks. However, for those working in physically demanding jobs, this period is longer. Your urology doctor's recommendations will be decisive regarding the recovery process and returning to social life.

Is There an Age Limit for HOLEP Surgery, and Who Is Suitable for This Method?

There is no upper age limit for HOLEP surgery. On the contrary, it is considered a safe method for elderly patients and those with additional health conditions.

Patients who use blood thinners and those who do not benefit despite using prostate medications can undergo HOLEP surgery without any age limit.