Understanding HoLEP- Advancement In Treating Enlarged Prostate- Dr Jeevagan Murugesan

Benign Prostatic Hyperplasia (BPH), is a condition in which the prostate is enlarged causing difficulties or disturbances in normal voiding of the urinary bladder and is most commonly seen in men above 60 years. Symptoms include a frequent urge to urinate, an increase in the frequency of urination in the night, difficulty in passing urine, inability to empty the bladder completely, difficulty in initiating urine flow and even sudden block in urine flow requiring catheter insertion.

According to research, India has a 93.3% incidence of benign prostatic hyperplasia among the elderly. Studies also suggest that more than 50% of men around the world will have a history of the disease and it is expected to increase in elderly men. There have been several treatment methods to treat the condition. TURP (transurethral resection of the prostate) is an endoscopic method involving cutting a part of the enlarged prostate that projects into the urinary bladder into chips using monopolar or bipolar electrocautery. This is the most commonly done procedure. However, one of the more advanced techniques is the Holmium Laser Enucleation Of Prostate (HoLEP). This minimally invasive treatment uses a laser to remove the enlarged prostate tissue blocking the urine outflow. Those who have troubling urinary symptoms despite medications, recurrent urinary tract infections, hematuria (blood in urine), stone formation in the urinary bladder, and excessive urinary retention affecting the upper urinary tract will need HoLEP.

It is a safe and effective minimally invasive surgical procedure. The procedure is performed under general or regional anaesthesia and typically takes 1-2 hours to complete without any incisions on the body. The procedure is done through the urethra using Holmium fibre where the enlarged portion of the prostate is enucleated and pushed into the urinary bladder. The enucleated gland is then cut into small pieces using a morcellator and removed. A catheter is left in place for a short time after the procedure, usually for a day. HoLEP can be performed on a gland of any size that is causing symptoms. It is a newer gold standard for glands weighing above 70 grams. In fact, it is one of the preferred surgical options for elderly patients over the age of 80, in view of its safety profile. The procedure can also be performed safely in cardiac risk patients and also those who are on blood thinning medications.

HoLEP offers several advantages over conventional surgery for BPH. It has a much lower risk of bleeding because the laser seals blood vessels as it vaporizes the tissue, reducing the amount of bleeding during the procedure. The patients also have shorter hospital stays after the procedure and can return to normal activities within a few days. The laser used in HoLEP is very precise, which reduces the risk of complications such as urinary incontinence, erectile dysfunction, bladder neck contracture (narrowing) and post-operative urinary retention and hematuria, unlike TURP.

Although HoLEP is a safe and effective treatment option for BPH, it may not be suitable for all patients. It is important to discuss the risks and benefits with a qualified healthcare professional before deciding on a treatment plan. The procedure is a niche area, where very few urologists are trained to perform the surgery. It requires meticulous training and mentoring, in order to perform the procedure safely and effectively.