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HoLEP: the gold standard for the surgical management of BPH in the 21st Century

October 27, 2019 , by brojen barman

Dr Brojen Barman MBBS, MS, MCh(Urology),

Consultant Urologist and Kidney Transplant Surgeon

Health City Hospital, Khanapara,Guwahati,Assam

What is HoLEP surgery ?

The prostate gland sits around the urethra as it leaves the bladder and, when it enlarges, it may block the flow of urine .HoLEP involves telescopic “shelling out” of the central part of the prostate using a laser to create a wide channel which allows urine to flow more easily.

Details of the procedure

HoLEP is done normally under general anaesthetic or a spinal anaesthetic.An injection of antibiotics before the procedure is given,a resectoscope is inserted through the urethra and a laser fibre cut away pieces of prostate tissue which are then flushed into the bladder. We morcellate and suck out the pieces of prostate, using a special instrument passed into your bladder .The prostate fragments are sent for pathology analysis .A catheter is placed into the bladder at the end of the procedure .Normally bladder irrigation through the catheter is used to flush through any clots or bleeding .

Normally the catheter is removed on the first or second day.

Are there any after-effects?

Complications are rare after HoLEP surgery . Some of the complications includes :temporary mild burning, bleeding and frequent urination, no semen is produced because it passes back into your bladder on ejaculation (retrograde ejaculation), continuing blood in your urine for several days, loss of urinary control which may be temporary or permanent, injury to the urethra causing narrowing which may require further surgery

Is HoLEP better than TURP?

For many years, transurethral resection of the prostate (TURP) has been accepted as the gold standard to surgically alleviate obstructive voiding dysfunction in men with benign prostatic hyperplasia (BPH). This historical standard has been challenged repeatedly over the last decade by consistent data demonstrating the superiority of Holmium enucleation of the prostate (HoLEP).

Our setup and experience:

We have 100 watt holmium laser with stortz resectoscope and morcelloscope,lumenis morcellator. We have started a HoLEP program in July 2019 and the results have been very satisfactory.

References

  • 1.Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, Valenti S, Vavassori I, Rigatti P. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004;172:1926–9.
  • 2. Vincent MW, Gilling PJ. HoLEP has come of age. World J Urol. 2015;33:487–93.
  • 3. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53:160–166.

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