What is benign prostatic hyperplasia (BPH)

BPH, or benign prostatic hyperplasia, is a common condition that affects many men as they age. The prostate is a small gland located just below a male bladder, and it surrounds the urethra (the tube that carries urine out of the body). The prostate gland begins to enlarge and can cause urinary symptoms such as a weak stream, difficulty starting and stopping urination, and frequent trips to the bathroom, particularly at night. If left untreated, BPH can lead to serious complications such as bladder infections and urinary retention.

Treatment options for BPH include medication, minimally invasive procedures, and open surgery.

What is HoLEP surgery for BPH?

HoLEP (Holmium Laser Enucleation of the Prostate) surgery is a minimally invasive procedure that is used to treat symptoms of benign prostatic hyperplasia (BPH). This procedure utilises a holmium laser to remove the inner part of the prostate gland, providing relief from symptoms such as difficulty urinating, frequent urination and a weak urinary flow.

How HoLEP surgery is performed

HoLEP surgery is performed under general or spinal anaesthesia through the urethra (the tube that carries urine out of the body) and does not require an incision. A laser fibre is inserted through a small telescope and used to separate the enlarged prostate tissue from its surrounding capsule. The fragments are then suctioned out through a small instrument called a morcellator. The outer capsule of the prostate is preserved along with the nearby nerves for sexual function.

After the procedure

Following the procedure, patients can expect a quick recovery time, with most patients returning to most activities within a few days. There may be some discomfort during the first few days after the procedure, but this can be managed with pain medication. It is also common to experience some urinary symptoms such as urgency and frequency during the first few weeks after the procedure, but these should resolve over time.

Benefits of HoLEP surgery over other BPH treatments

HoLEP surgery offers numerous benefits over traditional BPH treatments, including:

• Quick recovery time: HoLEP surgery usually has a shorter catheter time and hospital stay and patients can return to their normal activities in a matter of days, compared to several weeks with traditional surgical techniques.

• Minimal blood loss: The holmium laser seals blood vessels as it cuts, reducing blood loss during the procedure and the need for blood transfusions. It is also possible to have this surgery whilst on blood thinning medication.

• No upper size limit: Traditional surgery such as transurethral resection of prostate (TURP) can only be safely used for glands up to approximately 100cc in size and more invasive surgery such as open or robotic surgery is performed for larger gland sizes. HoLEP can be used for any gland size with no upper limit.

• Low risk of complications: The precision of the minimally invasive laser reduces the risk of complications more frequently seen in TURP or open simple prostatectomy.

• Long-lasting results: HoLEP provides functionally better outcomes and long-lasting relief from BPH symptoms compared to other laser surgery such as greenlight laser (GLL). There is also more tissue removed on average by HoLEP compared to TURP.

Dr Sethi offers HoLEP as a treatment for benign prostate hyperplasia, as many studies now show this to be a new gold standard in surgical BPH treatment. He has gained extra skills in this technique through a fellowship in Hamburg, Germany.

Symptoms that you may need HoLEP surgery

Symptoms that may indicate the need for holmium laser enucleation of prostate (HoLEP) surgery are those associated with an enlarged prostate, or BPH, as discussed above.

Often, patients needing medical attention experience the following:

• Getting up at night to urinate
• Urinating frequently
• Uncontrollable urge to urinate
• Reduced or variable urine flow
• Difficulty starting or stopping urination
• Incomplete emptying after passing urine
• Straining or pushing to pass urine
• Dribbling after urination

Conclusion

Whilst HoLEP surgery is a highly effective and minimally invasive procedure for treating symptoms of BPH, there remain many treatment options available for an enlarged prostate. Dr Kapil Sethi uses the latest diagnostic tools and treatment options to effectively manage BPH. From lifestyle changes and medications, to minimally invasive procedures and surgery, he will customise a plan to meet each patient’s individual needs.