Is your prostate gland enlarged and making it difficult to urinate? Let's learn about HoLEP laser surgery! (Holmium Laser Enucleation of the Prostate - HoLEP)

As men age, it becomes a little more difficult to urinate , right? The urethra becomes weak, there is a frequent need to urinate, or it feels like it can't be finished. The main reason for this is that the prostate gland is a little bigger. We call this condition BPH ( Benign Prostatic Hyperplasia ). So today we are talking about the latest, most successful and safest treatment for this.

Simply put, what is HoLEP surgery?

HoLEP (pronounced 'ho-lep') is a special laser procedure that treats urinary obstructions caused by an enlarged prostate. Think of your prostate as a rubber band around a water pipe. As you age, the gland swells and enlarges, putting pressure on that water pipe (your urethra). This makes it difficult to urinate.

HoLEP surgery involves inserting a laser beam along the urethra with a small camera, without any incisions, to carefully remove the excess tissue in the prostate that is obstructing the flow of urine. Since there is no incision in the skin , the recovery time is very short.

What are the common symptoms of BPH?

Take a look to see if you have any of these symptoms. If you have one or more of these, it is very important to talk to your doctor.

What happens before the surgery?

If your doctor decides that you are suitable for HoLEP surgery, you will need to undergo several tests before the surgery. These are done to accurately assess your condition.

• Medical consultation: The doctor will ask about your medical history and examine your prostate.
• Blood and urine tests: In addition to routine blood tests , a PSA (Prostate-Specific Antigen) test may be performed.
• Urinary flow tests: Tests that measure the speed and volume of your urine stream.
• Scans : An ultrasound or CT scan can accurately determine the size of the prostate gland.
• Cystoscopy: A thin tube with a small camera is passed through the urethra to examine the inside of the prostate and bladder.
• Urodynamics test: A special test that checks how your bladder is functioning.

You will be asked to stop taking some blood-thinning medications (e.g., Aspirin, Clopidogrel) about 10 days before the surgery. You should also avoid eating or drinking after midnight the night before the surgery. Your doctor will explain all of this to you clearly.

How is HoLEP surgery performed?

Don't be alarmed by this. You won't feel anything. The entire surgery is done under general anesthesia, which means you're completely asleep. Or you can have it done with a spinal anesthetic that numbs just the area below your waist.

1. After you are anesthetized, the doctor will insert a thin instrument called a `resectoscope` down your urethra. This has a camera on it so that the prostate gland can be seen clearly.

2. Next, a laser beam is sent through the device, which very finely cuts away the extra tissue in the prostate gland that is obstructing the flow of urine. At the same time, the blood vessels that carry blood are also sealed with this laser.

3. Then the laser is removed, and another device called a `morcellator` is inserted, which sucks up all the cut tissue pieces and removes them from the body.

4. Very important: The tissue removed in this way will be sent for a laboratory test (biopsy) to see if there is anything abnormal, such as cancer cells.

5. Finally, all the instruments are removed and a urinary catheter is inserted.

This surgery usually takes between 1 and 3 hours.

What happens after the surgery? How is the recovery period?

Most of the time, you can go home the same evening as the surgery. Sometimes, you may have to stay in the hospital for one day.

• Catheter: The catheter placed after surgery is usually removed the next day. Once the catheter is removed, you can go home if you are able to urinate well. It is normal to initially experience some burning, pain, and frequent urination.
• Blood in your urine: It's completely normal for your urine to be pink with a little blood for a few weeks . Don't worry about it. The more water you drink, the clearer your urine will become.
• Control: At first, it may be difficult to control urine. This means that a little bit of urine may leak when you laugh or cough. As the doctor says, doing `Kegel exercises` (exercises that tighten the muscles of the lower abdomen) can help a lot. This condition will almost completely improve in a few weeks.
• Rest: You can walk and drive the day after surgery. However, avoid strenuous activities such as lifting weights or running for two weeks . Avoid riding bicycles or motorcycles for six weeks .

Benefits, side effects, and risks of HoLEP surgery

Compared to other surgeries, HoLEP has many advantages. However, like all surgeries, there are some minor risks and side effects.

When to see a doctor immediately

If you experience any of the following symptoms after surgery, call your doctor immediately or go to the Emergency Department (ETU) at your nearest hospital.

• If your urine is dark red, like tomato sauce, and contains blood clots.
• Fever (over 38 Celsius / 101 Fahrenheit).
• If you have severe pain that does not subside even after taking medication.
• If you can't urinate at all.