Men: Learn about modern laser treatment for enlarged prostate (HoLEP)!

As we age, especially after the age of 50-60, a common but somewhat annoying health problem that many of our men face is the need to urinate frequently. Not only during the day, but also at night, we have to get up two or three times without even sleeping well. Sometimes when we go to urinate, it is difficult to start, the flow is slow, and even after we finish, we feel like there is more. Are these symptoms familiar to you? Then the main reason for this may be that your prostate gland or `(Prostate)` gland is a little enlarged. This is called `(Benign Prostatic Hyperplasia)` or `(BPH)` for short in medical science. So, in this article, we are talking about a very successful, modern laser surgery that is now available for this annoying condition.

Simply put, what is HoLEP?

The full meaning of HoLEP is `(Holmium Laser Enucleation of the Prostate)`. Although the name is a bit complicated, what happens in this is very simple. Imagine that the prostate gland is located around the tube (`(Urethra)`) that urine comes out of your bladder. In the case of BPH, this gland gradually grows and blocks that urethra. It's like someone squeezing a water pipe. That's when it becomes difficult for urine to come out.

So HoLEP is a surgery that uses a high-tech laser beam to delicately remove excess prostate tissue that is blocking the urethra. The biggest feature of this is that it is a ``minimally invasive`` surgery. That is, this surgery is performed by inserting a delicate instrument through the urethra, without making a large incision in the abdomen. Therefore, the strain on the body is minimal, and the recovery time is very fast.

Who needs HoLEP surgery?

Not everyone with an enlarged prostate needs surgery. Many people can manage their symptoms with medication. However, in some cases, surgery is best. Here are some situations where your doctor may recommend surgery:

• If your symptoms are not relieved by medication.
• If the symptoms interfere a lot with daily life.
• If you have frequent urinary tract infections (UTIs).
• If bladder stones develop.
• If the kidneys are affected due to improper urination.

Below are some of the symptoms that are commonly caused by BPH.

What should you do before surgery?

If you decide to have HoLEP surgery, your doctor will examine you carefully. This will usually include the following:

• Medical history: The doctor will ask about other illnesses you have and the medications you are taking.
• Physical examination: A special examination is performed to get an idea of ​​the size of the prostate gland.
• Lab tests: A blood test to check the level of PSA (Prostate-Specific Antigen) in the blood and a urine test (Urinalysis) to check for urinary tract infections may be done.
• Other special tests: Sometimes the following tests may also be required.

How the surgery is performed step by step

HoLEP surgery is usually done under general anesthesia, meaning you are completely asleep. This means you won't feel anything. For some people, it can be done with a spinal anesthetic that numbs only the lower back.

These are the main steps in the surgery:

1. Anesthesia: After you are completely asleep, you will be placed in an appropriate position in the operating room.

2. Insertion of the instrument: The surgeon inserts a thin instrument called a resectoscope, which has a camera on the end, through your urethra. This camera allows the prostate gland to be seen clearly on a screen.

3. Use of laser: Next, a laser beam is sent through the device. This laser is used to finely cut the extra tissue of the prostate gland that is blocking the urethra and separate it from the main gland. This is called `(Enucleation)`. One advantage of the laser is that it seals the blood vessels that carry blood while cutting the tissue. Therefore, bleeding is very minimal.

4. Tissue removal: The cut pieces of tissue are pushed into the bladder, and then another instrument called a ``Morcellator'' is used to cut the pieces into smaller pieces and scrape them out.

5. Tissue examination: The tissue pieces removed are sent for laboratory testing to see if there is anything abnormal, such as cancer cells.

6. Catheterization: Finally, all surgical instruments are removed and a urinary catheter is placed to help urine drain properly.

This surgery usually takes about one to three hours, which can vary depending on the size of your prostate.

What to expect after surgery?

After the surgery, you will be in the recovery room for a few hours and can usually go home the same day or the next day. You will only need to stay in the hospital for a day or two if there is any bleeding.

These things are normal after surgery:

• Catheter: You will be sent home with a catheter in place. This catheter is usually removed the next day. If you are able to urinate well two or three times after the catheter is removed, there is no problem. If not, you may need to have a catheter reinserted in a few days.
• Pain and burning: It is normal to feel some pain and burning when urinating in the early days. The doctor will prescribe painkillers for this.
• Blood in the urine: It's completely normal to have a little blood in your urine that's mixed with pink or light red for a few weeks. Don't worry about it. This can vary depending on how much you're doing and how much water you're drinking.
• Drink water: After removing the urethral catheter, you should drink plenty of water . This will help the blood in your urine to decrease quickly.
• Control: It may be a little difficult to control your urine at first. You may leak a few drops when you laugh, cough, or lift something heavy. This will go away in a few weeks. Your doctor may recommend doing Kegel exercises to help with this.
• Symptoms: Symptoms such as frequent urination and urgency may take several months to fully improve, as the bladder takes some time to adjust to this new situation.

Benefits, side effects, and risks

Like any surgery, HoLEP has benefits as well as minor risks and side effects.

How long will it take to heal?

Recovery after HoLEP surgery is relatively quick.

• Walking and Driving: You can walk the same day after surgery. You can also start driving in a few days.
• Going back to work: If you have an office job, you can return to work in a week or two. If you have a physically demanding job, you will need to rest for a while.
• Exercise and weight lifting: Avoid lifting weights over 5 kg for at least two weeks. Avoid strenuous exercise such as running for at least two weeks.
• Special warning: It is important to avoid activities such as cycling and motorcycling for at least six weeks .

When do you need to talk to the doctor?

Although some things are normal after surgery, you should contact your doctor immediately if you experience any of the following symptoms:

• If you have large blood clots in your urine or if your urine turns a dark red color like tomato sauce .
• If the fever is higher than 101°F (38°C).
• If you have severe pain that cannot be controlled even with painkillers.
• If you are unable to urinate .

What is the difference between HoLEP and TURP?

You may have also heard of a surgery called TURP (Transurethral Resection of the Prostate). This is another surgery to remove an enlarged prostate. The main difference is the method of removing tissue. In TURP, instead of a laser, pieces of tissue are cut out using an electric wire.

HoLEP surgery is generally considered to be more beneficial than TURP because it involves less bleeding, a shorter hospital stay, and a lower risk of the prostate growing back and requiring surgery. However, your doctor will decide which surgery is best for you.