Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to the standard Transurethral Resection of the Prostate (TURP) procedure for bladder outflow obstruction due to BPH. It requires a short period of hospitalisation and an anaesthetic. A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.
What are the advantages of HoLEP?
- There is no upper size limit of prostate that can be dis-obstructed – traditionally men with prostates over 100ml in size needed major open surgery
- There is often less bleeding than after a TURP
- Discharge is often quicker than after TURP at 1-2 days
- The chance of recurrence requiring further surgery is very low
- Unlike greenlight laser operations, large quantities of prostate tissue are sent for pathological analysis
- The PSA generally drops to very low levels after HoLEP operations
Why TURP is carried out?
TURP is often recommended when prostate enlargement (benign prostatic hyperplasia) causes troublesome symptoms and fails to respond to treatment with medication.
Symptoms that may improve after TURP include:
- Problems starting to urinate
- A weak urine flow or stopping and starting
- Having to strain to pass urine
- A frequent need to urinate
- Waking up frequently during the night to urinate (nocturia)
- A sudden urge to urinate
- Being unable to empty your bladder fully
How TURP is performed?
TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts (incisions) need to be made in your skin.
The loop of wire is then heated with an electric current and is used to cut away the section of your prostate that is causing your symptoms. A thin tube called a catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.