HOLEP (Laser Enucleation of the Prostate)
This technique was first described in 1998 in New Zealand. Currently its performance is accepted and recommended by the main international urological guides, although due to its technological requirements and its great technical complexity, it is only performed in highly specialized centers.
It is said that the prostate has an anatomy similar to that of an orange, with a peel and segments (the prostatic adenoma). When these «segments» grow, they obstruct the urethra and cause BPH.
In HoLEP, surgery is performed through the urethra. The surgeon looks for the boundary between the «shell» of the prostate and the «segments», cutting with the laser while coagulating the remaining surface, achieving a precision and absence of bleeding unattainable with other surgical techniques.
At the end, all the resected tissue is introduced en bloc into the bladder, crushed or «morcellated» so that it can be extracted and analyzed, thus ruling out the presence of prostate cancer.
Likewise, if there are bladder lithiasis, holmium is the only laser capable of pulverizing it and extracting it together with the prostate tissue, in the same surgical act.
Advantages of HoLEP over other surgical techniques.
- Absence of abdominal incision
- Unlimited prostate size
- Minimal surgical bleeding
- Early tube removal and short hospital stay.
- Complete and permanent removal of the adenoma.
- Histological analysis
- Treatment of bladder stones
- Excellent short and long term results
- Absence of recurrence and re-interventions due to BPH.
Side effects and complications of HoLEP
BPH surgery is one of the most risky surgeries and one that generates the most complications for the patient. Thanks to HoLEP these are reduced to a minimum:
- Blood transfusion, bladder perforations or urinary sepsis (<1%).
- Urinary obstruction due to residual fragments (<3%).
- HoLEP does not cause erectile dysfunction.
- Absence of semen during ejaculation (80%)
- Urinary incontinence for a few weeks (10%)
- Urethral stricture or inability to urinate (<1%)
- Permanent urinary incontinence (<1%)