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(HoLEP) Laser Prostatectomy

Holmium laser enucleation of the prostate or HoLEP is a form of laser used to remove blocking tissue from the prostate gland in patients with prostatic symptoms. It is used when medications have not been effective, or are causing side effects. It can be used as the first treatment in patients with severe symptoms, or those in retention of urine.

HoLEP has been used for over 15 years worldwide, and over 10 years in the United Kingdom. It is a NICE approved treatment. This article aims to answer some of the common questions patients ask regarding the treatment, and the clinical experience of users around the world.

Who would be suitable for HoLEP?

Male patients with lower urinary tract symptoms. This includes a slow stream, dribbling on the trousers after passing urine, having to wait for the urine to come out, and also to agree a degree, those who get up at night to pass urine and those going frequently and urgently during the day. Your urologist will make the final determination as to whether you are a candidate.

How does it work?

The laser is used as a ‘laser scalpel’ to cut out from within the blocking prostatic tissue. This is dropped into the bladder, and these pieces are chopped up and removed. A catheter is placed overnight. Most of the prostatic tissue is removed and it is an extremely efficient way of removing blockages. All patients having surgery on the prostate gland may have up to 6 weeks’ worth of bladder symptoms afterwards, but as they settle, initial symptoms are usually found to be a lot better. 

Why is it called enucleation?

The procedure is called enucleation because, unlike other laser techniques which burn the prostate tissue away, the laser is used like a knife, cutting out the tissue via the water pipe. There are no cuts in the skin and because of the way it works, there is little problem with bleeding. Unlike the old TURP operation, Patients usually go home same day or the next day. The rate of problems with erections after this operation is extremely low.

How long does it last?

There is evidence to suggest that the procedure will last as long as an open operation with good results, still, at 15 years.

What happens if it wears off?

The evidence is that the operation is as effective as open operating at 15 years, and this true in all prostate sizes. There is a low rate (1%) of a scar in the waterpipe, which is the commonest further operation needed. In a proportion of patients the bladder can slowly fail to squeeze as well as one gets older, and so bladder function testing (Urodynamics) would be offered to check this if symptoms came back.

What happens if it does not work?

If the effects wear off, the commonest but still rare issue is a stricture. Your urologist will reassess the water pipe and sort out the problem. Occasionally, regrowth of the prostate gland can get in the way and need further treatment. Alternative treatments include medication, open surgery and some of the newer techniques to either staple or stem treat the prostate gland. 
HoLEP is the only treatment licensed approved by NICE for prostates which are over 100ml.

Will I still need to use prostate medication?

If you are taking tamsulosin you will be able to stop this. You can stop finasteride or dutasteride if you wish, but it may prevent further problems which your urologist will discuss with you.

Content provided by Mr Stuart Graham Consultant Urologist Rivers Hospital and Director of Endourology Barts Health NHS Trust


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