Spire Thames Valley Hospital is delighted to be able to offer a modern alternative to the standard TURP, a Holmium Laser Enucleation of the prostate (HoLEP). It is fully endorsed by the National Institute of Clinical excellence *NICE) in the UK for the treatment of urinary symptoms or bladder outflow obstruction due to benign prostatic hyperplasia (BPH).
Fully endorsed by the UK's National Institute of Clinical Excellence (NICE)
It requires a short in-patient stay and a general anaesthetic. A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to avoid straining or heavy lifting for four weeks after the surgery.
Who is it suitable for?
HoLEP can be performed on men of any age with urinary symptoms caused by an enlarged prostate. It is particularly indicated in men with large prostates (over 60cc in size) and men on medications to thin the blood such as warfarin, aspirin or clopidogrel.
What are the advantages of HoLEP?
- There is no upper size limit of prostate that can be dis-obstructed – traditionally men with prostates over 100cc in size needed major open surgery
- There is less bleeding than after a TURP
- Discharge is usually quicker than after TURP often the next morning
- The chance of recurrence requiring further surgery is very lower than a TURP
- Unlike greenlight laser operations, large quantities of prostate tissue are sent for pathological analysis
- The PSA (blood test) generally drops to very low levels after HoLEP operations
What are the disadvantages of HoLEP?
The procedure takes slightly longer than a TURP and requires specialist training.
How does it work?
The aim of the HoLEP operation is to relieve pressure on the tube through which the urine drains (urethra) by anatomically enucleating the majority of excess benign prostate tissue. This is done under a general anaesthetic with the help of a telescopic camera inserted through the penis. The three lobes of the prostate that are cored out intact are pushed into the bladder before being sucked up (morcellated) by a special instrument inserted through the telescopic camera. The pieces are sent for laboratory analysis just in case they might be found to be cancerous. A catheter is placed into the bladder to drain the urine while the raw surface heals, then left in place for around 24 hours before being removed on the day of discharge from hospital. Sterile saline fluid may be irrigated into the bladder through the catheter to dilute any blood in the urine and prevent clots from forming but is often not required.
It is normal to have some blood in the urine after this operation, so it is advisable to drink plenty of water for a few days while it clears. Clots are sometimes passed 10-14 days afterwards; again, this is part of the healing process.
Apart from this and the risk of infection that accompanies any operation or invasive procedure, it is important to be aware that normal ejaculation ceases in 70% of patients. This is because the contraction that occurs during orgasm may not completely block the entrance to the bladder once some tissue has been removed, and the semen will flow back into the bladder (“retrograde” or “dry” ejaculation) rather than out through the penis. This is not harmful, but it does mean that future fertility is greatly reduced. The procedure has a very low risk of of affecting erectile function or continence, although the urinary symptoms may take a few weeks to settle down afterwards.
Alongside our highly experienced surgeons, At Spire Thames Valley Hospital we pride ourselves in providing a high standard of pre and post-operative care with outstanding clinical facilities for both day cases and overnight stays.
If you are interested in knowing more about the benefits of laser prostate treatments at the Spire Thames Valley Hospital then call us on 01753 665 404 or complete our online form on the right-hand-side of this page.