HoLEP – Holmium Laser Enucleation of the Prostate

Rate of bladder outflow obstruction disease has almost doubled in the last few decades. According to recent studies, majority of men above 50 years of age are suffering from this disorder all across the world. This disorder may give rise to dreadful prostate cancer. Holmium laser surgery for prostate is considered an ideal alternative treatment solution for bladder outflow obstruction caused due to a benign prostatic hyperplasia. Bladder outlet obstruction is a condition that causes blockage at the base of the bladder. It prevents the normal flow of urine into urethra, which is a tube that carries urine out of the body. HoLEP is a non-invasive treatment method & is more convenient & efficient than a traditional transurethral resection of the prostate (TURP). It is a faster treatment procedure than other alternative treatment methods such as conventional open-type surgery.

What is Holmium Laser Enucleation for Prostate?

Prostate is a vital part of the human reproductive system. Prostate is basically a plum-sized gland which is found in men that produces nutrients for the sperm, which make up part of semen when they ejaculate. With aging process, men’s prostate cells start to swell & which eventually expand the size of prostate. This condition is called as benign prostatic hyperplasia (BPH), signifying extra growth of normal (non-cancerous) cells. This is not mostly a serious issue, but sometimes prostate enlarges so much that it puts pressure on the urethra. In long term, this can severely damage their kidneys & bladder. HoLEP is a non-invasive surgery which involves removal of the obstructive part of prostate as is seen in conventional surgical treatment but without the need for any incisions.

Causes of Enlarged Prostate

In men, urine flows normally from the bladder through urethra. BPH is a benign enlargement condition of the prostate, which is non-cancerous & blocks the flow of urine through the urethra. Prostate cells constantly reproduce, resulting in an enlargement that creates pressure on the urethra. As urethra contracts, the bladder has to adjust more strenuously to excrete urine through the body. Eventually, the bladder muscle may grow thicker, stronger & overly sensitive. It may start to contract even when it contains fewer amounts of urine, causing a feeling to frequently urinate.

Signs & Symptoms of Enlarged Prostate

HoLEP eliminates obstructive part of the prostate. An enlarged prostate can be troublesome but it can be identified with the help of the following common symptoms.

  • Weak Urinary Stream – Slow or weak urinary stream may indicate an enlarged prostate. Patients may find difficulty starting urination.
  • Incomplete Bladder Emptying – A feeling of partial emptying of bladder is noticed more often in patients with an enlarged prostate.
  • Frequent Urination – Patients observe an urgency to urinate. They may get up frequently from sleep at night to urinate.
  • Straining to Urinate – Patient’s urinary stream develops a pattern that starts & stops. Constant dribbling of urine is common. Patients get an urge of returning to urinate again minutes after finishing.

When patient’s bladder does not empty appropriately, they develop a risk for urinary tract infections & prostate problems such as prostate cancer.

Good Candidates for Holmium Laser for Prostate Treatment

Men of any age can undergo holmium laser treatment for prostate that causes urine obstruction due to an enlarged prostate. It is especially ideal for men with large-sized (60 cm & more) prostates as well as for men taking blood-thinning medications.

Advantages of Holmium Laser for Prostate Treatment

There are several distinct advantages of using holmium laser treatment therapy for removal of enlarged prostates in men, as compared to other more conventional treatment methods. Some of these are listed below.

  • It can help break down large-sized prostates with more efficiency & ease.
  • There is less bleeding than it is in traditional TURP.
  • Hospital stay time is considerably reduced.
  • Prostate enlarging disorder is less likely to recur after this treatment.
  • Large quantities of prostate tissue samples can be sent for pathological analysis.
  • PSA (prostate-specific antigen) usually decreases to very low levels after this treatment

Preparing for Holmium Laser Enucleation for Prostate Cancer

HoLEP has proved to be a less invasive alternative to traditional methods of removing prostate obstructions. HoLEP additionally preserves removed tissue for microscopic pathological examination including presence of prostate cancer.

  • Pre-Surgery Counselling – When patients speak to their respective doctors or oncologists, they will be thoroughly examined & if whether they need HoLEP surgery or not will be determined based upon specific tests.
  • Physical Fitness – Pre-assessment sessions will be done by doctors where they will assess patient’s fitness & their suitability for HoLEP surgery under anaesthesia. Patients have to pass this test in order to proceed with HoLEP surgery.
  • Smoking – Patients should stop smoking prior to HoLEP surgery because it increases risk of developing either a chest infection or deep vein thrombosis condition. Apart from this, smoking also delays wound healing after completion of surgery.
  • Alcohol – Patients can consume alcohol but in limited amounts in order to avoid any post-surgery complications.
  • Medications – Patients should honestly tell the oncologist regarding the medications they are presently taking.

Questions to Ask Oncologist/Surgeon about HoLEP Surgery

Before undergoing HoLEP surgery, patients should clearly understand the procedure & have realistic expectations from this surgery.

  • What is the reason behind my enlarged prostate?
  • Why do I need HoLEP surgery?
  • What are the major benefits of HoLEP surgery for me?
  • Are there any risks & major complications associated with my HoLEP surgery?
  • What are the other problems that I might experience after HoLEP surgery?
  • What are the alternatives to HoLEP surgery?
  • What does this procedure of HoLEP involve?
  • What precautions do I need to take before HoLEP procedure?
  • What happens during HoLEP surgery?
  • What will happen immediately after HoLEP surgery?
  • What should I expect when I get home after my surgery?
  • When can I go back to my daily routine activities?
  • When will I have a follow-up session?
  • Are there any other significant points that I should look out for?

Holmium Laser Surgery Procedure for Prostate Cancer

Goal of holmium laser enucleation of prostate (HoLEP) treatment is to relieve pressure from urethra that is used to drain urine by essentially enucleating the major portion of the additional benign prostate tissue. Procedure for HoLEP surgery involves the following important steps.

  • Anesthesia – This surgery requires administering general anesthesia to the patient in order to reduce pain as well as discomfort during treatment.
  • Insertion of Camera – Surgeons will use a viewing device made of a thin & flexible tube attached with a tiny video camera at its end. This camera is inserted from the penis.
  • Suction Device – Surgeons will then push the three intact and cored-out lobes of the prostate into the bladder before removing them by using suction from a special minimally invasive suction device. Subsequently, prostate tissue samples are usually sent to a pathological laboratory to check if the benign enlargement is being caused due to a cancerous growth.
  • Catheter – Surgeons will then fix a catheter to the bladder for 1 – 2 days so as to allow urine to avoid passing over the raw surface of urether prior to getting easily discharged from the body.
  • Completion – At the end of the procedure, the surgeon will use sterile saline solution & insert it into bladder through the catheter in order to dissolve any blood in urine as well as to prevent blood clots from forming.

Recovery Following HoLEP Surgery

After completion of HoLEP surgery, patients should keep in mind the following points.

  • Let the healthcare staff know if there is any discomfort
  • Ask if the target which was planned has been achieved or not
  • Patients should ask how to take care of themselves after getting discharge from hospital
  • Feel free to clear any doubts & queries or discuss any concerns with the ward staff & surgical team

Patients, generally do not experience any pain from HoLEP surgery, but they may have some sort of discomfort from the catheter. Some men notice contractions of bladder or spasms caused by the catheter brushing against the muscle (trigone) inside of the bladder. These contractions result in urine passing down the corners of the catheter which may expose into patient’s underwear. Spasms may also make patients have a severe urge to pass urine, which can be very distressing at times. These symptoms are usually seen for few days, mostly 10 – 12 days after surgery. In case of such events, patients should contact the surgeon, as these symptoms can be relieved quite easily. Heavy weight lifting should be avoided for a couple of weeks or so following HoLEP surgery. However, light exercises can be performed when patients feel comfortable. Patients can recover faster when they seriously obey guidelines given by the doctors. Follow-up sessions are equally important. Apart from these, positive attitude & strong will-power to heal will definitely help patients attain a speedy & successful recovery.

Risks & Complications Associated with HoLEP Surgery

Following is a list of common risks & complications associated with HoLEP surgery.

  • Urinary Frequency & Urgency – Patients may experience this condition after the HoLEP procedure. These symptoms generally diminish within six to ten weeks of time.
  • Urinary Infection – Patients may observe several symptoms such as blood in urine, pain or burning feeling while passing urine; but these can be precisely treated with help of antibiotics. This happens to about six in every 100 patients.
  • Retrograde Ejaculation – This is not a harmful condition, but patient’s semen may leave the bladder next time they pass urine & may make also urine appear cloudy. This condition, generally, occurs in about six in 10 men undergoing HoLEP surgery. However, patient’s fertility may be affected.
  • Erectile Dysfunction – Nerves which control patient’s erections are very close to the prostate gland. Near about 15 in 100 patients notice a slight deterioration in erections but which will generally respond to medication. However, about three in 10 men will experience that erectile function significantly enhanced because their life has improved following HoLEP surgery.
  • Bleeding – There is extreme bleeding with holmium laser treatment when compared with other procedures for enlarged prostate conditions. When bleeding is serious, patients may require blood transfusion, but this is very rare.
  • Prostate Re-growth – Patient’s prostate may continue to enlarge even after HoLEP surgery and if symptoms persist, patients may need to undergo another surgery in future.

HoLEP Surgery Outcomes

Usually, HoLEP surgery has a high success rate. Removal of prostate does not adversely affect patient’s sex life provided they were getting normal erections before HoLEP surgery. Sexual activity can be resumed as soon as patients feel comfortable. Patients can perform floor exercises in long-term & flow of urine will be improved. Outcomes of any tissue eliminated will be available after 15 – 20 days. Patients can lead a healthy life after their HoLEP surgery. These benefits can be summarized as follows.

  • Effective procedure
  • Rapid recovery
  • No metabolic or electrolyte complications
  • Ability to destroy bladder stones if any present
  • Improved quality of life

Merits of Medical Tourism in India for HoLEP Surgery

India is at the forefront of medical tourism industry as of now. Patients from different developed countries travel to India to seek healthcare treatments because hi-class facilities are available at economical rates in India. Indian hospitals are well-furnished with top-class amenities & infrastructure. Prostate enlargement is becoming a monstrous problem which may eventually result in prostate cancer in many patients across the world. Holmium laser is more efficient & accurate in removing the obstructive portion of the prostate. This effective & less-invasive treatment procedure is being practiced by skillful surgeons of India with high success ratio. Holmium laser for prostate is fast becoming the preferred choice of surgeons & prostate cancer specialists from around the world & is being used more commonly & widely today due to its various distinctive advantages including less pain during surgery, less recovery time required, no incisions & shorter hospital stay as well.

Affordable HoLEP Surgery with Travcure Medical Tourism

Travcure Medical Tourism is a leading healthcare facilitator in India which is associated with top Indian oncologists, surgeons & renowned cancer hospital facilities. At Travcure, international patients are not merely just viewed as customers, but they are treated with utmost compassion because their dreams & hopes relating to their treatments are extremely important. Travcure assists these global guests right from the beginning of their medical journey to a hassle-free successful outcome till the time they fly back home.

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