HoLEP (Holmium Laser Enucleation of the Prostate) is an endoscopic enucleation of the prostate using laser. It is the most modern, minimally invasive solution for the treatment of Benign Prostatic Hyperplasia in patients of any age, aiming to relieve them of BPH symptoms (reduced urinary flow, frequent urination, urgency, nocturia). It is performed in modern medical centres by experienced surgeons.
Urologist Dr. Angelos Economides, using the state-of-the-art Holmium Laser System and with specialized training in this technique, removes the entire adenoma, not just part of it. This is why the technique is considered the reference method for large prostates. It is the only endoscopic technique that gives a result equivalent to open prostatectomy, without any incisions in the abdomen.
While in the resection technique used for smaller glands the tissue is removed gradually, layer by layer, with the enucleation method the entire adenoma is detached from the surgical capsule, exactly as happens in open surgery, and is then removed. The result is more complete and more durable over time.
Depending on the size of the gland, the HoLEP Laser technique avoids open surgery, in which, as the gland grows larger, the surgical time and the risk of bleeding increase disproportionately.
With the laser enucleation technique, prostates ranging from 40g up to 200g can be treated.
Urologist Dr. Angelos Economides, using the state-of-the-art Lumenis Pulse 120H Holmium Laser System and with specialized training in this technique as well as in all modern endoscopic techniques for treating BPH, recommends, on an individualized basis for each patient, the best technique for their particular case.
The HoLEP technique is indicated when:
- The prostate is large and other endoscopic techniques have limitations
- There is a history of urinary retention or a permanent catheter
- Obstructive and irritative symptoms are severe and immediate, definitive relief is required
- The patient is on anticoagulant therapy — laser haemostasis is very good
- A previous procedure has already been performed and the tissue has regrown
How the procedure is performed
The procedure is performed endoscopically through the urethra, without incisions, under general or spinal anaesthesia. Using the laser beam, the adenoma is detached from the surgical capsule and pushed into the bladder. There, a special tool morcellates and suctions the tissue out of the bladder. Its advantage over vaporisation is that the removed tissue is sent for biopsy. This is an important advantage, because it can reveal a coexisting cancer that had not been diagnosed.
After the procedure, a catheter is placed for one to two days. Hospital stay is usually one to two days, and the catheter is removed within that period. Return to daily work occurs after about one week, while lifting weights and strenuous exercise are avoided for four weeks.
Advantages of HoLEP Laser
- Complete removal of the adenoma
- Minimal blood loss
- Short catheter duration
- Short hospital stay
- Very low rate of need for re-intervention over the years
- Tissue available for histological examination
- Erectile function is not affected
Side effects & Complications
As with all enucleations, resection and vaporisation techniques, retrograde ejaculation is common. In the first few weeks, temporary urgency or urge incontinence may occur, which gradually subsides over 1–2 months. Irritative urinary symptoms gradually subside within four to eight weeks. The method has a demanding learning curve, so the surgeon’s experience is decisive for the outcome.
