From the Guidelines
Holmium Laser Enucleation of the Prostate (HoLEP) therapy is a highly effective and safe minimally invasive surgical procedure for treating benign prostatic hyperplasia (BPH), with similar mid- to long-term efficacy to other procedures such as Monopolar Transurethral Resection of the Prostate (M-TURP) and Open Prostatectomy (OP) 1.
Procedure Overview
HoLEP involves using a holmium laser to remove excess prostate tissue that is blocking urine flow. The procedure is typically performed under general anesthesia and takes 1-2 hours.
Key Benefits
The benefits of HoLEP include:
- Reduced blood loss and fewer blood transfusions compared to M-TURP 1
- Shorter catheterization and hospitalization times 1
- Similar urethral stricture and stress urinary incontinence rates to M-TURP 1
- Preservation of sexual function, with similar short- and mid-term erectile function changes to TURP, and significantly better long-term IIEF scores 1
- Low risk of incontinence, with attempts to maintain ejaculatory function successful in up to 46.2% of patients 1
Indications and Contraindications
HoLEP can be safely performed in patients taking anticoagulant and/or antiplatelet medications, although robust evidence regarding this practice is lacking 1. It is effective for prostates of any size and can provide long-lasting symptom relief.
Comparison to Other Procedures
HoLEP has been compared to other procedures such as B-TURP, OP, and ThuLEP, and has been found to have similar efficacy and safety profiles 1. However, the choice of procedure ultimately depends on individual patient factors and surgeon preference.
Post-Procedure Care
Patients typically stay in the hospital overnight and can return to normal activities within 1-2 weeks. A urinary catheter is often needed for 1-2 days after the procedure.
Conclusion is not needed as per the guidelines, the above information is based on 1.
From the Research
Definition and Overview of HoLEP
- Holmium Laser Enucleation of the Prostate (HoLEP) is a surgical procedure used to treat symptomatic Benign Prostatic Hyperplasia (BPH) 2, 3, 4, 5, 6.
- It is considered a size-independent gold standard for the surgical management of BPH, regardless of prostate size 3, 6.
- HoLEP has many advantages over traditional surgical modalities, such as open prostatectomy and transurethral resection of the prostate (TURP) 2.
Surgical Technique and Evolution
- The HoLEP procedure involves the use of a holmium laser to enucleate the prostate, followed by mechanical tissue morcellation 2.
- The technique has undergone significant changes since its introduction in 1998, including advancements in laser technology, endoscopic morcellators, and surgical technique 2.
- The modified 2-lobe and en-bloc techniques are considered a natural progression from the classic 3-lobe technique 2.
Efficacy and Safety
- HoLEP has been shown to be a safe and effective surgical treatment for symptomatic BPH, with durable long-term outcomes 3, 4, 5, 6.
- The procedure has a low immediate complication rate, and incontinence is rare 4.
- Retrograde ejaculation occurs in approximately 75% of patients 4.
- The retreatment rate for HoLEP is lower than reported for other endoscopic BPH procedures, demonstrating its durability 4.
Patient Selection and Outcomes
- HoLEP can be applied to the majority of patients with bladder outlet obstruction (BOO) from BPH, regardless of prostate size, previous operations, or detrusor condition 4.
- Patients with an important preoperative symptom burden or high post-voidal residue (PVR) should be carefully counseled on the risk of symptom recurrence 5.
- Predictors of symptom recurrence after HoLEP include preoperative PVR and International Prostate Symptom Score (IPSS) 5.