From the Guidelines
Yes, Holmium Laser Enucleation of the Prostate (HoLEP) can improve bladder function, particularly in patients with benign prostatic hyperplasia (BPH) and overactive bladder (OAB) symptoms. HoLEP is a minimally invasive surgical procedure that uses a laser to remove excess prostate tissue, alleviating pressure on the urethra and bladder, and improving urinary flow and reducing bladder-related symptoms. According to the most recent guideline evidence 1, men with OAB predominant lower urinary tract symptoms (LUTS) and BPH have shown significant improvements in maximum flow rate (Qmax), post-void residual (PVR), and the presence of detrusor overactivity after HoLEP. Additionally, patients have experienced significant improvement in International Prostate Symptom Scores, frequency, urgency, nocturia, and urinary incontinence. The procedure has been compared to other surgical therapies, such as transurethral resection of the prostate (TURP) and photovaporization of the prostate, and has been found to have similar efficacy and safety profiles 1. Some key benefits of HoLEP include shorter catheterization and hospitalization times, reduced blood loss, and fewer blood transfusions compared to TURP 1. However, it's essential to note that while HoLEP can improve bladder function, it may not be suitable for all types of bladder problems, and patients should consult with a urologist to determine if HoLEP is appropriate for their specific condition. Key points to consider when evaluating HoLEP for bladder function improvement include:
- Significant improvements in Qmax, PVR, and detrusor overactivity
- Improved International Prostate Symptom Scores, frequency, urgency, nocturia, and urinary incontinence
- Similar efficacy and safety profiles compared to other surgical therapies
- Shorter catheterization and hospitalization times, reduced blood loss, and fewer blood transfusions.
From the Research
Holmium Laser Enucleation of the Prostate (HOLEP) and Bladder Function
- HOLEP is a surgical procedure used to treat benign prostatic hyperplasia (BPH) and has been shown to improve bladder function in patients with BPH 2, 3, 4, 5, 6.
- The procedure involves the removal of the prostate tissue that is blocking the flow of urine, which can help to improve bladder function and reduce symptoms of BPH 2, 3.
- Studies have shown that HOLEP can improve voiding parameters, such as flow rate and postvoid residual, and can also reduce the risk of complications, such as urinary retention and incontinence 4, 5.
Predictors of Urgency Improvement after HOLEP
- A history of acute urinary retention (AUR) has been identified as a predictor of urgency improvement after HOLEP 4.
- Patients with a history of AUR are more likely to experience an improvement in urgency symptoms after HOLEP, suggesting that the procedure may be particularly beneficial for this subgroup of patients 4.
Comparison of HOLEP to Other Surgical Procedures
- HOLEP has been compared to other surgical procedures, such as transurethral resection of the prostate (TURP) and simple open prostatectomy, and has been shown to have similar or better outcomes in terms of improving bladder function and reducing symptoms of BPH 2, 3.
- HOLEP has also been compared to holmium laser ablation of the prostate (HoLAP) and has been shown to have similar outcomes in terms of improving bladder function and reducing symptoms of BPH 6.
Complications of HOLEP
- While HOLEP is generally considered to be a safe and effective procedure, it can be associated with complications, such as urinary incontinence, urethral strictures, and bladder wall injury 3.
- However, the risk of these complications can be minimized with proper patient selection and surgical technique 3.