Holmium laser enucleation prostate (HoLEP) how performed

Escrito por: Mr Andrew Ballaro
Publicado:
Editado por: Cameron Gibson-Watt

HoLEP is the operation of choice for men with large prostates causing obstruction to their urine flow. This type of laser surgery removes blockages of urine flow without having to make any incisions on the body.


In this article, Mr Andrew Ballaro, a senior consultant urologist in North London and Essex, aims to provide you with a quick overview of this minimally invasive procedure and what you can expect both during the operation and recovery.

 

 

What is HoLEP?

Holmium laser enucleation of the prostate (HoLEP) is an operation designed to remove the overgrown inner part of the prostate that is blocking the flow of urine from the bladder. HoLEP is used to treat patients with:

 

  • Urinary retention (unable to pass urine)
  • Catheter problems
  • Bothersome urinary symptoms
  • Poor urinary flow
  • Blood in the urine caused by large prostate

 

 

How is HoLEP performed?

HoLEP is a minimally invasive procedure that is performed from within the urethra. It is carried out under a general anaesthetic where you are unconcious or a spinal anaesthetic in which you are awake but numb from the waist down. It is typically a day case or overnight stay procedure and lasts between 60-180 minutes, depending on the size of the prostate.

 

During the procedure, a specialized laser beam is used to gently separate the obstructing prostate tissue from the tough outer prostate capsule - similar to removing the fruit of an orange from the inside leaving the peel. The tissue is then fragmented in the bladder and removed through the urethra leaving just the capsule. This removes the obstruction and results in a dramatically improved urine flow, and a big improvement in urinary symptoms overall.

 

How safe is HoLEP surgery?

Every operation carries a degree of risk, however HoLEP is the safest and most effective method of removing a very overgrown prostate. In fact, if the prostate is exceptionally large HoLEP is the only procedure recommended. Studies have shown that more tissue is removed safely during HoLEP compared to all other techniques, including transurethral resection of the prostate (TURP) and blood loss is minimal as the laser seals blood vessels instantly. Furthermore, it can even be performed for patients on blood thinners.

 

HoLEP has been in existence since the 1980s and is a tried and tested technique. It is approved by NICE and when performed for large prostates has been shown to result in greatly reduced length of hospital stay and complication rates compared to TURP. Furthermore, the benefit from the operation lasts longer as more prostate tissue is removed.

 

How long does it take to recover from HoLEP?

Most patients leave hospital the day after surgery without a catheter and are able to pass urine well. It may take a few weeks for urinary symptoms to settle down, however, patients are up and about the next day.

 

Most patients will require 1-2 weeks before returning to work and driving again. You should also avoid lifting heavy objects and physical straining during this time.

 

How much does HoLEP cost?

The cost of HoLEP varies according to which hospital you have it at, however they are similar to the costs of standard TURP. The procedure is usually fully covered by medical insurance companies.

 

If you are interested in this procedure, book an appointment with Mr Andrew Ballaro through to his Top Doctors profile.

Por Mr Andrew Ballaro
Urología

Andrew Ballaro es un urólogo privado y con gran experiencia en el NHS y se especializa en el diagnóstico y tratamiento de todos los problemas urológicos, incluida la sangre en la orina, las infecciones urinarias , la prostatitis , la enfermedad general de la próstata y la vejiga, y el diagnóstico de cánceres urológicos , incluida la investigación de casos elevados. PSA con resonancia magnética Biopsia de próstata . Tiene especial experiencia quirúrgica en el tratamiento de la enfermedad de cálculos urinarios y la hiperplasia benigna de próstata ( HPB ). Constantemente publica resultados líderes para operaciones complejas de cálculos y ofrece todos los tratamientos que van desde ondas de choque y láser hasta mini PCNL para cálculos renales . También ofrece una selección de procedimientos quirúrgicos para el agrandamiento prostático benigno, incluida la prostatectomía con láser de holmio ( HOLEP ) y el tratamiento con vapor Rezum . Tiene un título de investigación doctoral en vejiga hiperactiva y atiende a muchos pacientes con esta afección. Tiene clínicas los miércoles y viernes en el Hospital de St John y Elizabeth en St Johns Wood y también realiza consultas en lugares de Essex y cuenta con el apoyo de un equipo directivo amable y receptivo.

El extenso entrenamiento del Sr. Ballaro comenzó después de graduarse de la Escuela de Medicina del Royal Free Hospital en Londres y realizar su entrenamiento quirúrgico básico en Oxford. Fue galardonado con una beca del Royal College of Surgeons of London y completó una formación urológica superior en el Plan de Capacitación del Norte de Londres. Esto fue seguido por una capacitación avanzada en cirugía de cálculos complejos por parte de expertos nacionales e internacionales en su campo.

El Sr. Ballaro tiene un gran interés en la educación, actualmente enseña a los alumnos en el Decanato de Londres en muchos niveles, además de recibir una cátedra Hunterian del Royal College of Surgeons of England. Tiene una Maestría en Urología y un MD en Ciencias Clínicas del Instituto de Urología y ha publicado extensamente sobre el tema de la cirugía urológica mínimamente invasiva. Es coautor de la última edición del popular libro de texto para estudiantes de medicina 'Lecture Notes in Urology'.

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