Phone 03 9347 9911
Phone 03 9347 9911
Holmium Laser Enucleation of the Prostate, HoLEP is the telescopic removal of obstructing prostate tissue using a laser and temporary insertion of a catheter.
Reason for doing HoLEP
Blockage of the prostate can occur with ageing and influence of male hormones, it is often benign (BPH). Occasionally the operation is done to improve urine flow in prostate cancer. Complications of BPH itself include bladder overactivity, recurrent urine infection, bladder stones and blood appearing in the urine.
What occurs during the operation?
HoLEP is performed under a general or spinal anaesthetic and takes two to three hours.
A telescopic instrument is inserted through the urine passage (urethra), a laser is used to gently separate the obstructing prostate tissue from its surrounding capsule and to push it in large chunks into the bladder. An instrument is then used through the telescope to remove the prostate tissue from the bladder. A catheter is normally left to drain the bladder at the end of the procedure.
Potential complications of HoLEP
There is a risk of bleeding, mild burning, mild urethral scarring and frequency of urination.
Fertility WILL be affected because the ejaculate containing the sperm passes back into the bladder at climax rather than being expelled. This is called retrograde ejaculation and erectile function should be unchanged.
Incontinence sometimes occurs, but is usually mild and resolves within four to five weeks with pelvic floor exercises.
Retained tissue fragments floating in the bladder may require a second telescopic procedure for their removal (rarely).
What to expect post-operatively
After the operation, a catheter will drain the urine away. This may have some blood in it. Irrigating clear fluid may be run through the catheter to clear away blood and clots from the site of the operation. This normally clears within 12 hours.
Once the catheter has been removed (usually the next day), it is important to drink plenty of fluids to prevent clots forming.
Once the catheter has been removed most men are able to pass urine. There may be some initial discomfort due to the healing site and this could be accompanied with the need to urinate more frequently.These symptoms will settle in a few days. Also, when the catheter is first removed, the urge to urinate can be quite strong. This also tends to settle down over a few weeks.
Some of your symptoms of frequency may not improve for several months because this is often due to bladder overactivity, which takes time to resolve after prostate surgery. The bladder overactivity is a muscle problem due to the obstructed prostate.
If the obstruction is not relievedhowever this secondary bladder problem tends to progress and become more irreversible.
Occasionally, blood may be seen in the urine, it is important to increase the fluid intake until this disappears. If it persists, contact your GP immediately.
It is important not to overexert or strain for two weeks post-operatively as bleeding in your urine may re-occur. This includes heavy lifting, gardening, golf and other strenuous activities including driving in heavy traffic.
Avoid constipation. Straining may cause bleeding from the healing prostate. A mild laxative may be necessary if this is likely to be a problem.
Sexual activity may be resumed once full healing of the prostate has occurred, after your first post-operative visit which is usually after four weeks.