Holmium Laser Prostate Surgery (HoLEP)
Holmium Laser Prostate Surgery (HoLEP)
Benign prostatic hyperplasia (BPH) is a condition that often affects men over middle age. Half of 60-year-old men and 90% of 85-year-old men are affected by this condition. BPH may show a clinical course that starts with mild lower urinary tract symptoms and progresses to urinary retention (inability to urinate) and renal failure. Many different procedures are applied in the surgical treatment of BPH. Determining the most appropriate method for the patient will provide the best results after surgery and the least complication rates.
Prostate resection with Holmium laser was first described by Gilling and his friends in 1995, and a few years later; this method has been transformed into prostate enucleation. Recent studies have shown that HoLEP is more advantageous than other minimally invasive surgical methods. It has gained popularity and has become a preferred surgery worldwide for this reason.
Holmium laser technology is the most modern and successful treatment method of today, which is frequently used and preferred in the treatment of BHP (benign prostate enlargement). HoLEP Technology means that the prostate is stripped from the prostate capsule with laser. Although HoLEP has been a widely used method in the last 10 years, it has yielded very positive results in the treatment of prostate enlargement.
HoLEP surgery; In case of benign prostatic enlargement disease, it is considered necessary and applied in patients who cannot detect a significant improvement in the disease despite drug therapy, if the following situations are encountered:
• The patient has many complaints,
• Placing a catheter in the bladder due to the patient's inability to urinate (globe),
• High amount of urine (> 100 ml) remaining in the patient's bladder even after urinating,
• The occurrence of other problems such as infection, bleeding and stone formation, deterioration in kidney functions, whose symptoms do not disappear.
HOLEP SURGICAL TECHNIQUE
Holep operation is a surgical technique that can be applied under spinal anesthesia. The area where the prostate tissue is located is reached by entering the urethra (urinary canal) by means of a device called a 26 F diameter resectoscope. Prostate adenoma tissue, which grows and forms an obstruction by using holmium YAG laser energy with the help of laser fibers with a diameter of 550-600 microns, is entered between the prostate capsule and the adenoma tissue and stripped from the capsule. These tissues are thrown into the bladder in 2 or 3 pieces, depending on the technique. The prostate tissues in the bladder are separated into small pieces with the help of a separate device called a morcellator and taken out. The prostate parts taken out are sent to the pathologist for pathological evaluation and evaluated. The catheter of the patient, who is followed up in the hospital for 1 night after the procedure, is removed within 24 to 48 hours.
ADVANTAGES OF HOLEP SURGICAL TREATMENT
Since the HoLEP method is applied with the laser separation principle instead of burning with electrical energy, the patient with a probe does not experience a burning sensation called dysuria while urinating.
HoLEP surgery; patients can quickly return to their normal lives by getting rid of their catheter in a short period of 24 hours Since it offers advantages such as low risk of bleeding, short hospitalization period and rapid recovery process,.
Since the effect of HoLEP operation on healthy tissue is less than 0.4 mm, the nerves that pass around the prostate capsule and regulate sexual functions are not damaged. Therefore, postoperative erection problems are not expected in patients.
Since there is no burning defect in the tissues removed during HoLEP surgery, pathologists examine the tissue much more easily and the possibility of overlooking possible malignant formations is reduced.
Since the prostate tissue is completely removed with HoLEP technology, the risk of recurrence of the disease is very low.
Prostate enlargement surgery performed with HoLEP technology is an operation in which spinal anesthesia (numbing below the waist) is considered sufficient.
In surgeries treated with laser, the patient loses less blood thanks to the laser's ability to control bleeding. In addition, prostate surgery with HoLEP technology is a method that can be successfully applied for those who have heart and liver diseases and therefore use blood thinners.