HoLEP surgery (Holmium Laser Enucleation of the Prostate) is one of the modern, closed surgical methods used in the treatment of benign prostatic hyperplasia (BPH). In this method, the prostate tissue is separated from the surrounding tissues using a holmium laser, and the excess prostate tissue blocking the urinary canal is completely cleared. It is an advanced technology treatment method performed by entering through the urinary tract, without the need for open surgery.
HoLEP offers an effective and permanent solution, especially in patients with moderate and advanced prostate enlargement. Today, it is accepted as one of the “gold standard” methods in the treatment of prostate enlargement.
In Which Situations Is HoLEP Surgery Performed?
HoLEP is usually preferred in the following situations:
- Prostate enlargement that does not benefit from medication
- Severe difficulty urinating
- Frequent urination and getting up to urinate at night (nocturia)
- Significant weakening of the urine stream
- Inability to fully empty the bladder
- Urinary retention (being unable to urinate at all)
- Recurrent urinary tract infections
- Stone formation in the bladder
It can be safely applied as an alternative to open surgery, especially in patients with a large prostate volume.
How Is HoLEP Surgery Performed?
HoLEP surgery is performed entirely with a closed method. The surgery can be done under general anesthesia or spinal anesthesia (numbing from the waist).
During the procedure:
- A thin camera is inserted through the urinary canal
- Using a holmium laser, the prostate tissue is separated from the capsule
- The obstructing prostate tissue is pushed into the bladder
- The separated tissue is broken up and removed with a special device called a morcellator
Thanks to this procedure, all excess prostate tissue narrowing the urinary canal is cleared, and urine flow is relieved.
Although the duration of the surgery varies according to the size of the prostate, it usually takes between 1 and 2 hours.
What Are the Advantages of HoLEP Surgery?
HoLEP has many important advantages over classic prostate surgeries:
- No need for open surgery
- No incision on the skin (closed method)
- The risk of bleeding is low
- It can be applied even in large prostates
- The hospital stay is short
- The recovery process is fast
- The likelihood of repeat surgery in the long term is low
In addition, the removed prostate tissue is sent for pathological examination to evaluate whether there is a hidden prostate cancer.
What Is the Postoperative Process Like?
After HoLEP surgery, patients are usually monitored in the hospital for 1 to 2 days. The urinary catheter is mostly removed within 24 to 48 hours.
In the postoperative period:
- Mild blood in the urine can last a few days
- Burning and frequent urination may occur temporarily
- Drinking plenty of fluids is recommended
- Heavy physical activities should be avoided
The majority of patients can return to their daily lives within 1 to 2 weeks. Full recovery is usually completed within 3 to 4 weeks.
Are There Risks to HoLEP Surgery?
As with every surgical procedure, HoLEP surgery also has some low risks:
- Temporary urinary incontinence
- Burning when urinating and frequent urination
- Risk of infection
- Rarely, bleeding
The majority of these complaints are temporary and improve over time. The rate of permanent complications is quite low.
Is Sex Life Affected After HoLEP?
After HoLEP surgery, there is usually no change in sexual desire. However, in some patients, “retrograde ejaculation,” that is, the semen flowing back into the bladder, may occur. This condition is not harmful but can change the sensation of ejaculation. Erectile function is preserved in most patients.
Who Is HoLEP Not Suitable For?
It may not be suitable for every patient. In particular:
- Patients with a serious general anesthesia risk
- Those with an active urinary tract infection (which must be treated first)
- Some special urological anatomical conditions
require a preliminary evaluation.
Summary
HoLEP surgery is a modern, safe method with a high long-term success rate in the treatment of benign prostatic hyperplasia. Because it is performed with a closed technique, provides fast recovery and is effective even in large prostates, it is one of the most preferred surgical options today. Together with correct patient selection, it provides significant improvement in urinary complaints and an increase in quality of life.
