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Holmium Enucleation of the Prostate (HoLEP)

What is Holmium Enucleation of the Prostate (HoLEP)?

HoLEP is a NICE approved 21st century method of removing obstructing tissue from the prostate, using a laser.  It is associated with fewer complications than TURP (Transurethral Resection of the Prostate) and can be done as a day case.  It's published results are equivalent to open operations to remove the centre of the prostate.

When is this operation performed?

HoLEP is performed for the same reasons as TURP; it is a physical debulking operation to remove obstructing tissue from the middle of the prostate that is causing urinary symptoms such as:

  • Retention of urine.
  • A poor flow.
  • Dribbling on the trousers after urination.
  • Waiting a long time to start passing urine.

 It may be helpful in:

  • Urgency and frequency of urination.
  • A feeling of not being empty.
  • Getting up at night to pass urine.

How is HoLEP performed?

This is usually as a day case or overnight stay.  Your urologist will perform a procedure beforehand to assess the size of your prostate called a transrectal ultrasound.  On the day of the operation, you may have a general anaesthetic or a spinal anaesthetic.  If you have the latter, you will need to wear special goggles during the operation to protect your eyes from the laser light.

A camera will be inserted into the penis and a laser used, a bit like a knife, to core out the central portion of the prostate gland.  This is pushed into the bladder and converted into chips which are removed and sent for analysis.  You will have a catheter fitted afterwards which will be removed later the same day or up to five days later based upon the amount of tissue removed.

What are the benefits of this operation?

Traditional TURP uses a fluid called glycine which has issues with blood dilution.  HoLEP uses saline, so this does not happen.  Bleeding rates are generally significantly less with HoLEP and studies show that the proportion of tissue removed is significantly greater than TURP leading to better long term results.  To date, NICE have only recommended HoLEP by a suitably mentored urological surgeon.


Author: Mr Stuart Graham BSc MBBS FRCSEd FRCS(Urol)

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