HoLEP: A New Solution for Benign Prostatic Hyperplasia (BPH)

HoLEP: A New Solution for Benign Prostatic Hyperplasia (BPH)

By: Advanced Urology (Singapore) Dr. Lie Kwok Ying

When it comes to treatment of the prostate, most patients typically want to avoid invasive procedures. When Mr. H, a patient suffering from benign prostatic hyperplasia (BPH) was told that he will benefit from transurethral resection of the prostate (TURP), he did some research and decided to undergo HoLEP (Holmium Laser Enucleation of the Prostate), a newer established technique for treating BPH.

Typically, a normal prostate is about the size of a walnut, weighing about 20 grams. But with BPH, the prostate can get as big as a grapefruit and weigh as much as 100-200 grams, choking off the urethra, so the urine cannot flow normally. Despite its prevalence – BPH affects up to 50 percent of men between the age of 51 and 60 and up to 90 percent of men older than 80 – many of the current procedures available to treat the condition don’t work well for men with very large prostates, including TURP. With TURP and other surgical procedures, you are limited as to how big a prostate you can operate on. The bottom line is that it is very difficult to cut away adequate tissue when you’re dealing with a very large prostate.

The advantages of HoLEP are that you can treat a prostate of any size, with no incisions, less bleeding, a shorter hospital stay, abundant tissue for analysis and good long-term functional results. The excess tissue is also removed more completely than with TURP, which means there is less need for repeat treatment. Indeed, while the retreatment rate of TURP is over 5 percent, with HoLEP, it approaches zero. Furthermore, HoLEP can be safely performed on patients who are on blood thinners such as antiplatelet agents.

Dr. Lie Kwok Ying performed a HoLEP on Mr. H, who was discharged from the hospital the next day. Within two weeks or so, he was mostly back to normal and was able to fly back home. Best of all, after his surgery, he does not need to take any BPH medications which he has been on for the past 8 years.

What are the advantages of HoLEP?

  • Symptom improvement – severe urinary symptoms become mild or non-bothersome. As men pass urine more quickly, they spend less time in the toilet and empty their bladders more completely and pass urine less often
  • The improvement lasts longer than any other BPH procedure
  • No upper size limit of the prostate. The only endoscopic procedure is recommended for men with prostates more than 100cc. Any size or shape of the prostate can be treated unlike other procedures
  • Often less bleeding than after a TURP
  • Discharge is often quicker than TURP at 1-2 days
  • Unlike greenlight laser operations, large quantities of prostate tissue sent for pathological analysis
  • For men with urinary retention, HoLEP is a very effective form of treatment
  • Can be performed on patients who are on blood thinners

Disadvantages of HoLEP

  • Needs specialised equipment and training
  • Possible temporary stress urinary incontinence

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