Holmium laser enucleation of the prostate (HoLEP) is a method for treating benign prostatic hyperplasia, or BPH. Naren Nimmagadda, assistant professor of urology, explains the procedure, which uses a light beam called a holmium laser to remove the interior tissue of the prostate and relieve bladder obstruction.
So a whole lip conceptually is different from a Turp or green light laser, uh which is the more common approaches to manage P P H or prostate bladder A obstruction. The difference though is that when I'm sitting there doing a turp, I'm going layer by layer by layer, either with an electric loop or knife or with a laser essentially shaving inside of the prostate. The problem is is that that energy that's used to cut the tissue or vaporize the tissue does leave a significant amount of char behind and it's difficult to tell what's the edge of the prostate and what's the capsule of the prostate or what's still a residual prostate tissue. Additionally, you can't sit there going layer by layer by layer, removing tissue in very large prostates. So at some point, a urologist has to call it quits. And so they look at the space and they the eyeball and then they say, OK, that looks open enough and that is basically all that we rely on to uh say a surgery is complete, but that doesn't mean that surgeries that, that, that, that the prostate tissue is all gone. And so this is a prostate tissue that could regrow back with time. Or if somebody's in retention, that residual prostate tissue could still cause persistent retention. And that's where the difference with the, with the hold up is, is that from the very beginning of the surgery, I cut to the outside of the prostate and then I work outside to end as opposed to inside, to out the best patients for homi laser Nucleation. The prostate or hop are patients who have voiding symptoms related to presumably an enlarged prostate. Men may present differently as you've experienced. Some men might have urinary frequency and urgency while other ones may have more of a voiding complaint where the stream is weak, they might strain to urinate or they might, the urine stream might start and stop. Both of those camps of men are ideal for evaluation and if they're either interested in medicine, but not sure if they want to take medicine for a long term, they could, they might want to consider surgery or if they've already tried medications for a long period of time and they're not happier. Those uh, symptoms are progressing, then that would be reasonable for, for an evaluation. There are certain situations where I push men more towards getting surgery done. Those will be situations where they can't urinate at all. Then they have a catheter in place where they have to intermittently catheterize if they're having recurrent urinary tract infections because of because of urinary stasis, presumably they have recurrent gross hematuria, they're having bladder stones or they're starting to see kidney deterioration because of the pressures in their bladder from holding on to uh increasing volumes of urine. So typically after ho lips, uh I always see patients about six weeks after the surgery. Usually this is to just provide some reassurance to tell them that the symptoms they are experiencing are expected. Those symptoms could be more frequency and more urgency than their baseline, intermittent gross human material and also some incontinence, I reinforce kegel exercises to help them go through that incontinence period faster. And by the time I see him again, usually somewhere in that three month or six month window of time that incontinence has gotten better or has resolved. Very rarely do I have to send patients to pelvic floor physical therapy. And if somewhere in that 3 to 6 month window of time, they still have to bother some urine leakage. I do incorporate the the various providers in the area who specialize in pelvic floor physical therapy. And the other thing I checked for after surgery is their P S A. It's not uncommon that we find some focus of prostate cancer in the tissue that I remove after a whole. It, most of the time that prostate cancer tends to be a low grade kind that tends to be managed with active surveillance, but it does make both you and I more comfortable with an active surveillance approach. If we saw a dramatic decline in the P S A and then I use that postoperative P S A to then follow them as if uh for usual P S A screening guidelines, I usually return patients back to their primary care physician if they're doing well at that, after that six month time frame, uh should scar tissue develop. It's pretty unusual might happen in one or 2% of patients. And they usually come back to me saying, well, doc for the first couple of months, I was peeing really well, a nice strong stream and then the streams tapered down. At that point. I would do a cystoscopy uh in, in under a local uh and just take a peek and see if scar tissue were to develop and if it did, it's easily managed with a non invasive solution again.