Holmium Laser Enucleation of the Prostate
What is Holmium Laser Enucleation of the Prostate?
Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive surgical procedure designed to treat benign prostatic hyperplasia (BPH), a condition marked by an enlarged prostate gland that can disrupt normal urinary function.
Holmium Laser Enucleation of the Prostate (HoLEP) is effective across all prostate sizes and offers a durable solution with a low likelihood of needing retreatment. This procedure is increasingly preferred for its ability to significantly improve urinary flow and reduce complications compared to traditional methods.
How Holmium Laser Enucleation Works?
Holmium Laser Enucleation of the Prostate (HoLEP) uses a holmium laser to remove enlarged prostate tissue. The procedure involves inserting a scope through the urethra to reach the prostate.
The laser then cuts and enucleates the prostate tissue, which is subsequently removed through the urethra using a morcellator. This technique minimises damage to surrounding tissues and seals blood vessels to reduce bleeding, thereby enhancing its effectiveness as a treatment for BPH.
Indications
Holmium Laser Enucleation of the Prostate (HoLEP) is indicated for patients with benign prostatic hyperplasia (BPH) who experience moderate to severe urinary symptoms that significantly impact their quality of life. These include:
- Significant urinary retention that cannot be managed effectively with medication.
- Frequent urinary tract infections due to incomplete bladder emptying.
- Bladder stones or recurrent bleeding linked to BPH.
- Patients who prefer a minimally invasive option often choose HoLEP for its quicker recovery and fewer long-term complications compared to traditional surgical methods.
Benefits of Holmium Laser Enucleation
Holmium Laser Enucleation of the Prostate (HoLEP) offers several benefits that make it a preferred treatment option for benign prostatic hyperplasia (BPH):
-
Effectiveness Across Prostate Sizes
HoLEP is effective for prostates of any size, providing a flexible treatment option.
-
Reduced Risk of Bleeding
The holmium laser seals blood vessels as it operates, significantly reducing the risk of bleeding.
-
Rapid Symptom Relief
Patients typically experience rapid improvement in urinary symptoms and quality of life following the procedure.
-
Minimal Recurrence
Removal of obstructive tissue minimises the chance of symptom recurrence.
-
Quick Recovery
Patients can often return to normal activities more quickly than after traditional prostate surgery.
Possible Side Effects and Complications
While Holmium Laser Enucleation of the Prostate (HoLEP) is generally considered safe, there are potential side effects and complications associated with the procedure:
- Temporary Urinary Symptoms: Patients may experience mild discomfort, urgency, or frequent urination shortly after surgery. These symptoms typically resolve within a few weeks.
- Retrograde Ejaculation: This occurs when semen enters the bladder instead of exiting through the urethra during ejaculation. It is a common side effect but does not affect sexual pleasure.
- Urinary Tract Infection (UTI): As with any procedure involving the urinary tract, there is a risk of infection, which may require antibiotic treatment.
- Need for Re-treatment: While the need is rare, some patients may require additional procedures if symptoms reoccur, despite thorough tissue removal.
- Rare Complications: More severe complications, such as urethral stricture (narrowing of the urethra) or bladder injury, are uncommon but possible.
Patient Preparation
Effective preparation is essential for optimising outcomes with Holmium Laser Enucleation of the Prostate (HoLEP). Here are the key preparatory steps for patients:
Medical Evaluation and Medication Review
Patients undergo a comprehensive assessment that includes reviewing their medical history and a physical examination to ensure suitability for the procedure. This review also covers all current medications, with particular attention to anticoagulants or blood thinners that may need adjustment.
Diagnostic Testing
Necessary pre-procedure tests such as urine analysis, blood tests, and imaging studies like ultrasound or MRI of the prostate are conducted to assess the prostate's size and condition.
Fasting
Patients are usually required to fast for several hours before the surgery if anaesthesia is to be used.
Get an Accurate Diagnosis & Proper Treatment
for Your Urological Conditions
What to Expect in Holmium Laser Enucleation?
Understanding the steps of the Holmium Laser Enucleation of the Prostate (HoLEP) procedure can help patients prepare for what to expect during and after the treatment:
Anesthesia Administration
The type of anaesthesia used (local, regional, or general) depends on the procedure's extent and the patient's comfort and health. This ensures a pain-free experience throughout the surgery.
The Procedure
A scope is inserted through the urethra to access the prostate. The holmium laser is then used to enucleate, or core out, the obstructive prostate tissue, which is subsequently removed with a morcellator.
Monitoring Post-Procedure
After the surgery, patients are moved to a recovery area where their vital signs and overall condition are closely monitored to manage immediate postoperative issues.
Discharge
Most patients can go home the same day, though some might stay overnight for observation depending on their health and the complexity of the procedure. Before discharge, they receive detailed instructions on post-operative care, including medication, activity restrictions, and signs of complications to watch for.
Recovery and Post-Procedure Care
Recovery from Holmium Laser Enucleation of the Prostate (HoLEP) involves key steps to ensure optimal outcomes:
-
Immediate Post-Procedure
Expect temporary symptoms like discomfort, urinary urgency, and blood in urine, which improve within a few weeks.
-
Activity Limitations
Avoid strenuous activities for a couple of weeks. Resume normal activities gradually.
-
Hydration and Diet
Increase fluid intake to help flush the bladder and avoid irritants like caffeine and spicy food.
-
Follow-Up Visits
Essential for monitoring healing and evaluating the procedure's effectiveness in relieving urinary symptoms.
-
Monitoring for Complications
Watch for signs such as severe pain, fever, heavy bleeding, or urinary difficulties, and seek medical attention if they occur.
Dr Lee Fang Jann 
Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders
He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).
- Bachelor of Medicine and Bachelor of Surgery (Singapore)
- Membership of The Royal College of Surgeons (Edin)
- Master of Medicine (Surgery) (Singapore)
- Fellowship of the Academy of Medicine (Urology)
- Clinical fellowship at Oxford Transplant Centre in the UK
Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.
Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.
Our Clinic Locations
Farrer Park Medical Centre, #08-05
1 Farrer Park Station Rd, Singapore 217562
Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm
3 Mount Elizabeth, #11-16 Medical Centre, Singapore 228510
Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm
Frequently Asked Questions
Can HoLEP be performed on patients who have had previous prostate surgeries?
HoLEP is suitable for patients who have undergone previous prostate surgeries, including those who have had treatments that were not successful.
How long does the actual HoLEP procedure typically take?
The duration of the HoLEP procedure varies depending on the size of the prostate and specific patient conditions, but it generally takes 60 to 120 minutes.
Is there an age limit for undergoing HoLEP?
There is no strict age limit for HoLEP. Suitability is more dependent on the patient’s overall health and the severity of their symptoms rather than age alone.
What is the success rate of HoLEP in treating BPH?
HoLEP has a high success rate, with many studies reporting significant and sustained improvement in urinary symptoms and flow rates post-procedure.