Column for Hürriyet Newspaper dated 06.11.2020

HoLEP surgery is the process of removing the enlarged prostate tissue from its capsule endoscopically using holmium laser energy.

This method, which is one of the most up-to-date surgical methods used in the treatment of prostate hyperplasia and has become popular in Europe and America in a short time due to its superiority over other treatment methods, has taken its place as the gold standard treatment method in Urology Guidelines.

What is benign prostate hyperplasia?

Benign prostatic hyperplasia (BPH) is the situation where the prostate growing with age blocks the outlet of the bladder (urine bag) around it and prevents urine flow. This situation causes problems with urination in about half of men in their 50s and 60s, and in 90% of men in the older age group. Complaints such as weak urine flow, intermittent urination, feeling of incomplete voiding, frequent urination, waking up at night, sudden urgency, blood in the urine are the main symptoms. In advanced and delayed cases, it is an important health problem that causes serious problems up to kidney failure as well as impairing the comfort of life of the patient.

What is HoLEP surgery?

The term for HoLEP surgery is “Holmium Laser Enucleation of Prostate”, which means the removal of the enlarged prostate inner tissue (adenoma) from the capsule with the help of laser. This is done by entering through the urinary canal through an endoscope without any incision. The prostate tissue separated from its capsule with the help of laser is then separated into very small pieces in the bladder and taken out.

What is its advantage over open prostate surgery?

This procedure is actually performed according to the principles similar to open prostate surgery. However, unlike open prostate surgery, it is performed completely closed without any incision. Compared to open prostate surgery, the amount of bleeding is much less, the duration of catheter stay and hospitalization time is shorter. Patients can return to their daily life in the early period by experiencing a much more comfortable and rapid recovery process compared to open surgery. Since it is performed under wide vision by seeing directly with the eye, there is no tissue left inside, so better results are obtained compared to open prostate surgery.

What advantages does it provide over other closed techniques?

This technique has significant advantages over other closed prostate surgeries (such as TUR and Greenlight). Since the whole part of the prostate tissue outside the capsule is removed with this surgery, the risk of recurrence of the disease is almost negligible. Since the prostate tissue cannot be completely removed in operations performed with closed methods such as TUR and Greenlight, the results are not satisfactory, especially in large prostates. The prostate tissue remaining in these surgeries can grow over time and cause similar complaints again after a while.

Does it cause urinary incontinence and sexual dysfunction?

Tissue depth affected by the laser energy used in HoLEP surgery is very small. For this reason, it does not affect the nerves that are outside the prostate and provide erection (hardening), so postoperative sexual dysfunction does not occur. Since the structure we call the sphincter that allows us to keep urine is outside of the area we intervened and is protected in this surgery, problems such as urinary incontinence are not observed after the procedure.


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