Sri Ramakrishna Hospital, department of Urology, has done Holmium Enucleation of Prostate (HoLEP) for the prostate size from 90 gm to 260 gm in one endoscopic surgery with excellent results associated with negligible complications. Typically prostate sizes more than 120 gm require open surgery for complete removal of the prostate.
One 260 gm, one 160 gm, and one 140 gm prostate were successfully operated with HoLEP avoiding open prostate surgery. Open prostate surgery is associated with an increased risk of bleeding, post-operative pain, long hospital stay, delay in return to work and normal life also leaves the patient with a lower abdominal scar all these problems are avoided with HoLEP. Patients on blood thinners (antiplatelet drugs) for cardiac, neuro, and vascular problems are much benefitted from HoLEP as these drugs can be restarted the very next day. HoLEP is a boon to patients with BPH who need surgical intervention, according to a press release.
Benign Prostatic Hyperplasia (BPH)
The prostate is a male accessory gland of size 20 gm located just below the bladder and around the urethra. Prostate gland enlarges in size after the age of 40 years. Degree of enlargement varies from individual to individual; it is independent of food habits and lifestyle.
Acute Urinary Retention
Sudden inability to pass urine or empty the bladder. A catheter needs to be inserted into the bladder to help drain the urine.
Recurrent Urinary Infection
The presence of retained urine in the bladder increases the risk of urinary tract infection.
Renal Failure
Increased residual urine in the bladder increases the pressure in the bladder, ureter, and to the kidneys. This leads to a condition called obstructive uropathy, if not treated on time patient will end up in renal failure which may be reversible may not be reversible.
Chronic Urinary Retention
Patients with BPH symptoms if not addressed early will gradually accumulate urine in large quantities more than the capacity of the bladder. Eventually, the bladder will lose its emptying capacity and will end up in a lifelong indwelling urinary catheter. In those patients surgery for the enlarged prostate may not be helpful.
Holmium Laser Enucleation of Prostate (HoLEP)
HoLEP is a highly advanced endoscopic surgical procedure done for patients with an enlarged prostate who need surgical intervention. Not all the patients with BPH need surgery. About 70% to 80% of BPH patients do well with medical treatment which is to be continued for life like wearing a spectacle for vision. Approximately 20% to 30% of patients with BPH will need surgery.
HoLEP is a type of laser prostate surgery in which anesthesia is given and the patient stays calm and relaxed. Antibiotics are given to avoid the risk of infection. A surgical instrument called a resectoscope with a LASER working element is inserted through the urethra connected to a camera which helps to have a magnified vision of the surgical field. High high-power Holmium Laser is then passed through the working element and used to detach the entire prostate from its outer shell called a prostatic capsule.
During the detachment of the prostate bleeding vessels are simultaneously sealed. Prostatic tissue detached into the bladder. After the laser process, a morcellator is used to suck the tissue out of the bladder. Once the tissue is removed resectoscope is removed and a urinary catheter is inserted into the bladder and then the patient is kept under observation for a couple of hours to a day or two.
