What is Laser operation for the prostate?
HOLEP or Holmium laser prostatectomy is a modern alternative to TURP (Trans Urethral Resection of Prostate), the traditional operation for the prostate. In HOLEP, holmium laser energy is used to cut the prostatic tissue. This energy is absorbed by water and the subsequent heat generated in the tissues coagulates blood in vessels, achieving precise cutting and excellent control over bleeding. The plane between the capsule and the glandular tissue is dissected to scoop out the prostate which is dropped into the urinary bladder and then cut into smaller pieces by an instrument called a morcellator. After this, all the tissue is washed out of the bladder and sent to the pathologist for examination.
What are the advantages of HOLEP?
The purported advantage of HOLEP over a TURP is the lesser amount of bleeding. This is possible because of a more efficient control over bleeding by the laser and the technique of enucleation whereby the tissue is cut only once as compared to repeated cuts in a TURP. Since saline is used for irrigation, the likelihood of dangerously low sodium levels which are occasionally seen after TURP is unlikely.
As compared to some of the other lasers, HOLEP allows the pathologist to examine tissues which is of vital importance in the age group of men who present with enlarged prostates.
Can the surgery be done on antiplatelet medications like Tab. Clopidogrel?
While HOLEP can be done while taking Tab. Clopilet, we would prefer to stop it for 5-7 days before surgery. If a patent is taking Tab. Ecosprin, it can be continued.
What should I expect after a HOLEP?
At the end of the surgery, a catheter is inserted through the opening of the penis to drain urine from the bladder into a collection bag. Urine is drained this way for a few days allowing the surgical wound to heal undisturbed. In some instances, your bladder may be irrigated (flushed with water) via the catheter to keep it clean. Once irrigation has stopped, you may notice that your urine is a little red. Don’t be alarmed as some bleeding is normal. It should clear up by the time you are discharged from the hospital which is usually 2-3 days after the surgery.
What are the complications of the procedure?
While HOLEP is considered a safe procedure; like any other surgery, it has some inherent risks. The likelihood of bleeding requiring transfusion is around 1%. The risk of loss of control over urine is transient in most cases and resolves over a few weeks. The likelihood of this persisting at 1 year after surgery is around 1%. Retrograde ejaculation is seen in most patients. Complications like urinary tract infection and urethral stricture may be rarely encountered.
Taking care of yourself after the operation?
- Following TURP, you will not experience too much discomfort. You should avoid lifting heavy objects or strenuous exercise for three to four weeks after surgery
- Many patients notice a pinkish tinge to the urine immediately following the operation. Check with your doctor if the blood seems excessive. You may also experience a burning sensation when urinating for a few days.
- During the fortnight or so after surgery, blood may reappear in the urine for a short time. If this occurs, drink plenty of water and limit activity. But do not exceed two liters of water a day. Try not to drink before you go to bed, or you may be awakened by a full bladder otherwise.
- It is advisable to refrain from sex for a month or so. Do continue your annual prostate examination as prostate cancer can still appear from the remnant in the capsule.
- There are usually no specific dietary restrictions. However, you should take lots of roughage/fibre and fruit to ensure smooth bowel movement, without straining.
- Campbell Urology 11th edition, Chapter 105.