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Treatment for an Enlarged Prostate

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Men with large prostates usually report symptoms of a weak urinary stream, difficulty urinating, incomplete emptying of the bladder, etc. For men with enlarged prostates who are not interested in taking medications or are not experiencing an improvement of their symptoms with medication have another option - a surgery called Holmium laser enucleation of the prostate, also known as HoLEP. This laser procedure removes the part of the prostate that is causing blockage of the urinary tract.

This procedure is unique because it uses a special laser to remove the part of the prostate causing difficulty with urination. A common example used to describe a HoLEP is comparing the prostate to an orange. The prostate tissue is like the flesh of an orange, and the capsule of the prostate, also known as the outer layer of the prostate, is considered the orange peel in this example. The laser uses energy to separate the “flesh” (prostate tissue) from the “orange peel” (the prostate capsule). The prostate tissue is then sent to the lab to make sure there is no cancer present. There are no incisions made on the body for this procedure; the surgery takes place through the urinary channel, also known as the urethra.

graphic of enlarged prostate

Benefits of Holmium laser enucleation of the prostate (HoLEP)

All men with enlarged prostates who are surgery candidates can have treatment with this procedure. It is beneficial in men with large prostates and men taking blood thinners (aspirin, Plavix, warfarin, apixaban, etc.). Men who have large prostates are often given the option of simple prostatectomy (incisions made on the abdomen to remove the part of the prostate causing blockage), which comes with the risk of bleeding, requiring blood transfusion and possible bowel injury. Men taking blood thinners are at higher risk for bleeding after procedures like the transurethral resection of the prostate (TURP), another procedure that removes prostates by coring out the part of the prostate that is causing a blockage. The Holmium laser enucleation of the prostate procedure is designed to decrease bleeding risk compared to these other procedures. Like the UroLift and transurethral resection of the prostate, the laser procedure is an approved procedure to treat an enlarged prostate and has a low re-treatment rate compared to other procedures; less than 2%.

Day of surgery expectations

The length of your surgery depends on the size of the prostate gland. Some patients may require an overnight stay in the hospital for observation, but most patients are discharged the same day with a foley catheter, which helps the bladder drain the urine. Typically, the foley catheter stays in for one day. For patients unable to urinate the following day, the catheter is replaced and can remain for an additional five to seven days.

Recovery and restrictions

Our dedicated nursing staff teach patients how to care for the foley catheter at home. Patients should avoid aggressive physical activity, including straining to have bowel movements and sexual activity for at least three weeks after the procedure.

One of the most important parts of recovery is to drink a large amount of fluid. After surgery, it is advised that patients drink 5 to 6 bottles (not glasses) of water per day, unless medically restricted. Since there is some blood in the urine, drinking plenty of fluids helps prevent the formation of blood clots and minimizes irritation. Patients will only require Tylenol for pain control and as needed bladder spasm medication to treat the urge to urinate. Patients can expect urge-related leakage of urine after the procedure; this is temporary and goes away with time. Erectile dysfunction may occur with surgery, but this is temporary as the surgical area heals.

Patients interested in the Holmium laser enucleation of the prostate procedure should contact a provider trained in this technique. Dr. Omotola Ashorobi has training in this procedure and is available at Ochsner West Bank.

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