HOLEP (holmium laser enucleation of the prostate) is a treatment for men with benign enlargement of the prostate . The treatment is done without any incisions on the body. HOLEP in last 5 years has challenged other surgeries for prostate and has emerged as the new gold standard for benign enlargement of the prostate. Patients undergoing HOLEP have greater improvement in flow of urine, post-op greater reduction in symptoms, and greater reduction in the size of the prostate and lesser repeat surgeries in comparison to TURP.
HOLEP has replaced TURP as the standard based on years of data that consistently demonstrate superior outcomes with fewer post-operative complications and longer durability based on reoperation rates. In most of the trials, there are near zero reoperation rates for BPH in HOLEP as compared to 15-18 reoperation rates in synsloi TURP group. HOLEP also offers an advantage to the patients of dealing with urethral stricture structure, associated bladder stone in the same sitting with laser prostate. In cost comparison, HOLEP is slightly costlier than TURP but has definite clinical advantages.
Patients undergoing HOLEP have shorter hospital stay (1-2 days), require usually less or no blood transfusions. HOLEP can be used to treat prostates more than 100 gms which is a limitation for TURP. So all the morbidity of open prostatectomy in large prostate can be reduced by HOLEP. HOLEP is done under normal saline and the risk of glycine toxicity, hyponatremia associated with TURP is not there.
One more advantage of HOLEP is in elderly patients who are on blood thinners or have a cardiac pacemaker in place. In HOLEP, there is usually no need to discontinue Tab Ecospirin or clopidogrel (blood thinners) as HOLEP has reduced blood loss. In patients with Place markers use of electrocautery is not as safe as it interferes with a pacemaker. But with Holmium Laser prostatectomy there is no interference with pacemaker & has added advantage for cardiac patients.
HOLEP is the new gold standard for surgical therapy of benign prostate. Multiple studies & trials have proved HOLEP superior to other surgical therapies of benign enlargement of the prostate.
Content Edited By - Dr. Ritesh Mongha