Holmium laser enucleation of the prostate (HoLEP) is a type of laser surgery used to treat obstruction (blockage) of urine flow as a result of benign prostatic hyperplasia (BPH). In men with BPH, the prostate gland is not cancerous but has become enlarged. An enlarged prostate can result in a number of urinary tract symptoms such as frequent urination, inability to urinate, difficulty in starting urination, or loss of bladder control.

What happens during a holmium laser enucleation of the prostate (HoLEP) procedure?
* HoLEP requires the patient to be under general anesthesia (“asleep” throughout the procedure). If a patient cannot have general anesthesia for some reason, a spinal anesthetic can be used—this allows him to remain awake but blocks all feeling from the waist down.
* An injection of an antibiotic is given to reduce the chances of infection.
* The patient is placed on his back with the legs raised during the procedure.
* A surgical instrument called a resectoscope is inserted through the urethra (the channel that carries urine from the bladder). The resectoscope includes a camera that allows the surgeon to view the internal structure of the prostate gland, and to see where incisions are being made during surgery.
* The laser is inserted into the resectoscope and is used to enucleate (free up) the enlarged prostate tissue from the capsule (outer shell)and then to seal up any blood vessels. The tissue that has been removed is deposited in the bladder.
* The laser is removed from the resectoscope and is replaced by a morcellator. This device is used to suction out the tissue that was left behind in the bladder.
* When tissue removal is complete, the resectoscope is withdrawn and a urinary catheter is put in place.


HoLEP offers a unique advantage in being able to remove a large amount of tissue without any incisions on the body, even in very large prostates, while decreasing the risk of bleeding and providing tissue for pathology (to look for cancer). This decreases the need for blood transfusions during surgery, minimizes the time of stay in the hospital to one or two days, and reduces the risk of needing repeat treatment.


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