Advantages and Outcomes for Holmium Laser Enucleation of the Prostate Performed for Benign Prostatic Hyperplasia

Dr. Amy Krambeck discusses the advantages and outcomes for holmium laser enucleation of the prostate (HoLEP) performed for benign prostatic hyperplasia (BPH).

HoLEP was first performed in the United States in 1998; however, has been slow to gain widespread acceptance due to its steep learning curve. The procedure has been shown to have superior short and long-term outcomes to transurethral resection of the prostate (TURP) and suprapubic prostatectomy.

Benefits of the HoLEP procedure include complete removal of the adenoma to the level of the prostate resulting in a less than 2% retreatment rate, lack of surgical incision, and no effect on erectile function. Furthermore, HoLEP can be performed on prostate glands of any size. HoLEP is performed as an outpatient procedure or as a 23 hour observation and the urethral catheter is removed the day after surgery. All patients experience hematuria for 1 to 2 weeks post procedure, but the need for blood transfusion is 1%. Transient urinary incontinence is common, but permanent incontinence at 1 year post procedure occurs in approximately 1% of patients. We are now offering HoLEP at Mayo Clinic in Arizona and Minnesota.

2 Comments

  1. David Turetsky
    Posted January 3, 2011 at 10:37 am | Permalink

    How much (range) of the prostate is removed by HoLEP?

    To what degree are functions performed by the prostate compromised?

    Are there further detailed descriptions of the procedure?

    • Miriam Wuensch
      Posted January 6, 2011 at 10:54 am | Permalink

      Dr. Krambeck responds:

      How much (range) of the prostate is removed by HoLEP? 80-90% of the prostate is removed with this technique.

      To what degree are functions performed by the prostate compromised? Prostate function, which is liquifaction of the seminal fluid, is preserved. Patients do develop retrograde ejaculation after the procedure, however, so the semen is deposited in the bladder instead of out the urethra.

      Are there further detailed descriptions of the procedure? There are multiple published articles on the procedure as well as many videos on the internet.


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