HoLEP for Enlarged Prostate

HoLEP is an established, safe and effective treatment for enlarged prostate. Benefits of HoLEP include:

• Decreased blood loss and blood transfusion rates
• Improved urinary flow
• Improvement in uncomfortable urinary symptoms
• Largest amount of prostate tissue resected of any transurethral BPH treatment
• Lowest rates of retreatment among BPH treatments (0.7% after ten years, compared with up to 15% at five years for TURP, Rezum and Urolift)
• Reduction in post-void residual urine
• Shorter hospital stays and shorter catheter duration than TURP or robotic simple prostatectomy

As with all surgical procedures, there are risks to consider. Your doctor can help you understand your personal risks and decide if HoLEP is right for you. The risks associated with HoLEP include:

• Bleeding: A small amount of blood in the urine is normal after HoLEP. In rare cases, patients may need a blood transfusion. This may be due to a lower blood count before the start of the procedure.
• Damage to the prostate capsule or bladder. This requires urinary catheter drainage for several weeks while the tissue heals.
• Retrograde ejaculation is when semen passes up into the bladder instead of out the tip of the penis. This is not dangerous and will not result in stones or infection. Studies have not shown decreased erectile function or orgasm after HoLEP.
• Urethral stricture is scar tissue in the urethra. The scar tissue obstructs urine flow downstream from the prostate. This often does not develop until months or years after HoLEP.
• Urinary incontinence, usually in the form of dribbling after urination. It may be more pronounced in men who have urge-type leakage prior to HoLEP. Incontinence usually diminishes in the months after the procedure. Your doctor may prescribe medication for urge-related incontinence.
• Urinary tract infection, usually contained within the bladder, or able to be treated with antibiotic pills alone.

Sometimes, cancer is found in the prostate tissue that is removed during HoLEP. This is called incidental prostate cancer and is typically low risk. Your doctor will talk to you about next steps and monitoring your prostate cancer.

Urinary obstruction is often associated with benign prostate enlargement. However, many men with prostate cancer develop bothersome urinary symptoms. Men with very low-risk prostate cancer on active surveillance programs may be candidates for HoLEP.

HoLEP does not treat prostate cancer. But it can improve urination without compromising treatment. Prostate tissue removed during HoLEP can be examined for evidence of prostate cancer.

Recovery after HoLEP can differ for each patient. Before your procedure, talk to your doctor about any concerns related to your medical history.

Some patients are able to get their catheter removed and go home on the same day as surgery, while other patients with medical issues may stay in the hospital overnight after HoLEP.

The first few days after your HoLEP procedure, you may feel some burning with urination. This is related to urine passing over the area of the procedure. It does not necessarily indicate a urinary tract infection. This discomfort or mild pain is normal. It should be manageable with over-the-counter pain medications.

While your prostate heals, it is also normal to see some blood in your urine. This may come and go for up to eight weeks after HoLEP if you are on blood thinners, but it is usually much shorter. You may also see some clots in your urine, which should pass easily. If the clots increase in volume or grow larger than the size of a dime, call your doctor.

Your urinary urgency, frequency and leakage symptoms may not improve immediately. In a few cases, they may temporarily worsen. But your bladder will re-equilibrate after the first weeks to months, and your symptoms should improve. If your symptoms do not improve, talk to your doctor. They may prescribe medication that can reduce bladder spasticity.

In your first few weeks after surgery, drink large amounts of liquids. This helps your body produce ample urine to flush your urinary tract of any small amounts of blood or tissue. It is okay to resume your regular diet when you return home.

To help with urinary control after HoLEP, try Kegel exercises. Repeatedly squeezing your pelvic floor muscles will increase strength and muscle tone. Complete ten squeezes in a row, three times per day for the first two weeks after surgery.

Your return to work and exercise depends on the level of exertion. You will likely feel fatigued for about a week or two after surgery as your body recovers and heals.

Begin by moving and walking short distances every day. Plan to resume exercise after about two weeks if you are doing well, and there is minimal blood in your urine.

Returning to work depends on your job requirements. If you work at a desk with minimal exertion, it may be possible to return sooner. If your job requires heavy lifting or other strenuous activities, you may need longer to recover. Your doctor can help you determine when to return to work.

Contact your doctor if you experience the following:

• Blood clots larger than a dime
• Bloody urine the color of red wine or darker
• Difficulty with urination
• Fever of 101 degrees or higher
• Increased urinary frequency with small volume urinations
• Significant increase in pain
• The sensation that you are not emptying your bladder