Benign prostatic hyperplasia
Benign prostatic hyperplasia is an increase in prostatic volume that can lead to difficulty in bladder emptying, accompanied by lower urinary tract symptoms (decreased flow rate, increased voiding frequency, etc.) or complications (urinary retention, urinary infections, etc.).
If medical treatment is no longer sufficient, surgical treatment will be proposed. It was traditionally based on endoscopic electrical resection (mono- or bipolar) of the adenoma for small prostatic volumes, or on an open procedure for prostatic volumes greater than 80 g, with hospitalization of 5 to 7 days and a non-negligible risk of complications.
The Holmium laser technique aims to remove the entire adenoma (a tumor developing on a gland or organ) by separating it from the external prostatic capsule. The adenoma is then pushed back into the bladder, from where it is removed in small pieces using an instrument called a morcellator.
The entire procedure is performed through natural channels, without incision or scar. The risk of complication is reduced and the duration of hospitalization is shortened, since patients usually return home the day after the procedure. In addition, this technique is effective for operating fragile patients who cannot stop their antiplatelet treatment. There is also no risk of injury to the nerves involved in erection.
This technique remains underused in France, as it requires a substantial equipment investment and specialized surgical training.
What are the properties of the Holmium laser?
The Holmium laser is a tool that allows all tissues to be cut and coagulated. It can be used to treat tumors of the bladder and ureter endoscopically, as well as prostatic adenomas. It can also be used to treat urinary tract stones with great efficacy.
Its maximum power is 120 watts, which is much higher than the lasers usually used in urology (notably for stone treatment), whose power is 15 to 20 watts.
The management of prostatic adenoma by Holmium laser is revolutionary because it makes it possible to restore the anatomy of the urinary tract regardless of prostatic volume, while reducing the risks and duration of hospitalization compared to older techniques such as open adenomectomy.
What are the risks of HoLEP?
There are several types of risks with a procedure such as HoLEP.
The most frequent risks:
- Intermittent presence of blood in the urine.
- Increased urinary frequency, transient, often accompanied by a sensation of burning or stinging when urinating.
- Retrograde ejaculation, almost systematic and irreversible.
More occasional risks:
- Urinary infections.
- Inability to urinate after removal of the catheter following the surgical procedure.
- Narrowing of the urethra and/or the bladder neck.
- Lack of improvement of urinary symptoms.
- Transient urinary incontinence, most often on exertion.
Rarer risks:
- Significant bleeding requiring blood transfusion.
- Technical inability to complete the procedure endoscopically, requiring conversion to open surgery.
- Bladder injury during extraction of the adenoma by morcellation.
How to recover after a HoLEP laser prostatic enucleation?
After one night of hospitalization, patients return home. It is normal to have blood in the urine for a few days as well as irritation symptoms (frequent urge to urinate, etc.) related to the healing of the prostate.
Strenuous physical activity is not recommended in the weeks following the procedure. Sedentary professional activity can be resumed quickly. It is particularly important to drink abundantly in the weeks following the procedure. It is also not recommended to resume driving immediately after the procedure or to have sexual intercourse for a few weeks.
Management by Doctor VARDI
Dr Adam Vardi, urological surgeon in Paris and Neuilly-sur-Seine, is a specialist in the Holmium laser. He can support you in the assessment of your urinary symptoms and will advise you on the medical and surgical management of your prostatic adenoma.