The standard surgical treatment of Benign Prostatic enlargement causing bladder outflow obstruction leading to retention of urine or other urinary symptoms is transurethral resection of the prostate (TURP). However, relatively high morbidity associated with TURP has led to the development of a range of minimally invasive techniques, some of which use thermal energy. One such minimally invasive technique is the use of holmium: yttrium-aluminium-garnet (YAG) laser which is the only laser treatment approved by the National Institute for Health and Clinical Excellence.
Holmium laser enucleation of the prostate (HoLEP) utilises the holmium laser as a precise cutting instrument to enucleate large lobes of prostate. Initially a bilateral bladder neck incision is made to define the margins of resection. The median and lateral lobes are then individually undermined and peeled off the prostate capsule in a retrograde direction until only a bridge of tissue remains at the bladder neck.
HoLEP is performed with a modified continuous flow resectoscope that has a circular fibre guide in the tip of the scope. An end-firing laser fibre is used as a precise cutting instrument to enucleate large pieces of prostate.
Holmium laser enucleation of the prostate (HoLEP) is the most evolved laser procedure so far in which the intact prostatic lobes are removed with the holmium laser and then passed into the bladder where they are cut into smaller pieces, before removal.
A primary advantage of HoLEP over other laser prostatectomy techniques is that it can rapidly create a large cavity by immediately removing obstructing tissue, rendering it suitable for large prostates of up to and more than 100 grams. The coagulative ability of the holmium laser effectively seals tissue planes as the operation progresses, which makes HoLEP a relatively bloodless operation with a concomitant reduction in transfusion requirement, and also avoids the dangers of systemic fluid absorption.
Other postulated advantages include a reduced need for bladder irrigation, shorter postoperative catheterisation period and length of hospital stay, and the ability to retrieve tissue for histological examination.