HoLEP is proven to be extremely durable and effective for LUTS due to BPH

Das et al. release updated information on the HoLEP as proven to be extremely durable and effective for LUTS due to BPH.

Article reference: Das AK, Teplitsky S & Humphreys MR (2019), ‘Holmium laser enucleation of the prostate (HoLEP): a review and update’, The Canadian Journal of Urology, 26 (Aug), pp13-19.

HoLEP is when the “adenoma is enucleated from the surgical capsule and displaced into the bladder before removal with an endoscopic device (transurethral soft-tissue morcellator). The HoLEP technique takes advantage of the distinct anatomical planes to remove the entire prostatic transition zone.

From classical techniques to the newer systems, the procedure in short involves laser fibre “delivered through a laser catheter to help stabilize the laser fibre while at the end of the catheter there is a locking mechanism to keep the laser fibre at a fixed length during the procedure”. The prostatic tissue is then enucleated with precision along the anatomical planes of the prostate. “Initial reports on these newer techniques suggest a decrease in both enucleation and total operative time, and easier identification of the surgical capsule”.

With improvements in morcellators operative efficiency has enhanced. The difference between the morcellators available are highlighted with the statement made that “most HoLEP surgeons’ prefer the Piranha to the VersaCut due to the improved ergonomic design, efficient tissue removal properties and its safety profile”.

Concern patients have regarding their prostate surgery is the impact it may have on their erectile function. A study of 393 patients pre and post operatively showed a small decrease in average IIEF score of 5. Although this is a slight change it is important to highlight to patients retrograde ejaculation post procedure. This is when semen does not emerge through the penis but rather enters the bladder instead. It’s essentially a dry orgasm, where men are still able to climax. A study found that “70.3% of men undergoing HoLEP reported a loss of antegrade ejaculation, while 21% report a reduction in semen quality”.