Extreme volume: what is important to know
Adenomas of 200–250 g are rare and are usually accompanied by prolonged urinary retention, cystostomy, bladder stones and renal failure. Before surgery, such patients undergo extensive examination, and in case of infection, drainage and antibiotics. Enucleation itself is technically similar to smaller volumes, but requires the endurance of the surgeon and a reliable morcellator. Bladder stones can be removed at the same time. After the operation, the cystostomy is closed, and urination is restored on its own.
When to choose HoLEP
- prostate adenoma of any volume, especially more than 80 cm³, when TUR is technically difficult;
- taking anticoagulants and antiplatelet agents (the laser ensures minimal bleeding);
- urinary retention, cystostomy, bladder stones against the background of adenoma;
- ineffectiveness of drug therapy, residual urine, recurrent infections;
- the patient’s desire to quickly return to normal life with a minimum duration of the catheter;
- re-growth of adenoma after TURP or other operations.
How is HoLEP surgery performed?
Under spinal or general anesthesia, an endoscope with a thin holmium laser fiber is inserted through the urethra. A laser operating in a physiological solution dissects the tissue exactly along the border between the adenoma and the prostate capsule - the surgeon “husks out” the entire lobes of the adenoma, like a kernel from a nut, while simultaneously sealing the vessels. The separated lobes are displaced into the bladder, where a special device - a morcellator - crushes them and removes them through an endoscope. All tissue is collected for histological examination.
Due to the complete removal of the adenoma within the capsule, the result of HoLEP is comparable to open adenomectomy, but without an incision and with minimal blood loss. The operation lasts 60–120 minutes depending on the volume of the gland; The catheter is installed, as a rule, for one day.
Advantages of HoLEP over TURP and open surgery
- suitable for prostates of any size - from 40 to 300 g and more;
- blood loss is minimal, blood transfusion is practically not required, you can operate on anticoagulants;
- the catheter is removed after 1 day, the hospital stay is 1-2 days (after TUR - 2-3 days, after open surgery - 7-10);
- the adenoma is completely removed, so repeated operations are needed in less than 1% of cases;
- all tissue is available for histology - reliable exclusion of cancer;
- lower risk of TUR syndrome, strictures and incontinence with an experienced surgeon.
Preparation and recovery
The examination is standard for prostate surgery: PSA, TRUS, uroflowmetry, blood and urine tests, coagulogram, ECG, consultation with an anesthesiologist. Urine culture with treatment of infection is mandatory. Hospitalization on the day of surgery, 8 hours on an empty stomach.
After surgery: the catheter is removed the next day; if the urine is clear, the patient is discharged on the 1st or 2nd day. In the first 2-3 weeks, there may be increased urge, a slight burning sensation and a small amount of blood - a normal stage of healing. Drink 2 liters of water a day, avoid constipation, heavy weights, cycling, alcohol. Work - after 7-10 days, sex life - after 3-4 weeks. As after TUR, most men experience retrograde ejaculation; the erection remains.
HoLEP in Tashkent: where they make it
Laser enucleation requires a holmium laser, a morcellator and a specially trained surgeon, so it is not performed in every clinic. In the clinics below, HoLEP is performed by urologists with endoscopic experience for adenoma of any size - the price list is divided by gland volume (up to 50 g ... more than 300 g) and includes histology; anesthesia and bed days are paid according to the price list. Sign up for a consultation - using TRUS, the urologist will determine the volume and confirm the method.
