WPZ is a pioneer in modern laser therapy

Since 2004, the West German Prostate Center has been one of the pioneers in the use of modern laser techniques in the surgical treatment of benign prostate enlargement. Compared to conventional prostate excision, modern laser procedures such as holmium laser enucleation (HoLEP) and diode laser therapy are more effective, lead to fewer complications and reduce the likelihood of re-operation. With the HoLEP procedure, even men with very large prostate volumes can be operated on gently without the need for open surgery.

For decades, transurethral resection of the prostate (TUR-P) was considered the "gold standard" for the surgical treatment of benign prostatic hyperplasia (BPH) and still accounts for 70 percent of surgical procedures. However, modern laser procedures offer a major advantage over conventional excision due to lower complication rates and excellent results and are being used more and more frequently, especially in specialized centers.

HoLEP: The most modern and least bleeding procedure

"At the West German Prostate Center, we have specialized in minimally invasive laser surgery using diode and greenlight lasers for 20 years. In total, we perform over 300 surgical procedures for benign prostate enlargement every year," says Dr. Stephan Neubauer, head urologist at the West German Prostate Center. In 2021, the interdisciplinary center expanded its range of services to include another state-of-the-art laser procedure - holmium laser enucleation (HoLEP). The most modern and least bleeding BPH treatment procedure is currently only used at a few centers in Germany. With 150 HoLEP procedures per year, the WPZ is already the center with the highest number of cases in the greater Cologne area

How does the HoLEP work?

In contrast to classic prostate resection or laser vaporization, in which the excess prostate tissue is removed layer by layer, HoLEP uses a flexible laser fibre to remove the prostate tissue "as a whole" from the prostate capsule, which is then shredded and suctioned out in a second step. The entire procedure is performed endoscopically through the urethra and usually takes between 45 and 90 minutes, depending on the volume of the prostate. A bladder catheter remains in place for 1-2 days after the operation. Once it has been removed, normal urination is possible again and the patient can leave the clinic.

Scientific studies prove advantages compared to TUR-P

The special enucleation technique minimizes the risk of bleeding during the procedure and significantly reduces it compared to TUR-P. As long-term studies (1,2) have shown, the rate of possible complications after the procedure, such as post-operative bleeding, sphincter injury, urinary tract infections or bladder neck sclerosis, is also significantly lower than after conventional excision. The likelihood of repeat operations due to residual or regrown tissue is also very low. According to studies, HoLEP surgery leads to an operation-free period of 10 years in over 90 percent of cases with large prostates (3). Due to significantly fewer side effects and excellent long-term results, HoLEP of the prostate is explicitly recommended as an alternative to TUR-P in the guidelines of the European Association of Urology (EAU).

Own data confirm research results

"The better risk profile of HoLEP surgery is also reflected in our data," confirms Priv.-Doz. Dr. Dr. Holger Gerullis, prostate specialist at the West German Prostate Center. For example, no more blood transfusions have been necessary in recent years and the average length of stay in hospital is 2.3 days. "The average prostate volume of the glands we operate on is 102 ml. But we were also able to successfully and gently operate on men with a prostate volume of 300 ml using HoLEP," says Priv.-Doz. Dr. Dr. Gerullis.

Shorter hospital stay than with TUR-P

Modern laser procedures also offer advantages in terms of the length of the inpatient stay. While the average length of stay is 5.1 days, we can discharge our patients after just 3 days. Thanks to HoLEP, there is no prolonged hospitalization, especially in the case of large prostate volumes. Meta-analyses (4) have shown that HoLEP enucleation promises the shortest hospital stay, while diode laser vaporization requires the shortest catheterization.

"Thanks to our expertise, we can offer the most appropriate BPH surgery for each individual patient with the fewest side effects and significantly shorter catheter and recovery times," summarizes Dr. Neubauer. "Older men, patients who are dependent on blood-thinning medication and men with a very large prostate benefit explicitly from modern laser therapy.

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