Holmium Laser Enucleation of the Prostate (HoLEP)
Holmium laser enucleation of the prostate, or HoLEP for short, is one of the most modern procedures for treating benign prostate enlargement. The advantage of this method compared to the conventional, transurethral resection of the prostate is a significantly lower blood loss and the possibility to operate even very large glands.
Until now, holmium laser enucleation of the prostate - also due to a relatively complex learning curve - has only been used at a few clinics in Germany. At the West German Prostate Center we are equipped with a state-of-the-art holmium laser of the latest generation, the MultiPulse HoPLUS from JenaSurgical. In the WPZ, Dr. Neubauer has already performed more than 7500 endoscopic procedures, and with Priv.-Doz. Dr. Dr. Gerullis, who has enriched the team since 2020, another proven expert in the field of innovative endoscopic surgical techniques. Dr. Gerullis has already performed numerous HoLEP procedures at the University Hospital Oldenburg before joining the WPZ and has outstanding competence and experience.
How does holmium laser enucleation of the prostate work?
In contrast to classic prostate resection or laser vaporization, in which the excess tissue is removed layer by layer, with HoLEP the prostate tissue can be released directly from the prostate capsule using a flexible laser fiber. The released tissue is then crushed and aspirated with a so-called morcellator.
A major advantage of the MultiPulse HoPLUS used in the WPZ is the combination of tissue removal (enucleation), comminution (morcellation) and suction of the tissue, which are integrated in a single device. This optimizes intraoperative procedures by eliminating the need to change instruments, thus significantly shortening the operating time. This makes the procedure even safer and gentler.
The entire procedure takes place endoscopically through the urethra and usually lasts between 45 and 90 minutes depending on the prostate volume. After the operation, a bladder catheter remains in place for 1-2 days. After its removal, normal urination is then possible again and the patient can leave the clinic.
HoLEP offers many advantages
The enucleation technique detaches the troublesome prostate tissue directly from the capsule, thus further minimizing the risk of bleeding. The likelihood of repeat operations due to remaining or regrown tissue is also very low.
Due to the very low bleeding tendency and thus excellent visibility, important structures can be better visualized and reliably spared during this procedure. This virtually eliminates the risk of sphincter injury with subsequent incontinence. Also, the punctual use of laser energy avoids damage to the nerves located in the immediate vicinity of the capsule and responsible for potency.
For whom suitable?
HoLEP is suitable both for men who cannot completely do without blood-thinning medication for the procedure and for patients with very large prostate volumes. At the West German Prostate Center, prostate adenomas from about 60 ml to over 200 ml in volume are operated on using HoLEP. The previously common open surgical adenoma enucleation could be completely avoided at the WPZ by using the modern laser procedures for more than 15 years.
