Laser enucleation of the prostate (LEP) is a minimally-invasive procedure to remove the inner portion of an enlarged prostate through instruments passed up the urethra in men having obstructive urinary symptoms or urinary retention.
This procedure typically uses a holmium (HoLEP) laser to simultaneously divide and cauterize the tissue to limit bleeding. A specialized morcellation device is then used to divide the detached prostate tissue and remove it through the urethra. Importantly, unlike other minimally invasive BPH procedures that cannot be used for prostates larger than 80-100 grams, HoLEP can treat even very large prostates. That means we are able to treat your lower urinary tract symptoms without the need for an incision even if your prostate is very large! HoLEP is an exciting alternative that can avoid the need for traditional abdominal surgery (simple prostatectomy).
When to ask a Urologist about Laser Enucleation of the Prostate
You should speak with a Urologist about Laser Enucleation of the Prostate if you have obstructive urinary symptoms or urinary retention and a prostate that is too large to be treated by other minimally-invasive procedures.
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
HoLEP has been shown to provide at least equivalent or better symptom and functional outcomes as the gold standard procedure for prostate tissue removal called transurethral resection of the prostate (TURP). These outcomes are achieved regardless of prostate size. The average improvement in urinary flow rate is 20 ml/sec, and the average improvement in IPSS urinary symptom score bother is 18 points. The need for reoperation due to tissue regrowth after HoLEP is less than 1%.
Possible Side Effects
The risks of the procedure include pain, bleeding, infection, damage to surrounding structures and the risks of anesthesia. The risk of subsequent scar tissue formation in the urethra is around 2%. As with many procedures to relieve prostate obstruction, the majority of men report retrograde ejaculation with little or no semen coming out of their penis during orgasm. Urine leakage is rare and typically related to the bladder adjusting to the reduction in prostate resistance.
Alternatives to HoLEP typically require an abdominal surgery either through an open incision or a minimally-invasive approach due to the large underlying size of the prostate. Observation without treatment is an option though this approach may risk renal insufficiency, worsening bladder function, recurrent infection, recurrent bleeding, and bladder stone formation.
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The surgery typically requires an overnight stay in the hospital for observation. You will wake up with a catheter in your penis to drain your bladder. The catheter is usually removed in the morning following surgery before discharge. Blood in the urine is expected and may persist for several days or longer. You may have burning with urination and other bothersome urinary symptoms such as urgency and mild urine leakage. These symptoms improve as the bladder adjusts to the decreased prostate resistance over several weeks.