Again, this type of surgery is especially useful for men who are on blood thinning tablets or men who are taking anti-coagulation drugs. This is because there is very little blood loss as the blood vessels of the prostate are sealed while the enlarged tissue is destroyed. HoLEP is a suitable treatment option for men with large prostates.
HoLEP involves passing a small telescope-like instrument called a cystoscope into the urethra (water-pipe) and the high powered laser is led in through this telescope. The laser is then used to carefully trim off the extra prostate tissue causing the blockage and these pieces are carefully pushed into the bladder.
Another piece of equipment called a morcellator is used to take the pieces of prostate tissue out of the bladder. The operation generally lasts about 45-60 minutes depending on the size of the prostate and will usually be carried out under a general anaesthetic or a spinal anaesthetic. After the operation, there might be a catheter put into the bladder. For more information, please see caring for your indwelling catheter at home (a catheter is a thin flexible tube that is inserted into the bladder and drains urine into a bag) for a short time, usually around 12- 24 hours to allow the prostate some healing time and will normally be taken out before you go home. Discharge from hospital is normally in about 1-2 days. Most men find that they require about 1-2 weeks off work and heavy lifting should be avoided.
For further information see Spotlight on treatment for an enlarged prostate
Potential Side-effects
It’s quite common to see some blood in the urine for about 12 hours after the operation although this might be for slightly longer. After the catheter is taken out urine may become bloody again for about 24-48 hours. It’s fairly common to pass very small amounts of blood in urine every now and again for up to 6 weeks after treatment.
After HoLEP, because the urethra might be a bit swollen, some men will experience a mild burning feeling when first starting to pass urine. Some men find they need to pass urine more frequently for a week or so after the operation with an urgency to pass urine for the first few days. Occasionally very small pieces of prostate tissue might pass out in the urine during the first month as your prostate heals.
Some men find that there is a small change in the quality of their erections and a very small number of men find it difficult to get and keep an erection.
Between 50- 70% of men who have HoLEP will experience retrograde ejaculation or dry orgasm. This means that at the point of orgasm you will not ejaculate because the semen has passed backwards into your bladder rather than down the penis. This won’t do any harm and will pass out in your urine the next time you go to the toilet but it will make your urine look cloudy. It is however quite common to leak a little urine at the time of ejaculation as the muscles relax. The procedure reduces fertility but does not make you infertile so you should not rely on this as a method of contraception.
Most side-effects and symptoms settle down over a couple of weeks. Retrograde ejaculation is usually permanent when it occurs.