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What is Laser Prostate Enucleation?

The endoscopic enucleation of the prostatic adenoma with Holmium laser (HoLEP) or Thulium laser (ThuLEP) represents one of the most innovative and effective therapies for the treatment of Benign Prostatic Hyperplasia (BPH) and is now accepted as a surgical alternative to both TURP and open prostatectomy.

This technique involves the use of laser technology (Thulium or Holmium), allowing the removal of the prostatic adenoma in a minimally invasive procedure. It is suitable for treating even large prostate volumes (>80 grams) and has become the minimally invasive alternative to the traditional open adenomectomy procedure (ATV).

Moreover, the laser enables precise tissue dissection, reducing the risk of bleeding and transfusions. The prostatic adenoma is enucleated and subsequently morcellated and removed.

Eliminating the need for prolonged hospital stays, the laser also mitigates potential adverse effects on urinary and sexual function, while reducing the risk of intraoperative and postoperative bleeding.

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Which patients are candidates for Laser Prostate Enucleation (ThuLEP or HoLEP)?

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This intervention is indicated in all cases of symptomatic Benign Prostatic Hyperplasia, with its true application found in prostates with large volumes (>80 grams).

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What should I do before undergoing ThuLEP or HoLEP?

Before undergoing the surgical procedure, the patient will undergo a thorough urological check-up:

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  1. Urological Examination with Rectal Exploration: This allows the assessment of the prostate's size and consistency to detect the presence of hard, uneven areas suspicious of a glandular tumor.

  2. PSA (Prostate-Specific Antigen) Measurement: This test is crucial to exclude the presence of neoplasia (a high PSA, >4 ng/dl, may be suspicious).

  3. Transrectal Prostate Ultrasound: This method precisely defines the dimensions of the prostate gland and identifies areas suspicious for tumors.

  4. Urinalysis: This helps detect the presence of urinary tract infections.

  5. Uroflowmetry: This test is the simplest and least invasive urodynamic investigation. The patient urinates into a special device similar to a WC connected to a computer that analyzes urinary flow.

  6. Urodynamic Examination: This test reveals the presence of functional bladder disorders, particularly distinguishing between a deficit in bladder contractility and mechanical obstruction during emptying.

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What is the duration of the prostate enucleation procedure?

 

The duration of the surgery depends on the size of the prostate. Usually the duration is 60-90 minutes

 

What type of anesthesia is performed?

 

The operation is almost always carried out under 'spinal' locoregional anesthesia, only in some cases when the patient's condition does not allow it, general anesthesia is preferred

 

How long will I have to wear the catheter and after how long can I return home?

 

After removal of the catheter, which usually occurs 24-36 hours after surgery,  the patient will be able to return home

 

What are the risks of this type of intervention?

 

  • The risks are the same as other endoscopic prostatic operations (TURP, Greenlight Green Laser Vaporization) but considerably lower than traditional open surgery. The reduced risk of bleeding and the possibility of not suspending anticoagulant and/or antiplatelet therapies make this operation particularly suitable for heart disease patients

 

After how many days will I be able to return to work?

 

Usually you can return to work one week after surgery

 

After how many days will I be able to return to normal sexual activity?

 

A period of 4 weeks without sexual intercourse is recommended

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