Holmium Laser Resection

Holmium laser resection prostate surgery is a minimally invasive treatment for an enlarged prostate. It is used to treat the blockage of the urinary flow that results from benign prostatic hyperplasia (BPH).

The prostate is a gland that surrounds the neck of the urinary bladder connecting the urethra. It is a muscular gland in the male reproductive system. This helps during the passage of urine and it produces more fluid in semen and contracts to propel urine through the urethra and the semen during ejaculation.

BPH is a benign (noncancerous) enlargement of the prostate which blocks the flow of urine through the urethra. As the prostate cells gradually multiply and enlarge, it puts pressure on the urethra, through which urine and semen exit the body. Over time, the bladder muscle will become stronger, thicker, and sensitive. This results in many urinary tract symptoms such as frequent urination, inability to urinate, difficulty in urination, or loss of bladder control. The inability to urinate is a serious complication and can develop bladder or kidney damage.

BPH could be managed medically or surgically. The standard surgical treatment for BPH is transurethral resection of the prostate (TRUP). High morbidity that is associated with TURP has led to the development of various minimally invasive techniques, few of them use thermal energy. One such minimally invasive technique is the use of holmium.

Holmium laser resection of the prostate (HoLRP) uses the holmium laser as an effective cutting instrument to resect large pieces of the prostate.

In this procedure, first, a bilateral bladder neck incision is made to define the margins of resection. The median lobe is resected first and then the lateral lobes because the tissue needs to be retrieved endoscopically, the lobes are cut into small pieces while being freed from the surgical capsule. Large pieces are taken out from the bladder using a modified resectoscope loop that engages and holds the tissue against the resectoscope sheath, and smaller fragments are removed by using an Ellik evacuator.

An advanced evolution of the HoLRP procedure is holmium laser enucleation of the prostate (HoLEP)

Many patients resume their normal activities within 2-3 days after surgery. Drink a lot of water to flush out any small pieces of stone. The doctor may prescribe a medicine called alpha-blocker to make it easier to pass the pieces of stone.

The main advantage of HoLRP over other laser prostatectomy techniques is -

• It rapidly creates a large TURP-like cavity by immediately removing the blocking tissue.
• The holmium laser effectively seals tissue planes as the operation progresses.
• It provides immediate relief of symptoms
• It causes less blood loss