What is HoLEP? Prostate Treatment with HoLEP Technology

What is Prostate Enlargement? Why Does the Prostate Grow?

In men, the prostate grows twice during early puberty. After the age of 25, the prostate grows differently in all men. This growth, which is mostly a benign development, continues at a variable pace starting from the late 40s until the end of life. The exact cause of benign prostatic enlargement (BPH), which is generally seen with aging, is not known exactly. Although prostate enlargement is quite common, it may not cause a similar problem in every man. In other words, although it is detected as a natural part of aging in some people, it may not create a need for treatment. However, in some patients, the enlarged prostate gland may cause obstruction and narrowing in the urinary tract and bladder outlet, interrupting the flow of urine. This may impair both the urine storage and urine voiding function of the bladder.

If prostate enlargement causes uncomfortable complaints and symptoms, causes distress in urination function, or reaches levels that can harm the body, it becomes necessary to treat it. Although the causes of prostate enlargement are still unknown today, it is thought that testosterone and estrogen are quite effective on this growth.

In Which Age Groups Does the Prostate Grow? What Is the Extent of This Growth?

While the prostate gland usually begins to grow in men in their 30s, this growth continues until the end of life. While there is an enlargement of the prostate in half of men over the age of 50, the rate of prostate incidence increases to 65% after the age of 60. With the advent of the 80’s, the prostate growth rate exceeds 90%. Most of these patients are closely followed up with medication or surgery.

What are Prostate Diseases?

Prostate diseases are examined under three main headings. These:

  1. Prostatitis (Prostate inflammation)
  2. Benign prostatic enlargement (BPH = Benign Prostate Hyperplasia)

Prostate cancer

Complaints in Prostate Diseases

Although prostate diseases cause many complaints, we can list the most prominent complaints as follows:

Difficulty in starting and ending urination

Poor or intermittent urine flow

Burning or pain when urinating

The need to urinate frequently

Feeling of not fully emptying the bladder

Getting up to urinate frequently at night

Sudden urinary congestion, difficulty in holding urine

Drips that continue after urinating

Inability to urinate

Blood in urine or semen

Painful ejaculation

Pain in the groin, hip, waist, back and leg areas

These complaints are specific to prostate and lower urinary tract problems. However, the type of disease the prostate is related to can only be determined as a result of the urologist’s examination and the necessary diagnostic examinations.

Prostate diseases may not cause any complaints in the early period. In some cases, no obvious complaint is encountered in the patient. However, the diagnosis of the disease is possible thanks to methods such as digital prostate examination, PSA (Prostate Specific Antigen) test, urine analysis, prostate biopsy, radiological imaging (ultrasonography, multiparametric prostate MRI). Only a doctor can tell the underlying cause of the symptoms and signs concerning the urinary tract. Individuals with such complaints should definitely see a urology specialist.

Prostatitis Treatment

Treatment of prostatitis varies depending on whether the disease is acute (sudden) or chronic (recurrent). Medications are generally used in the treatment process of prostatitis. These medications include pain relievers-inflammatory, prostate and bladder neck relaxation alpha-blockers, and some antibiotics. Although prostatitis improves in most men within a few weeks to a few months, this process may take longer in some people.

Acute Bacterial Prostatitis

Acute inflammation of the prostate, although rare, should be taken very seriously. In the case of acute bacterial prostatitis, the most common symptoms can be listed as follows:

  • High temperature,
  • Cold,
  • Shivering,
  • Pain and burning during urination,
  • Difficulty urinating,
  • Thinned urine flow,
  • Pain during ejaculation,
  • Feeling of not fully emptying the bladder,
  • The need to urinate frequently and urine coming in an urgent way,
  • Seeing blood in the urine.

The main starting point of this type of prostatitis is the bacteria in the urinary system and large intestines. Acute bacterial prostatitis is a serious clinical condition that should not be ignored. For this reason, it is beneficial for people with such complaints to see a doctor immediately. Antibiotics, pain relievers and antipyretics are used in the treatment of acute prostatitis. Depending on the severity of the symptoms and the complaints of the patients, inpatient treatment may be required.

Chronic Bacterial Prostatitis

Prostatitis that lasts for three months or more can be defined as bacterial prostate infection. Although it is a more common condition than acute prostatitis, the main cause of chronic bacterial prostatitis is unclear. It may manifest itself due to bacteria in the urinary system, bladder or blood infection. Stones that may occur in the prostate gland or structural defects in the prostate can also cause prostatitis. In addition, infection can occur as a result of trauma or some procedures performed in the urinary system.

In the case of chronic bacterial prostatitis, symptoms develop more slowly and quietly than acute prostatitis. We can list the symptoms of chronic bacterial prostatitis as follows:

  • Frequent urge to urinate,
  • Burning sensation while urinating,
  • Difficulty urinating,
  • Loss of sexual desire,
  • Pain during ejaculation,
  • Sensation of tension in the intestines,
  • Pain in the anus and testicles.

In this type of prostatitis, fever is not expected.

How Is Chronic Bacterial Prostatitis Treatment?

While antibiotics and anti-inflammatory drugs are used in the treatment of chronic bacterial prostatitis, these drugs should be used for a long time.

Asymptomatic Inflammatory Prostatitis

This type of prostatitis, which does not manifest itself with any symptoms, is detected by chance in the surgical specimen or prostate biopsy sample of patients who underwent surgery due to prostate enlargement or prostate cancer. This type of prostatitis does not require treatment.

What is Chronic Prostatitis (Chronic Pelvic Pain Syndrome)?

Chronic non-bacterial prostatitis, also known as Chronic Pelvic Pain syndrome, is the most common type of prostatitis (prostatitis) in men. This type of prostatitis is also known as “chronic non-bacterial prostatitis”. The reason one of its names is non-bacterial is that the prostate is inflamed regardless of a specific bacterium. Although symptoms of weakness and fatigue are usually observed, the pain caused by the disease continues for three months or more. However, chronic prostatic is often seen with psychological conditions such as anxiety and depression.

We can list the symptoms of chronic prostatitis as follows:

  • Pain in the penis, testicles, anus, lower abdomen and lumbar region,
  • Pain during urination,
  • frequent urination,
  • Urgent urge to urinate, especially at night,
  • Noticing enlargement or sensitivity in the prostate during prostate examination,
  • Erection problem,
  • Pain during ejaculation or after sexual intercourse.

When chronic prostatitis tests are performed; Bacterial infection cannot be clearly detected in cultures taken from urine, semen and prostate secretion. Therefore, the diagnosis and treatment process of this prostatitis type is very difficult. In the chronic prostatitis treatment process, the main purpose is to reduce the symptoms. Complaints accompanying the disease are often reduced by treatment.

Chronic Prostatitis Treatment

Long-term antibiotics, anti-inflammatory drugs and anticholinergics may be useful in the treatment of chronic prostatitis. In addition to these, prostate massage can be recommended for the treatment of patients who do not benefit from conventional treatment methods. Because prostate massage; It regulates the circulation, opens intraprostatic channels and provides maximum optimization for the passage of antibiotics into the tissue.

What is Prostate Cancer?

Prostate cancer, which can be defined as cancer that develops in the tissue of the prostate gland, is one of the most common types of cancer, especially in western countries. Although the reasons for its occurrence are not yet fully explained, it is known that the risk of developing prostate cancer increases with age in men. Although prostate cancer is usually seen in men over the age of 65, we can say that the risk of prostate cancer increases in the period after the age of 50. If there is prostate cancer in close male relatives such as father, uncle, brother and uncle, the probability of prostate cancer is higher than normal.

When prostate cancer is detected at an early stage, the treatment process generally results in a positive way. Prostate cancer differs from other cancers in its slow course and variable behavior.

How is Prostate Surgery Performed?

Transurethral Prostate Resection (TUR-P)

In Transurethral Prostate Resection surgery, which is called TUR-P in short, the prostate tissue is burned from the inside and removed in small pieces by using electrical energy. Since the risk of bleeding is very high in this operation, the blood thinners that the patient has to use are discontinued one week before. The use of blood thinners can be resumed at the earliest 1 week after surgery. After this operation, it is imperative that the patient be probed for at least 3 days.

We can list the negativities that can be seen after Transurethral Prostate Resection surgery as follows:

TUR-P syndrome, (Transurethral resection of prostate)

  • Urethral stricture,
  • Infection,
  • Urinary incontinence,
  • Difficulty urinating,
  • Retrograde ejaculation (withdrawal of the semen)

In addition, it has been suggested in many studies that re-surgical treatment is required after this operation.

Open Prostatectomy

Open Prostatectomy is a surgical method that can be applied to patients with a prostate size of 100 g or more. In this operation, in addition to the skin and subcutaneous tissues of the patient, the urine bag is opened and the prostate is removed with the help of a finger. Since this operation is an operation method with very high bleeding rates, blood support is usually needed. In addition, the duration of hospitalization after this operation is longer than other methods. After the operation is over, the patient must remain with a probe for a minimum of one week.

Laser in Prostate Surgery

The use of laser in the urology unit has also paved the way for the use of laser in surgical operations.

We can list the laser methods used in prostate surgery as follows:

Greenlight Laser,

Photoselective Prostate Vaporization (PVP),

Prostate Enucleation with Thulium Laser (ThuLEP),

Prostate Resection with Thulium Laser (TmLRP),

Prostate Enucleation (DiLEP) with Diode Laser,

Prostate Vaporization with Diode Laser (DiLVP),

Prostate Resection with Holmium Laser (HoLRP),

Prostate Enucleation with Holmium Laser (HoLEP).

What is HoLEP Technology?

HOLEP (Holmium Laser Prostatectomy) Technology is the most modern and successful treatment method of today, which is frequently used and preferred in the treatment of BHP (benign prostate enlargement). HoLEP Technology means the removal of the prostate by laser enucleation. Although HoLEP has been used widely in the last 10 years, it has yielded very positive results in the treatment of prostate enlargement. The word HoLEP means the removal of the prostate inner tissue using a holmium laser. In general, benign prostate enlargement gradually increases with the number of living men and age. Symptoms begin to manifest themselves in 50% of men in their 60s, while prostate enlargement manifests itself over time in 90% of men in the 80s.

For Which Patients Is HoLEP Surgery Suitable?

All patients suffering from prostate disease and considering surgical operation are eligible for HoLEP. The fact that the HoLEP method can be applied in all prostate sizes makes HoLEP independent from prostate size. The HoLEP method, which is also independent of prostate enlargement, can be applied for both large and small prostates depending on the needs of the patient and the physician’s need.

What are the Features of HoLEP Surgery?

We can roughly list the features of HoLEP surgery as follows:

  • Since the HoLEP method is applied with the laser separation principle instead of burning with electrical energy, the patient with a probe does not experience a burning sensation called dysuria while urinating.
  • HoLEP surgery; Since it offers advantages such as low risk of bleeding, short hospital stay and rapid recovery, patients can quickly return to their normal lives by getting rid of their catheter in a short period of 24 hours.
  • Since the effect of HoLEP operation on healthy tissue is less than 0.4 mm, the nerves that pass around the prostate capsule and regulate sexual functions are not damaged. Therefore, postoperative erection problems are not expected in patients.
  • Since there is no burning defect in the tissues removed during HoLEP surgery, pathologists examine the tissue much more easily and the possibility of overlooking possible malignant formations is reduced.
  • As the prostate tissue is completely removed with HoLEP technology, the risk of recurrence of the disease is very low.

When Is HoLEP Surgery Required?

HoLEP surgery; In case of benign prostatic enlargement disease, it is considered necessary and applied in patients who cannot detect a significant improvement in the disease despite drug therapy, if the following situations are encountered:

  • The patient has many complaints and complaints,
  • The patient’s having to urinate by placing a catheter into the bladder,
  • Remaining urine in the patient’s bladder even after urinating,
  • The occurrence of other problems such as infection, bleeding and stone formation in the patient whose symptoms do not disappear.

How Is Prostate Surgery Performed with HoLEP Technology?

The widespread use of laser technology in the urology department has paved the way for HoLEP technology. Prostate enlargement surgery performed with HoLEP technology is an operation in which spinal anesthesia (numbing below the waist) is considered sufficient.

Enlarged prostate tissue is separated from its capsule by entering through the normal urinary tract with HoLEP surgery. Subsequently, the prostate tissue pushed into the urinary bladder is cut into small pieces with a special tool and taken out. Thanks to the Holmium laser, the enlarged prostatic adenoma is separated from the capsule of the prostate and removed, and the remaining tissue does not grow again. The diseased tissue removed is then examined pathologically and it is investigated whether this tissue is cancer tissue or not. In surgeries treated with laser, the patient loses less blood thanks to the laser’s ability to control bleeding. In addition, prostate surgery with HoLEP technology is a method to be applied with peace of mind for those who have heart and liver diseases and therefore use blood thinners. Prostate enlargement treatment with HoLEP technology is increasing its popularity day by day due to the positive results it has given so far.

What are the Advantages of HoLEP Technology?

The advantages of HoLEP technology, which paves the way for many developments in prostate

treatment, are listed:

In the prostate enlargement surgery performed with Holmium laser, there is no recurrence of the disease since the prostate tissue is removed with laser.

Since it is easier to control the bleeding that may occur during the surgery with laser, male patients who use blood thinners (antiaggregant-coagulant) due to the presence of heart and lung disease can easily undergo operations using this method.

Thanks to HoLEP surgery, patients can return to their normal lives very quickly, and they feel like they have returned to their 30s with their own expressions.

Frequently Asked Questions About Prostate Surgery and HoLEP Technology

How Long Does Prostate Surgery Take?

The duration of prostate surgery varies depending on the size of the prostate and the patient. The biggest factor affecting the duration of the operation is the preferred surgical method for treatment.

Is getting up from bed frequently and going to the toilet at night an indicator of an enlarged prostate?

One of the early symptoms of prostate enlargement is the need to toilet at night. Prostate enlargement often causes urinary difficulty and patients often go to the toilet at night. However, even if you go to the toilet that much at night, this need continues during the day. The most important reasons for frequent urination at night are diabetes, cardiovascular diseases. In addition, with advancing age, the secretion of antidiuretic hormone (vasopressin) from the brain pituitary gland at night decreases and the amount of urine produced at night increases. Therefore, patients whose main complaint is the need to go to the toilet at night should be examined in detail. Finally, prostate may not be the underlying cause of frequent urination at night. In such cases, even if you receive prostate enlargement treatment or have an operation, your need to go to the toilet frequently at night will not decrease and the same problem will continue to be experienced.

What is the process after prostate surgery?

The things to be considered in the period after prostate surgery and postoperative complications vary depending on the method of prostate surgery.

What are the likely complications after prostate surgery?

The most common complication after prostate surgery is bleeding. If there is bleeding while the operation continues, the prostate may not be cleaned sufficiently. If the bleeding occurs after surgery, the patient may have to be operated again. Apart from this, stenosis in the urinary tract after surgery may occur rarely; This is a very troubling development for both the doctor and the patient. In addition, in order to avoid urethral stricture, it is necessary to work with as fine tools as possible. However, these tools should be maintained completely. It is one of the conditions where infection can also be seen in the urinary tract after prostate surgery. In short, complications may occur after prostate surgery, but the risk of complications is also minimal with the help of modern instruments in the hands of an experienced surgeon.

What is the place of robotic methods in prostate surgery?

Robotic surgery has a considerable place in prostate cancer surgeries. In prostate cancer operation, the prostate and the glands around it are widely removed. For this reason, it is necessary to be extremely careful not to damage the nerves and structures that pass near the prostate and provide urinary retention with erection. Since there is no bleeding in robotic surgery, every point can be seen very clearly, but the developing technology makes a great contribution to the physicians in performing the surgery. In addition, while cancerous tissues are cleaned in this operation, almost no patient faces urinary incontinence problem after surgery. Apart from this, most of the patients do not have any problems regarding sexual functions and sexual life is not affected negatively.

In prostate surgery where robotic methods are applied, it is the surgeon, not the robot, who performs the operation. So, the main point here is that the surgeon is doing the surgery using the robotic system. However, in the case of prostate enlargement, since the operations can be performed through the urinary hole, robotic surgery is not applied unless it is necessary. In short, robotic surgery is an extremely successful method in prostate cancer surgery, while it is a method that has a limited place in prostate enlargement operations.

How are MR (Magnetic Resonance Imaging) assisted prostate biopsies applied in the diagnosis of prostate cancer?

In the standard prostate biopsy procedure, while the peripheral zone, which is the capsule part of the prostate, is divided into 12 regions, a random piece is taken from each region. Since the ultrasound device cannot distinguish between standard prostate tissue and cancerous tissue, it is not possible to target suspicious areas for biopsy. At this stage, it is hoped that tumor tissue will be encountered by taking random samples from different areas of the prostate. These random biopsies cannot detect cancers that have the potential to progress rapidly in some cases. In the new type of MR fusion biopsies, a special prostate MRI is first performed on the patient. Then, suspicious areas for prostate cancer are determined in MRI and these areas are marked digitally. Subsequently, these images are uploaded to special ultrasound devices and prostate biopsies are taken especially from the suspicious areas indicated by the MR. Since MR shows aggressive cancers in the prostate, especially over 0.5 cc, prostate cancers that can cause life-threatening are not missed with this method

How is patient follow-up after HoLEP surgery?

Patients are called for control in the early period, 3-4 weeks after discharge. In the first place, there may be complaints of burning in the urine and infection. If such a situation occurs, treatment for complaints is applied. If there is no complaint in the following periods, the patient; he is invited to routine control at the end of the third, sixth and first year. In the next process, only in case of any complaint comes to the control.

Does HoLEP technology have a negative effect on sexuality?

Around the prostate capsule are nerve cells that regulate sexual functions. Since the effect of the Holmium laser on the tissue is only 0.4 mm, the cells located deeper are not affected by this. For this reason, after prostate surgeries performed with HoLEP Technology, the patient can continue his sexual life as he wishes.

Will there be urinary incontinence after surgery performed with the HoLEP method?

Among the surgeries that prevent prostate growth, the operation that preserves the urine retention muscles called the sphincter in the best way is surgery performed with HoLEP technology. Due to the sphincter muscles that are lazy about urine retention before the operation, a few small drops may be seen temporarily in some patients after the catheter is removed. However, these drips can be eliminated within a few days or weeks with the help of medication or exercise. Of course, the duration of these drips varies depending on the patients. In short, there is no urinary incontinence problem in any patient after HoLEP surgery.

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