ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
What is HoLEP Treatment?

The prostate is a chestnut-sized male gland located under the bladder. The urinary tract passes through it. It develops after puberty. It supplies some of the semen in adult men, and the semen duct opens into the urethra through the prostate. As the prostate compresses the urinary tract and makes it difficult to urinate, the urinary bladder is forced, thickened and sensitive. The bladder trabeculates, that is, it becomes indented. In the advanced period, pits and diverticula form and the kidneys may deteriorate. If the patient is unable to urinate, a catheter should be placed.

In some men after the age of 40-50, a new tissue begins to grow around the urethra that passes through the prostate. It compresses the urinary tract passing through it. This tissue that grows later is called “adenoma”, it is not cancer. The adenoma pushes the patient's original prostate outward, making it a capsule. Complaints such as weak urination, waking up to urinate at night, frequent urination, intermittent urination, waiting to urinate, inability to completely empty the urine are seen.

With today's scientific research and developing technology, significant progress has been made in the diagnosis and treatment methods used in the field of health. In particular, newly defined surgical intervention methods have provided advantages such as high treatment success, rapid recovery period, shorter hospitalization time and fewer complications after treatment. In this sense, a new surgical method, which is applied for prostate problems that are common in elderly male patients, and which has been increasingly preferred in recent years, is the method called HoLEP treatment. It has been widely used in all European countries and America in the last 10 years and is seen as the new gold standard in prostate treatment.

What is HoLEP Treatment?

HoLEP method; It is an abbreviation of the treatment method expressed as “Holmium Laser Enucleation of the Prostate” in English. In this method, it is aimed to eliminate the problem of urinary tract obstruction of the prostate tissue, which occurs as a result of benign prostatic hyperplasia (BPH), which is one of the most common health problems in elderly men, by laser surgeryThe most important advantage of the HoLEP treatment is that it provides an effective and fast healing treatment with closed surgery without the need for any incision in the patient.

In the current clinical approach, in severe cases that do not respond to drug treatment, TUR-P (Transurethral resection of the prostate), which is the method in which the prostate gland is removed by entering the urethra with the closed surgery method, is a more effective and less risky method compared to the methods in which the prostate gland is removed by open surgery. It has become the preferred method.

Who is HoLEP Treatment Applied to?

It is inevitable to resort to surgical treatment in cases where drug therapy is insufficient and prostate size increases. The HoLEP method can be applied with a high success rate in cases where prostate enlargement of any size is seen, causing obstruction as a result of prostate enlargement in the urinary tract.

How is HoLEP Treatment Applied?

Before applying HoLEP treatment, a detailed physical examination is performed by taking the patient's detailed disease history. In order to determine that the patient does not have any additional health problems that may prevent the operation, various blood and urine tests may be required. Appropriate precautions and procedures are applied prior to surgery to prepare patients with additional chronic conditions for surgery. The surgery is performed under spinal or general anesthesia.

HOLEP surgery is performed by entering through the canal where the patient urinates, that is, closed. With the Holmium Laser, the enlarged adenoma is removed from the patient's own prostate, which has taken the form of a capsule, and there is no adenoma tissue left in the patient, that is, the tissue that subsequently grows and compresses the urinary tract.

Therefore, there is no need to make any incisions outside the body during the surgery.

The catheter is withdrawn 24-48 hours after the surgery. And he is discharged. The patient can start eating and drinking on the same day after the surgery. 

What are the Advantages of HoLEP Treatment?

The HoLEP method has some advantages compared to other interventions used in prostate surgery, since it is a method that is applied with the closed surgery method, without the need for any incision or additional intervention.

1. It is done closed with Holmium Laser, it is a less bleeding surgery.

2. It can also be applied to those who use blood thinners.

3. It is the preferred surgery in patients with heart and lung problems.

4. It does not damage the nerves associated with erection (hardening).

5. The entire adenoma is removed. The removed tissues are sent for analysis.

6. Most patients can go home the next day. The probe time is short.

7. The patient urinates very easily.

8. It can be performed on prostates of any size.

9. Since the enlarged part of the prostate (Adenoma) has been completely removed, it is very rare to grow again in the following years.

What Risks does HoLEP Treatment Involve?

Although HoLEP treatment is a very successful method in prostate-related diseases, it also brings some risks and complications, as in any surgical treatment method. In this sense, the complications that can be seen in the patient after the application of HoLEP treatment are as follows:

• After the surgery, temporary burning sensation and light bleeding may occur while urinating.

• Among prostate surgeries, HOLEP surgery is the method that best protects the urinary sphincter muscles. Urinary-holding muscles are very well visible, unapproachable and well-protected. However, if the urinary-holding sphincter has become sluggish before surgery, some patients may rarely experience temporary urinary drips after catheter removal. These drips resolve with medication and exercise, sometimes within a few days, sometimes within a few weeks. Permanent urinary incontinence is not seen.

• As in all kinds of surgeries, namely TUR, Plasmakinetic or Greenlight surgeries, since the semen and bladder neck are open, they go to the urinary bladder and are then excreted with urine. This is called retrograde ejaculation and has no harm to affect the patient's health.

• The depth of the Holmium Laser in the tissue is 0.4 mm. It is not possible for this laser to pass through the 6-7 mm thick capsule and damage the masculine nerves, so it has no harmful effect on erection.

• Various complications such as injury to the organs and tissues of the urinary tract, obstruction in the urinary tract, severe bleeding and urinary tract infection are very rare due to the development of scar tissue in the urinary tract after surgery.


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