Holmium Laser Enucleation Of The Prostate (HoLEP) in Bangalore: Procedure & Cost

What Happens Before HoLEP Surgery?

• Before the surgery is scheduled, it is advisable to discuss the entire procedure with the doctor, along with its steps, benefits, and risks. Take your time to explain your expectations and any questions you may have.
• The doctor will discuss your symptoms, medical history, and surgical history. They may also order a complete health check to evaluate a number of aspects such as the symptoms’ severity and prostate size. The required tests for BPH diagnosis before laser holmium prostate surgery are:
  • Health examination: This includes a detailed physical examination and a digital rectal exam. The digital rectal exam is about the surgeon using a finger to palpate as well as examine the size of the prostate gland. 
  • Lab tests: This involves blood work, a PSA (prostate-specific antigen) test, and a urinalysis. PSA is a protein made by your prostate gland. If the level of PSA is too high in the blood, it may indicate prostate cancer. 
  • Transrectal ultrasound: This test helps visualize and assess your prostate gland size as well as shape. It’s better than a digital rectal exam in accuracy. It also helps assess the volume of urine retained by the bladder post-urination.
  • Cystoscopy: A cystoscopy helps examine the bladder and urethral lining with a camera lens. It’s essential for repeat procedures for the evaluation of the scar tissue amount present on the urethra, prostate gland, and bladder to rule out urethral strictures.
  • Urodynamics: It refers to a series of tests done to examine how your bladder, urethra, and sphincters are functioning. It also helps determine how able they are in holding and releasing urine. Urodynamics involves a catheter in the bladder and various pressure sensors. It helps in determining whether the urinary symptoms/issues are because of prostate enlargement or some other urinary problems. 

After the completion of these diagnostic tests, the treatment procedure is determined. Once that too is done, the below-mentioned instructions are given to the patient:

• Have a urine culture within 2 to 4 weeks of the surgery for minimizing the risk of infection later.
• Not to take blood thinners for up to 10 days prior to the laser enucleation (HoLEP) surgery.
• Not to consume any foods or drinks from midnight of the day of the surgery.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty tasks of finding the best hospital, the finest doctor, and the latest procedure at the lowest costs. Let us take charge while you sit back and focus on your health & recovery. Think surgery! Think Medfin!

What are the Potential Complications Associated With HoLEP Surgery?

This laser prostate surgery is successfully carried out in Bangalore. However, like any surgery, it has certain complications associated with it. These include:

• Infection of the bladder, testes, or kidneys
• Long-term urine leakage
• Recurrence of urinary problems
• Blood loss that requires a blood transfusion
• Injury to the surrounding structures (like the urinary bladder, urethra, and prostate capsule, accompanied by extensive scarring)
• Anesthesia-related complications
• Extensive urethral swelling leading to prolonged catheterization

What Are The Side Effects of HoLEP Surgery?

The most common HoLEP side effects are:

• Temporary bleeding and burning sensation during urination: These are not very serious instances and should resolve on their own with healing.
• Temporary urinary incontinence: In those with BPH, the urinary sphincter (a ring of muscle around the urinary opening) can weaken with time because the excess prostate tissue holds urine in the body rather than the sphincter. After HoLEP surgery, it can take some time for the sphincter muscles to regain their strength, leading to temporary urinary incontinence and harder-to-control urination in the first few days of the surgery. Pelvic floor exercises like Kegel exercises may be helpful here in improving your urinary control.
• Retrograde ejaculation: Also known as dry orgasm and backward ejaculation, this is a condition wherein the semen enters the bladder instead of the penis after ejaculation.

What are the Benefits Of HoLEP Surgery Over Other Treatments?

When it comes to treating BPH (benign prostatic hyperplasia), Holmium Laser Enucleation of the Prostate or HoLEP is an extremely safe and effective treatment option. Its benefits include:

• Suitability for severe cases of BPH 
• Minimally invasive so carries lesser chances of risks
• A large amount of prostate tissue can be removed without major incisions
• Availability of tissue for pathology to look for prostate cancer
• Chances of heavy bleeding post-surgery are very low
•  Minimal need for blood transfusions during surgery
• Short hospital stay 
• Reduced recovery period
• Lowered chances of recurrence rate of BPH 
• Reduced risk of the requirement of repeat treatment

When To Contact The Doctor After HoLEP Surgery?

Contact your surgeon immediately upon noticing any of the following symptoms after the HoLEP procedure:

• High fever
• Severe bleeding
• Passage of blood clots
• Increasing urinary frequency
• Pain 
• Sudden difficulty in passing urine

What Are Some Tips For Recovery After HoLEP Surgery?

• For driving, wait at least 2 weeks or until you get your doctor’s approval.
• Avoid all strenuous activity for 2 weeks. 
• Eat healthily to avoid constipation.
• Avoid caffeine because it enhances your urge and frequency to urinate.
• Consult your doctor about pelvic floor exercises to help with recovery.
• Sexual activity should only be resumed post-consultation with your doctor.

How Long Is The Recovery Post-HoLEP Surgery?

Discharge from the hospital is usually within 24 to 48 hours of the surgery. During the recovery phase, 1 to 2 weeks of rest are fine before you return to work if it’s a desk job. However, 3 to 4 weeks of rest are needed for work involving daily strenuous physical activity. The HoLEP procedure recovery time is generally 4 to 6 weeks for most people.

What Happens Post-HoLEP Surgery?

• Generally, an overnight stay is required for observation and catheter care after Holmium Laser Enucleation of the Prostate (HoLEP) surgery. 
• The extra prostate tissue removed during surgery is sent to a laboratory for testing for findings such as the presence of prostate cancer.
• You can expect some bleeding from the prostate which resolves in about 12 hours.
• The surgical team will flush fluid through the catheter to clear blood from the urine.
• You may be allowed to eat and drink on the same day as the surgery after being cleared by the team.
• The catheter is removed the next day in case bleeding is normal as well as manageable. You may be discharged 24 hours after the procedure.  However, if there is too much swelling and you can’t urinate without the catheter, then catheterization is carried on for 7 days.
• Finally, there can be some pain and discomfort during urination after the procedure. This is managed with pain and anti-inflammatory medication easily. 
• You may be instructed to consume more fluids during this phase to clear the blood from the urine with more efficiency and speed.
• Note that the bladder takes time to readjust itself after the removal of excessive prostate tissue and muscle control in the pelvic area can be weakened by the surgery. That is why the symptoms caused due to BPH such as frequent urination and waking up in the night to urinate may take several months to resolve.

How is HoLEP Surgery Performed?

The steps of HoLEP surgery as carried out in Bangalore are:

• General or spinal anesthesia is given, depending upon the preferences of both the doctor and the patient.
• The patient may be given an antibiotic injection to reduce the chances of infection.
• The patient is then laid in a proper surgical posture as required for this surgery, that is, on the back with legs raised.
• The modified resectoscope is inserted through the patient’s urethra. Through the resectoscope, the surgeon is able to view the internal structure of the prostate gland and determine the points of incision to be made during surgery.
• HoLEP laser is inserted through the resectoscope and pulses a beam of Holmium laser to enucleate (remove) the enlarged prostate tissue. The laser beam pushes and peels the tissue to separate the core from its outer layer. 
• The cuts in blood vessels are then sealed back with the laser. This prevents bleeding. 
• The removed prostate tissue (in the form of 2-3 large pieces) is now deposited in the urinary bladder. 
• Now the laser instrument is removed from the resectoscope. It is replaced with another instrument known as a morcellator. This device suctions out the removed tissue from the bladder.

As the HoLEP procedure ends, a catheter is placed in the bladder. This helps with urination because the urethra may be swollen from the surgery. The catheter placement further helps in flushing out blood clots from the bladder post-surgery.

What Are HoLEP Surgery’s Indications And Contraindications?

Indications for HoLEp surgery or HoLEP operation can be summed up as follows:

• Blood in urine
• Frequent urination
• Inability to urinate
• Difficulty in starting urination
• Loss of bladder control
• Recurrent urinary tract infections (UTIs)
• Bladder pain with bladder stones’ presence
• Recurrent acute urinary retention

Contraindications of HoLEP prostate surgery include:

• Severe bleeding/clotting disorders
• The inability of the patient to lie down on his back with legs raised (a posture necessary for the surgery) due to spine abnormality
• High fever or pre-existing infection
• Severe cardiopulmonary disease
• History of prior prostate treatments

How Does HoLEP Surgery Work?

A modified resectoscope is an instrument/tube used during this surgery, also known as holmium laser prostate surgery in Bangalore. The resectoscope is an endoscopic instrument with a camera and a light at one end. This tube is inserted through the urethra during the surgery. A laser fiber instrument is inserted through the resectoscope and the excess tissue of the prostate gland is chipped away with the help of a high-powered laser beam.

The extra prostate tissue to be discarded is deposited into the bladder. The laser instrument is removed from the resectoscope and replaced with a special device called a morcellator. This device suctions out the tissue left behind in the bladder.

As a part of this surgery, the tissue removed can be sent for examination in a laboratory to check for other conditions, including prostate cancer.

What Is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia or BPH refers to the non-cancerous enlargement of the prostate gland. The gland naturally gets enlarged in men because of hormonal changes. The two main growth periods for the gland are puberty and after the age of 40. 

An enlarged prostate can cause symptoms such as blocking the flow of urine out of the bladder. It can also result in urinary bladder, urinary tract, and kidney problems.

About 50% of men between 51 and 60 years of age suffer from urinary problems because of BPH. Furthermore, 90% of men above 80 years of age experience symptoms of this condition.

What is HoLEP Surgery?

HoLEP is an abbreviated form of Holmium Laser Enucleation of the Prostate. It’s a minimally invasive laser surgery used to treat lower urinary tract symptoms or LUTS caused due to BPH (benign prostatic hyperplasia).
HoLEP is useful in treating severe cases of BPH by removing excess prostate tissue and undoing the blockage of urine flow. The surgery may also be referred to as “Holmium laser prostate surgery”, or simply “HoLEP operation.”