Holmium Laser Ablation Of The Prostate

Overview

Holmium laser ablation of the prostate, commonly known as HoLAP, is a surgery to treat the symptoms of benign prostatic hyperplasia. It is a laser surgery that does not involve any cuts and incisions on the body. Benign prostatic hyperplasia is an age-related disease of the prostate seen in men. 

There is an enlargement of the prostate gland, which leads to difficult urination. HoLAP involves using a specific type of laser beam, called the holmium beam, to ablate the excess tissue in the bladder, thus enlarging the urinary channel.

What Is Holmium Laser Ablation of The Prostate (HoLAP)?

Holmium laser ablation of the prostate (HoLAP) is a surgical procedure to deal with the symptoms of benign prostatic hyperplasia (BHP). BHP is a common condition seen in old men. It is a disease characterized by an increase in the size of the prostate that leads to symptoms like-

• Frequent urination, especially at night
• A weak stream while urinating
• Sensation as if the bladder is not emptied fully
• Dribbling of urine after urination

HoLAP is a surgical technique that helps to resolve all these symptoms. It is a minimally invasive procedure that uses a special laser beam, called the holmium laser, to melt and vaporize all the excessive growth in the prostate. 

This helps to widen the urinary channel, providing relief from the symptoms. HoLAP is performed under general anesthesia. You can go home the next day once all your vitals are fine and you can urinate normally.

When Is HoLAP Surgery Recommended?

HoLAP is recommended for men over 60 years who suffer from the typical symptoms of benign prostatic hyperplasia. Men who have undergone medical treatment for BHP and have failed to respond to the treatment are ideal candidates for HoLAP.
HoLAP is recommended for men who:

• Are suffering from benign prostate hyperplasia
•  Have not responded to medical treatment for BHP
• Do not suffer from any bleeding disorders
• Can lie on their backs with their legs raised, as this is the position necessary for the surgery.

How To Prepare For HoLAP?

HoLAP is a minimally invasive procedure that aims to melt and vaporize the extra tissue growth in the prostate. This helps to widen the urinary channels and provide relief from the symptoms.
Here is how you can prepare yourself for the surgery-

Before Surgery:

• Discuss your medical history with your surgeon and inform him about: 
  • All the medications that you are currently taking for your health conditions
  • Any dietary supplements and herbs that you are taking
  • Allergies towards medicines, if any.
• You will be advised of certain tests before you go in for surgery. These tests include:
  • Complete blood count: To check for your overall health
  • Urinalysis: To check for the presence of infections
  • Cystoscopy: This test is done to evaluate the bladder and prostate anatomy and to rule out the presence of blockages and strictures
  • Transrectal Ultrasound: This test is done to measure the enlargement of the prostate gland
  • Urodynamics: This test is done to study the working of the bladder and to determine how surgery on the prostate would affect your bladder function
• You will be asked to stop medications like blood thinners (to prevent excessive bleeding during and after surgery) a week before surgery.
• You will be asked to fast for at least 12 hours before the surgery.
• You will be asked to arrange for a friend or relative to drive you home after you are discharged.

How Is HoLAP Performed?

Holmium laser ablation of the prostate is recommended when the symptoms of BHP have not been resolved with medical treatment. It is a minimally invasive laser procedure that is done under general anesthesia. It takes about 30 minutes to 2 hours when performed by a skilled urologist (a doctor specializing in diseases of the male reproductive tract and the urinary system) 

During Surgery:

• An IV line will be attached to a vein in your hand. This helps to keep administering fluids into your body.
• As per your discussions with the surgeon, general anesthesia is administered.
• You will be asked to lie flat on your back with your legs raised up. This is the position in which the surgery will be performed.
• Once you are sedated, the surgeon will insert a narrow, fiber-optic scope through the tip of your penis into the urethra. The scope is fitted with a tiny camera that enables the surgeon to visualize the insides of the urethra through a monitor.
• Through this scope, the surgeon inserts the laser. The laser does the process of thermal ablation or melting and vaporizing the extra tissue in your prostate
• Once the surgeon has successfully removed all the extra tissues, the procedure is completed, and the laser is tuned off. The catheter is left behind. This is done because there may be swelling in the area of the procedure that may block the flow of urine.

What To Expect After HoLAP?

Once the procedure is done, you will be shifted to a recovery room Here is what you should expect after the HoLAP procedure.

After Surgery:

• The vitals like your pulse rate, respiratory rate, temperature, and blood pressure will be monitored.
• Some amount of bleeding from the prostate is expected. It usually resolves about 12 hours after the procedure
• The catheter will be removed the morning after the surgery. If you can urinate 2 to 3 times without the catheter, you will be sent home without the catheter. If you face difficulty in urinating then the catheter is reinserted and removed after a week.
• Urination will be difficult and painful post-surgery. You will be prescribed medications for the same.

Home Remedies & Aftercare Tips

Recovery from the HoLAP procedure takes about 6 weeks. You need complete bed rest for a week or two after the surgery. After this, you can start with gentle activities. Avoid strenuous work till you have healed completely. Recovering from the HoLAP procedure poses certain difficulties. Here is what you can do at home to recover well.

• Avoid strenuous activities for 1-2 weeks after surgery. Take adequate rest. You may be able to get back to work the next day, but you will end up feeling exhausted very quickly. Hence it is advisable to take things slow.
• Keep up your nutrition levels. Preferably eat bland food for a couple of weeks. Avoid spicy, oily, and salty food. Include a lot of fibrous food in your diet as they help in the free motions of the bowels.
• Take all the medications prescribed regularly and on time
• Drink plenty of fluids as they help your bladder and urethra to recover faster.
• You may notice that you are not able to hold your urine well and that you have to urinate quite frequently, especially at night. These symptoms of BHP will get resolved gradually. This is because your bladder muscles were used to functioning in a certain way with the enlarged prostate. They will take time to adapt to the changes. 
• Perform Kegel’s exercises to decrease leakage from stress-inducing activities like coughing and sneezing
• Avoid sexual activities for a week or two. An erection may be painful and lead to bleeding.

What Are The Benefits & Risks of HoLAP Surgery?

Laser surgery for prostate problems ensures freedom for urinary complaints. The results are long-lasting. It may happen that the laser does not melt all the tissue and some of it remains, leading to urinary blockage. This may need further treatment.

 Benefits of HoLAP: 

• The improvements in the symptoms are noticeable right away after the surgery
• HoLAP involves a short hospital stay
• There is no risk of bleeding as the procedure is done with laser
• Traditional procedures require a catheter to stay in place for a long time. With HoLAP, the catheter is retained for a maximum period of one week.

Risks of HoLAP: 

• Urinary tract infections: These are common risks due to the presence of the catheter. Ensure that you take the prescribed antibiotics regularly
• Stricture formation: The scars after the surgery can lead to strictures and blockage in the urine flow
• Erectile dysfunction: This is a very rare complication, but there is a chance that laser surgery for prostate complaints can cause erectile dysfunction
• Retrograde Ejaculation: This can happen when the semen is released into the bladder rather than the penis. This is known as a dry orgasm. Though you get a normal erection, the ability to father a child is affected.
• Men who have had a HoLAP procedure done may need further treatment in the future. This is because the procedure may sometimes miss out on vaporizing some tissues or the tissues may grow back after several years.

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 task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!