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HOLMIUM LASER ENUCLEATION OF THE PROSTATE HoLEP PATIENT INFORMATION BOOKLET THIS IS MODERN MEDICINE

HOLMIUM LASER ENUCLEATION OF THE PROSTATE HoLEP PATIENT INFORMATION BOOKLET What is the Prostate Gland Why Do I Need Prostate Surgery The Prostate Gland is the size and shape of a large walnut and can even grow to the size of an orange It lies just beneath the bladder and is wrapped around the urethra the water pipe through which your bladder empties Your Urologist will have explained that you cannot empty your bladder properly due to bladder outflow obstruction and you have a poor stream This occurs when the prostate gland becomes enlarged This is usually due to a condition called Benign Prostatic Hyperplasia BPH Almost all men over the age of 45 have BPH to some extent Drug therapy may have been tried but did not work or your symptoms have returned Ureters This operation aims to relieve symptoms of bladder outflow obstruction The Holmium laser enucleation of the prostate or HoLEP is a technique used to remove all of the obstruction of the prostate with the aim of improving the flow of urine through the urethra and to improve emptying your bladder Bladder Seminal Vesicle Prostate Gland Ejaculatory Duct Urethra What Are The Alternatives Drug therapies use of a catheter observation open operation to remove prostate or conventional transurethral resection of the prostate TURP What Preparations Should be Made You will receive an appointment for pre assessment to assess your general fitness to screen for MRSA and to perform some baseline investigations Testes Penis The main job of the prostate is to produce fluid to nourish and carry the sperm The bladder neck contracts around the urethra when you ejaculate This prevents the sperm from backfiring into the bladder Depending on the most up to date Covid guidelines you may be required to take a Covid test prior to your scheduled surgery You must bring a list of all current medication you are taking with you This list is extremely important and should in particular include any blood thinners you may be taking If you are unsure of the names dosages of your medications ask your doctor or pharmacist to print you a list If any medications need to be stopped prior to your surgery this will be discussed with you at your appointment

You must also bring along a list of your past medical history This should include any relevant diagnosis or past medical or surgical procedures You will be seen by a urology nurse prior to your admission At this appointment you will be taught pelvic floor exercises discuss your hospital stay and will have the opportunity to ask any questions you may have You will be given instructions on when to stop eating and drinking once you have your operation date and time of admission You will come into the hospital to the Surgical Day Unit SDU on the day of surgery After admission you will be seen by members of the medical team and nursing staff You will be asked to sign a consent form giving permission for your operation to take place showing you understand what is to be done and confirming that you wish to proceed Make sure that you are given the opportunity to discuss any concerns and to ask any questions you may still have before signing the form You may be given elasticated stockings provided by the ward to wear which will help prevent thrombosis clots in the veins This is a normal precaution How is The Operation Performed The HoLEP procedure usually involves a one night stay in the hospital This will be discussed with you by your consultant The operation is performed under a general anaesthetic you are put to sleep The surgeon uses a telescope see see the enlarged prostate Once this is in place a laser fibre is passed through the telescope The laser energy is used to separate the obstructing prostate tissue from the capsule of the prostate The tissue is then disintegrated into small pieces and removed from the bladder All tissue removed will be sent away for analysis in the laboratory The operation takes between 45 120 minutes depending on the size of the prostate At the end of the operation a catheter tube is placed into the bladder through your water pipe Irrigation is sometimes attached to flush blood through your bladder for a few hours and this is collected in a catheter bag What Happens Afterwards After your operation you will be brought to the ward to recover Once you feel able to you will be allowed to eat and drink once again You may have a drip in your arm to keep you hydrated which will be stopped when you are eating and drinking normally As you stay in hospital overnight a nurse might remove your catheter the next morning This does not usually cause pain but can be uncomfortable when moving and occasionally bladder spasm can occur but these can be treated with tablets After the removal of your catheter you will remain in hospital for a further 2 3 hours to ensure that all is well before going home When the catheter is removed the urine may be blood stained and the desire to pass urine may be surprisingly urgent Both these features are common and should subside over the next 2 4 weeks On rarer occasions some patients experience these symptoms for up to three months Are There Any Side Effects Most procedures have a potential for side effects but the majority of patients do not suffer any problems after this urological procedure HoLEP is a commonly performed operation Common Side Effects Greater Than 1 in 10 Temporary mild burning bleeding and frequency of urination after the procedure No fluid is produced during an orgasm in approximately 75 this is called Retrograde Ejaculation or dry orgasm Where the prostate tissue has been removed it is less effective at contracting the water pipe when you ejaculate Therefore although the sensation of orgasm is usually unaltered the sperm may leak backwards into the bladder rather than through the water pipe You will pass the sperm when you next pass urine This does not necessarily mean you are sterile and should not to be used as reliable contraception Treatment may not relieve all prostatic symptoms Failure to pass urine immediately after surgery requiring placement of a new catheter in 10 which is then removed almost always successfully within a week 10 15 Infection of the bladder testes or kidneys requiring antibiotics

well as the TURP and studies have shown that men do not have to use a catheter for as long after surgery and may have a shorter stay in hospital It is just as safe as a TURP and patients experience less bleeding with the holmium laser prostatectomy than the after a TURP At Home It may take several weeks for you to fully recover from this surgery A stronger than usual desire to pass urine can occur quite commonly in the first month following surgery A small number of men have some leakage and may be required to wear pads This will improve with pelvic floor exercises A little bleeding can occur for a couple of weeks and can look dramatic as a drop of blood colours a large volume of urine red You should drink plenty of water to flush out your system Injury to the urethra causing delayed scar formation Loss of urinary control incontinence which reduces within 6 12 weeks 10 15 this can usually be improved with pelvic floor exercises Occasional Between 1 and 10 and 1 in 50 Finding unsuspecting cancer in the removed tissue which may require further treatment May need self catheterisation to empty the bladder if the bladder is weak Weaker or no erections Two recent studies have shown no significant difference in ability to have an erection in men before and after HoLEP surgery but there is still a small risk probably less than 5 of a decreased ability to have an erection Some men s erections improve after surgery Rare Less Than 1 in 50 Need to repeat treatment later due to re obstruction from prostate regrowth approx 1 in the first 7 years after surgery Self catheterisation or permanent catheter to empty bladder if the bladder is weak 1 Persistent loss of urinary control which may require a further operation less than 1 Retained tissue fragments floating in the bladder which may require a second telescopic procedure for their removal less than 1 Very rarely perforation of the bladder requiring a temporary urinary catheter or open surgical repair less than 0 5 Bleeding requiring return to theatre and or blood transfusion less than 0 5 HoLEP is a relatively new procedure and a superior alternative for the more conventional transurethral resection of prostate TURP HoLEP works just as Should the bleeding persist and become heavier you may need to contact your G P Some discomfort on passing urine may also persist for two to three weeks Mild painkillers such as paracetamol may be helpful Most men return to work two weeks after their operation It is important to avoid heavy lifting and strenuous exercise bicycle riding and sport for the first 4 6 weeks after surgery We recommend that you should avoid driving for at least two weeks or until you are able to do an emergency stop without hesitation Normal sexual activity can be resumed as soon as you feel comfortable usually after three to four weeks If you have been taking medication for your urinary symptoms such as Tamsulosin or Finasteride you will be able to stop taking these tablets after your operation Laboratory Results As mentioned earlier tissue removed from your prostate will be tested in the laboratory The laboratory will send the results of these tests to your Urologist At your clinic appointment with your Urologist 6 weeks after HoLEP he will discuss your results with you Points of Contact If you have any other questions or require more information prior to your treatment please contact the Urology Department on 01 650 4680 between the hours of 08 30 to 16 30 or leave a message on the answer machine

Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 6600 www beaconhospital ie Version 1 1 2022