Which surgical procedure for BPH is right for you?

Holmium Laser Enucleation of Prostate (HoLEP) versus Transurethral Resection of Prostate (TURP)

When it comes to treating benign prostatic hyperplasia (BPH) or an enlarged prostate, patients often face a range of treatment options. Two popular and effective procedures for prostate enlargement are Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TURP). While both procedures are minimally invasive and help improve urinary symptoms, there are distinct differences between them that can influence a patient’s treatment choice. Let’s take a closer look at the benefits of HoLEP over TURP.

What is HoLEP and TURP?

Before diving into the advantages of HoLEP, let’s understand what each procedure involves:

• TURP: TThis is the most common surgical procedure for treating BPH. During the procedure, the surgeon uses a resectoscope inserted through the urethra to remove parts of the enlarged prostate tissue. TURP is effective for many patients, but it comes with certain limitations and risks.
• HoLEP: In contrast, HoLEP uses a holmium laser to enucleate (remove) the prostate tissue. A small laser fiber is passed through the urethra to precisely remove prostate tissue, typically in larger amounts. This method is gaining popularity due to its effectiveness and advantages over traditional TURP.

Key Benefits of HoLEP Compared to TURP

• Less Risk of Bleeding One of the most significant advantages of HoLEP over TURP is the reduced risk of bleeding. HoLEP uses a laser to precisely enucleate and remove the prostate tissue. The laser also coagulates blood vessels as it works, reducing bleeding during the procedure. This makes it particularly beneficial for patients with large prostates or those who are at risk of bleeding complications. In contrast, TURP involves cutting away tissue using electrical current, which can lead to more bleeding and the need for blood transfusions, particularly in patients with larger prostates. HoLEP, therefore, offers a safer, alternative for patients with underlying health conditions that may increase the risk of bleeding.
• Better for Larger Prostates While TURP is often effective for moderate prostate enlargement, it can be less successful for men with significantly enlarged prostates (greater than 80 grams). In these cases, HoLEP is often the procedure of choice. HoLEP can safely and effectively remove much larger volumes of prostate tissue, making it an excellent option for men with severely enlarged prostates. For men with very large prostates, HoLEP provides more comprehensive tissue removal and is associated with better long-term symptom relief compared to TURP.
• Faster Recovery Time Patients who undergo HoLEP often experience shorter recovery times compared to those who have TURP. The precise nature of the laser procedure reduces trauma to the surrounding tissue, which can result in less postoperative discomfort, a shorter hospital stay, and quicker return to normal activities. On the other hand, TURP typically involves a longer recovery period. Patients may need a catheter for a longer duration after the procedure, and the risk of complications such as urinary retention or infections can lead to a slower recovery.
• Lower Risk of Postoperative Complications HoLEP has been shown to have a lower risk of certain postoperative complications, such as:
• Retrograde Ejaculation: A common side effect of TURP, retrograde ejaculation occurs when semen is directed into the bladder rather than out of the urethra during orgasm. While retrograde ejaculation is still possible after HoLEP, the risk is lower compared to TURP, especially when a bladder neck sparing approach is used.
• Bleeding: The enucleation method (as compared to resection) when combined with the laser’s ability to control intraoperative bleeding very effectively in HoLEP allows for near bloodless procedure and the bleeding risk is significantly lesser with a HoLEP. While complications can occur with any surgery, HoLEP’s advanced technique and precision result in fewer side effects in the long term.
• Reduced Risk of TUR Syndrome: TUR syndrome is a rare but serious complication of TURP, which results from the absorption of too much irrigating fluid during the procedure. This condition can cause symptoms like confusion, nausea, and electrolyte imbalances. Since HoLEP uses a different method (enucleation) to remove prostatic tissue, the risk of TUR syndrome is significantly reduced with this procedure.
• Long-Term Effectiveness: In terms of long-term benefits, HoLEP offers excellent durability. Studies have shown that HoLEP leads to long- lasting symptom relief and a reduced need for retreatment, even in patients with large prostates. This is especially important for men who want to avoid multiple procedures or repeat visits to the doctor. TURP, while effective, may not always provide the same level of long-term relief, particularly for men with larger prostates or those experiencing recurrent symptoms.
• Improved Quality of Life With a lower risk of complications, quicker recovery time, and better long-term symptom relief, many patients report an improved quality of life after HoLEP. The ability to resume normal activities sooner and experience fewer side effects post-surgery makes HoLEP an appealing option for those who want to get back to their routines quickly.

Conclusion

What is Right For You?

Both HoLEP and TURP are effective options for treating BPH, but there are distinct advantages to Holmium Laser Enucleation of the Prostate. HoLEP is particularly beneficial for men with larger prostates, those at higher risk of bleeding, and those who want a faster recovery with fewer long-term complications.

As with any medical procedure, the right treatment for you depends on your individual health condition, prostate size, and any other relevant factors. It is essential to consult with your urologist to determine the best treatment plan for your unique situation.
Ultimately, HoLEP represents a modern, minimally invasive option that offers many advantages over traditional TURP, especially for patients with complex or advanced prostate enlargement.
If you're considering treatment for BPH, discussing the benefits of HoLEP with your doctor could help you make a more informed decision about your care.