Bening prostatic hyperplasia (BPH, benign prostatic enlargement) is a disease whose incidence increases with age. Endoscopic treatment methods are generally...
Urology at Ege University Faculty of Medicine. He became a Urologist in 1993.
He worked as a lecturer at various universities and hospitals.
He became a Professor in the field of Urology at Istanbul University Cerrahpaşa Faculty of Medicine.
He was included in the World's Most Influential Scientists List of American Stanford University as a Turkish doctor.
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Urology Specialist Prof. Dr. Emin ÖZBEK
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Holmium Laser Prostate Enucleation with the clear spelling HoLEP
In benign prostate enlargement, prostate adenomas that cover the urinary canal with the middle lobe from the sides or from the bottom are stripped from the capsule of the prostate and removed almost without damaging the vessels and nerves that provide sexual power. The removal of prostate adenoma from its capsule with Holmium laser is called HoLEP.
HoLEP : It is an abbreviation consisting of the initials of Holmium Laser Enucleation Prostate.
Laser: If it is defined very simply, it is the light energy that can be focused at high intensity with the help of mirrors placed parallel to the photons emanating from the source and emitted from the atoms.
Holmium is a type of laser like KTP (GreenLight) or Diod (RedLight).
Holmium laser, its actual scientific name is holmium:YAG laser. It has a pulsed laser feature. (This term “pulsed” may be easier to grasp when you consider the logic of hammer drills in which power is applied sequentially in our lives). It emits light with a wavelength of 2.1 microns pulsed.
The holmium laser, which can easily pass through optical fibers, can be used in endoscopic surgeries due to this feature. In urology, it is used in endoscopic stone breaking at low watts, while it is used in prostate enlargement and tumor surgery at high watts.
Devices that give holmium laser energy are portable but very sensitive and heavy devices.
With a wavelength of 2.1 microns, the holmium laser is highly absorbed by water and has a window to shallow depth in tissues. This depth is about 0.4 mm. Its pulsating feature ensures that holmium does not have a high temperature effect on deep tissues.
In other words, while we are cutting the tissue with the holmium laser in a bloodless manner, the probability of causing damage due to high heat that we do not notice in the depths of the tissue we cut or in the tissue parts that are not in our target is very low. 25 watts) focusing only on the vein, the bleeding is controlled.
In prostate enlargement, also known as BPH, benign enlarged prostate adenomas obstruct the urinary tract either from the sides, from the bottom with the lobe we call the middle lobe, or from both the bottom and sides. The most common benign tumor seen in men is actually BPH. (We can also say that it is the development of fibroids in women in men).
Enlarged prostate adenomas (or galls) narrow the urinary canal, causing a decrease in the rate of urination, and the person begins to urinate by waiting and straining. His urine flow decreases and he starts to urinate intermittently, and unfortunately he feels as if there is still urine in his bladder even if the urine flow is interrupted, because he cannot completely empty his urine.
As explained in the technical specifications of the holmium laser, there is no serious bleeding when cutting the tissue with the holmium laser. However, slightly larger (2-3 mm) arteries feeding the adenoma tissue bleed when cut with a laser, but since it is fixed to cauterize the vessels at low watt energy, the vascular mouth is cauterized by laser. Therefore, the amount of bleeding in HoLEP prostate surgery is quite low.
If possible, it would be better to stop one but continue with the other, if possible, in those who use anti-thrombotic drugs called very heavy and combined blood thinners or thinners. However, HoLEP prostate surgery can be performed alone, for example, with drugs such as acetylsalicylic acid (ecopirin, baby aspirin, aspirin …).
It is necessary to be more careful in patients using Coumadin. And if possible, it would be more appropriate to perform HoLEP with low molecular weight heparin applied under the skin.
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