HOLEP can be successfully applied to patients who have relapsed after TUR-P or Greenlight Surgery. Benign prostate enlargement (BPH), which is seen in older men and causes complaints such as difficulty urinating and frequent urination, is a condition that requires surgery if it does not respond to medications. The most commonly used methods in the surgical treatment of prostate enlargement are open prostate surgery and TUR (TUR-P), called transurethral resection.

In the surgical treatment of BPH, open prostate surgery was commonly performed in the past, but TUR surgery is widely performed today. In addition, the Greenlight method, which is a form of laser, is also used in patients with prostate enlargement. In this method, it is not possible to completely remove the prostate and most of the patients relapse. In recent years, laser prostate surgery called “HOLEP” has been accepted as the best option in the surgical treatment of benign enlargement of the prostate (laser prostate surgery, laser prostate surgery). Unlike Greenlight and TUR, there is no recurrence (recurrence) or extremely rare in HOLEP surgery.

In TUR-P surgery, prostate adenoma cannot always be completely cleared and some tissue may remain or recurrence (recurrence) may occur in the future. The reason for recurrence is usually that the enlarged prostate (adenoma) is not completely cleared. Especially in large prostates, this situation is more common and patients may need to be operated again in the future. HoLEP surgery is a method successfully applied to such patients.

Successful results can be obtained if TUR surgery is performed by experienced doctors, especially in patients with small prostates. However, bleeding is a common condition in large prostates, and there may be symptoms such as TUR syndrome, which occurs as a result of absorption of the fluid used during surgery into the body.

In HoLEP surgery, prostate adenoma is completely removed by entering through the urinary canal. In order for the adenoma to be completely removed, the adenoma must be removed up to the membrane surrounding the prostate, which we call the capsule. It is very difficult to perform this procedure properly and completely in TUR surgery. However, in laser prostate surgery, it is possible to completely remove the enlarged prostate up to the capsule.

If patients apply to a doctor with complaints before surgery after closed prostate surgery, it should be considered that the prostate cannot be removed completely, that it recurs (recurs) or that there is a narrowing in the urinary tract. The narrowing of the urinary tract after prostate surgery may occur in the urinary tract, which we call the urethra, or in the bladder neck. It is possible to understand that there is narrowing or recurrence by examination, ultrasound or cystoscopy method.

Surgical treatment is the most effective treatment if there are conditions such as narrowing of the urinary tract or recurrence or inability to completely excise the prostate. The surgical methods to be applied in these cases are the operations performed with the closed method, which we call endoscopic. Constrictions in the urinary tract are easily opened by closing the narrow part (endoscopic internal urethrotomy). If the stenosis recurs frequently and is in a long area, open surgery may be required in these cases.

If recurrence or recurrence occurs in those who have undergone TUR surgery due to benign enlargement of the prostate, and if their complaints are too high, these patients should be operated again in the same way. These patients can have their second surgery with the TUR method. According to the results of studies published in reputable medical journals in the field of Urology, it has been reported that the HOLEP method is very successful in the surgical treatment of patients who relapse after TUR, because with this method, the capsule is fully reached and the remaining tissues can be completely cleaned. Previous TUR surgery does not prevent HOLEP from being performed or, as with normal HOLEP, going down to the capsule and removing the remaining prostate completely.

To summarize, there is almost no recurrence in HOLEP surgery, and if patients have had prostate surgery with methods such as TUR, green light, and the prostate has recurred, it is possible to completely clear these tissues with HOLEP surgery. In this way, any negative side, namely complications, of performing laser surgery in previously operated and unsuccessful cases have not been observed. Significant improvements were noted in patients after surgery.

Literature

Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH). BJU Int. 2012 Dec;110(11 Pt C):E845-50.

Prof. Dr. Emin ÖZBEK

Urology Specialist