Prostate is a chestnut-sized male gland that surrounds the urethra under the bladder. It provides some part of the semen in adult men, and the semen duct opens into the urethra through the prostate
After the age of 40-50, a new tissue begins to grow around the urinary tract in some men, This tissue compresses the prostatic urethra ( urinary tract). The tissue growed is called as ADENOMA. It is not a cancer. As the adenoma grows, the patient's prostate is pushed outward and becomes a capsule. The basis of benign, ie non-cancerous, prostate surgeries is to remove the adenoma by leaving the capsule in place. Picture 1: Prostate is a chestnut-sized male gland that surrounds the urethra under the bladder. When it is enlarged, it makes the urination difficult by obstructing the urethra.
WHICH COMPLAINTS ARE SEEN IN THE PATIENT IN BPH, BENİGN PROSTATE HYPERPLASIA?
In non-cancerous enlargement of the prostate, one or more of the complaints, such as difficulty in urination, getting up to urinate at night, interrupted or weak urination, delays in urination, dripping after urination and inability to fully empty the bladder are seen. These can also be signs of prostate cancer. Picture 2: When the prostate is enlarged, one or a few of the coplaints may occur.
WHICH EXAMINATIONS ARE PERFORMED IN THE PATIENT WITH PROSTATE COMPLAINTS?
To the patient who applied with prostate complaints;
PSA test is done to see if cancer is suspected,
Ultrasonography and residual urine tests are done to see the size of the prostate,
Uroflowmetry test is done to see the flow rate of urine,
Urinalysis and urine culture test are done to see if there is inflammation in the urine.
According to the results of the examinations, drug treatment is recommended in mild prostate enlargement, and the prostate is followed up by regular controls of the patient.
WHEN IS THE SURGERY DONE?
According to uroflowmetry; in cases where the urine is made too weak or the catheter is placed, if there is urine that cannot be discharged in the bladder or the patient has too heavy complaints, surgery is decided upon.
WHAT TYPES OF SURGERY ARE DONE IN BPH, NON-CANCEREOUS PROSTATE ENLARGEMENT?
In surgical prostate treatment, such as TUR, Plasmakinetic or Greenlight operations, the patient may not always be able to urinate comfortably due to the incomplete removal of the prostate tissue. The remaining prostate tissue may enlarge over time and cause complaints for the patients, such as bleeding, weak urination, frequent urination, and burning while urinating. Thus, some patients may need reoperation. Picture 3: Residual adenoma, after TURP, Plasmakinetic or Greenlight operations, is shown in the orange figure. In the picture to the right, it is seen that there is no residual tissue. Although the prostate tissue that grows around the urinary tract, which is called adenoma, is completely removed in open surgery, it may cause problems, such as bleeding, problems in healing of the wounds, erectile disorder, and urinary incontinence.
if there is urine that cannot be discharged in the bladder or the patient has too heavy complaints, surgery is decided upon.
Since the prostate tissue called adenoma, could not be completely removed by methods, such as TUR, Greenlight and plasmakinetics, better methods were needed. In the HoLEP surgery, which was developed as a result of the developments in laser technology, the patient's urination channel is entered in completely closed methods. That is, without any cutting or drilling, the enlarged prostate called adenoma is separated (enucleated) from the patient's own prostate which has taken the form of a capsule, and pushed into the urinary bladder with the Holmium Laser. Thus, the patient does not have any adenoma tissue left, that is, the tissue that can subsequently enlarge and compress the urinary tract. Therefore, the patient urinates very easily, and there is no regrowth in the future. Picture 4: The shell of the orange looks like the prostate capsulae. In HOLEP operations, with laser, entering between the shell of the orange and the inner part (between prostate capsulae and andenoma) adenoma is enucleated and pushed into the bladder.
Picture 5: In HOLEP operations, the enucleated adenoma is pushed into the bladder in one or two pieces. The prostate tissue pushed into the urinary bladder is removed by grating in a small parts, with a special tool called a morcellator and collected in a container. This removed prostate tissue is sent for analysis and it is understood whether there is prostate cancer with the pathology examination. Picture 6: Adenoma in the bladder, is grated and removed in small parts with a tool called morcellator, and collected in a box. Since the bleeding can be controlled very well with the laser, the patient loses very little blood. After the operation, the patient comes to their room very comfortably. video 1: Our patients report that they are very satisfied with the HOLEP operation and advise the operation to other patients with the same problems.
Video 1: Our patients report that they are very satisfied with the HOLEP operation and advise the operation to other patients with the same problems.
HoLEP (Holmium Laser Enucleation of Prostate), means the removal of the prostate by enucleation with Laser.
It has been widely used in all European countries and America in the last 15 years and is seen as the new gold standard in prostate treatment. The HoLEP method, which is not used everywhere in Turkey since it requires a special laser device and devices that grind the prostate called morcellator, HOLEP operation, is applied by Prof. Dr. Remzi Sağlam in the urology group in Anakar and Istanbul, since 2010. The number of patients is gradually increasing due to the satisfaction of 1400 patients treated until today and their recommendations to other patients. Video 2: In this video, you can watch the HOLEP operation performed due to prostate enlargement. Just like in open surgery, it provides advantages, such as removing the entire enlarged prostate tissue called adenoma, performing in a closed method , allowing the patient to go home within 1-2 days, urinating very easily and not causing any sexual disorders.
HoLEP surgery can be performed by adjusting medications for those with heart or lung disease or who use blood thinners.
It can be performed on prostates of any size. It provides advantages such as being able to go home in a short time, urinating very easily, no possibility of recurrence in the future and no harm on erection.
DOES IT HAVE A HARMFUL EFFECT ON ERECTION?
The depth of the Holmium Laser in the tissue is 0.4 mm. It is not possible for this laser to pass through the 6-7 mm thick capsule and damage the nerves related to erection. Therefore, it has no harmful effect on erection.
CAN THE HoLEP METHOD BE USED IN LARGE PROSTATES?
While only prostates up to 80 ml can be operated with TUR or plasmakinetic methods, the HoLEP method can be applied to prostates of all sizes up to 400 ml.
CAN URINE INCONTINENCE OCCUR AFTER HoLEP SURGERY?
Among prostate surgeries, HoLEP surgery is the method that best protects the urine-retaining muscles called sphincter. Urinary-retaining muscles are very visible, and very well preserved.
However, if the urinary-holding muscles, namely the sphincter, were already sluggish before the surgery, temporary urinary drips can be seen in one-tenth of the patients after the catheter is removed. These drips resolve in a few weeks or months with medication and exercises, and permanent urinary incontinence is not observed.
DOES SEMEN CONTINUE TO COME AFTER THE SURGERY?
As in all kinds of surgery, namely open surgery, TURP, Plasmakinetic or Greenlight surgery, in HOLEP too, after the operation the semen goes to the urinary bladder because the bladder neck is open after surgery, and then excreted with urine. This is called retrograde ejaculation and does no harm to the patient's health.
DOES PROSTATE ENLARGEMENT REPEAT AFTER HoLEP SURGERY?
NO, regrowth in the prostate is very rare since the adenoma of the prostate is completely removed.
CAN HoLEP SURGERY BE DONE IN PATIENTS USING BLOOD THINING MEDICATION?
Since bleeding can be controlled with Holmium Laser, HoLEP can be performed in these patients. However, before the surgery, depending on the reasons for using blood thinners and with consultation of cardiology or related branches, the drugs may be stopped for a certain period of time or replaced with another drug.
THE ADVANTAGES OF HoLEP SURGERY IN SUMMARY
1. It is done in closed method with Holmium Laser.
2. It is an operation with minimal bleeding.
3. It can also be applied to those who use blood thinners.
4. It is a preferred surgery in patients with heart and lung problems.
5. Does not damage the nerves related to erection.
6. The entire adenoma is removed. The removed tissues are sent for analysis
7. Recurrence is very rare.
8. Most patients can go home within 1-2 days. The catheter time is short.
9. The patient urinates very easily in a high flow rate.
10. IT CAN BE PERFORMED ON PROSTATE OF ANY SIZE.