Laser prostate treatment HoLEP

What is benign prostatic hyperplasia

The prostate is part of the male reproductive system, located just below the bladder, with the urethra running through its centre. In most men over 40, the inner layer of the gland begins to enlarge benignly - and as it grows, it compresses the urethra and obstructs the flow of urine.

Typical symptoms (known as LUTS) include a weakened urinary stream, frequent urination, a feeling of incomplete bladder emptying, waking at night to urinate and, in advanced cases, complete urinary retention. Left untreated, the condition can lead to permanent bladder damage, recurrent infections, bladder stones and even kidney damage.

How qualification works

Qualification starts with a consultation: a detailed medical history (the IPSS questionnaire is helpful) and a physical examination. Diagnostics include ultrasound, uroflowmetry (a non-invasive measurement of urine flow), blood tests (PSA) and urinalysis; in selected cases, an MRI of the prostate.

The goal is to assess how severe the symptoms are, rule out other causes (including differentiation from prostate cancer) and choose the right treatment - not every patient needs surgery straight away. If the severity of the symptoms does not match the size of the gland, bladder and sphincter function is assessed by urodynamic testing.

When medication, when surgery

With mild symptoms, watchful waiting and regular check-ups are often enough. The next step is pharmacological treatment (including alpha-blockers and 5-alpha-reductase inhibitors). Medication, however, mainly relieves symptoms - it does not remove the cause, and in some men it produces significant side effects.

When pharmacotherapy is ineffective or not acceptable, we consider surgical treatment. Besides HoLEP there are other methods (including TURP electroresection, thermal procedures and open adenomectomy) - during the consultation I discuss their advantages and limitations for your specific situation.

How the HoLEP procedure works

HoLEP (Holmium Laser Enucleation of the Prostate) involves introducing an endoscope through the urethra and enucleating the overgrown tissue with a holmium laser using the AEEP technique. I seal the blood vessels with laser or bipolar coagulation and remove the enucleated tissue with a morcellator - all of it is sent for histopathological examination. The shallow depth of thermal effect makes it possible to seal vessels as the surgery proceeds, which limits bleeding.

The method makes surgery possible regardless of prostate size - even when other endoscopic techniques are not feasible - and in patients taking anticoagulants. HoLEP is recommended in the guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA) as a surgical treatment option for benign prostatic hyperplasia regardless of prostate size.

The procedure usually takes 60–90 minutes, depending on the size of the prostate. General anaesthesia is the preferred option.

After the procedure and recovery

After surgery, a catheter with bladder irrigation stays in place for about 12 hours; once it is removed and you have successfully passed urine, you usually go home - the hospital stay is normally one day. In some cases the patient is discharged home with a catheter for a few days, or stays in hospital for that time.

Improvement in urinary stream is usually felt quickly. Urgency and night-time urination may subside gradually over several months - the bladder needs time to adapt. Some patients experience temporary stress urinary incontinence, which usually resolves within a few to a dozen or so weeks.

You can return to office work after 10–14 days, and to physical work after about 4 weeks.

Follow-up visits after HoLEP take place at 4 weeks, then at 3, 6 and 12 months, and once a year after that. Scheduled follow-up visits are paid; I agree their timing and the terms of payment individually before the procedure.

Possible consequences and limitations

A common and permanent consequence of HoLEP - as with other procedures that remove prostate tissue - is the absence of ejaculation during orgasm in the vast majority of patients.

In the first weeks after the procedure, erections may be temporarily weaker; permanent dysfunction is very rare. The procedure does not affect the sensation of orgasm.

Like any operation, HoLEP carries a risk of complications:

• bleeding
• infection
• temporary urinary retention
• urinary urgency
• painful urination
• urethral stricture
• bladder neck contracture

Such complications are rare; I discuss the exact risk individually during qualification.

Watch: prostate surgery - then and now

In this video (in Polish) I talk about how the surgical treatment of benign prostatic hyperplasia has changed - from open surgery to modern laser enucleation.

• What is HoLEP laser prostate surgery about? (in Polish)↗(opens in a new tab)
• Ask the urologist - LIVE Q&A about HoLEP (in Polish)↗(opens in a new tab)
• Modern prostate treatment without a scalpel - Q&A (in Polish)↗(opens in a new tab)

Price of the procedure in Kraków

The price of HoLEP laser prostate enucleation is set individually after the qualification consultation - it depends on the size of the gland and on the treatment so far.

• Qualification consultation - PLN 350, full ultrasound diagnostics included in the visit
• HoLEP - priced individually after the qualification consultation
• Payment by cash, card or BLIK · invoice on request
• Private visits, not covered by the Polish NFZ

The full list is on the pricing page.

Where I qualify and operate

The qualification consultation takes place at my office: Andromeda Centrum Medyczne, ul. Mogilska 69A, 31-545 Kraków, Poland. The procedure itself - under general anaesthesia - is performed at Szpital na Klinach hospital in Kraków.