A Modern Solution for Enlarged Prostate Symptoms

If you’re making frequent trips to the bathroom, waking up several times each night to urinate or struggling with a weak urine stream, an enlarged prostate could be the cause. These symptoms often result from benign prostatic hyperplasia (BPH), a common condition that affects millions of men as they age and can significantly impact quality of life.

While medications can help manage symptoms for many men, they may become less effective over time. When that happens, surgery may be recommended. Today, several procedures are available to treat an enlarged prostate, but many are best suited for specific prostate sizes or involve longer recovery times.

One advanced option is HoLEP (Holmium Laser Enucleation of the Prostate), a minimally invasive procedure that can effectively treat prostates of nearly any size without external incisions. The procedure typically involves a short hospital stay, brief catheterization and durable long-term results with a low likelihood of requiring additional treatment.

What makes HoLEP unique is its ability to provide the benefits of a comprehensive surgical treatment through an endoscopic approach, allowing patients to experience significant symptom relief while minimizing recovery time. Although HoLEP is offered at only a limited number of medical centers throughout Texas and neighboring states, it is available at UT Health Tyler through urologist Dr. Andrew Navetta, who explains how the procedure works and who may benefit from it.

What is the prostate, and why does it cause urinary symptoms?

The prostate is a gland found only in men. It sits just below the bladder and surrounds the urethra, the tube that carries urine out of the body.

As men age, the prostate often enlarges. This enlargement can place pressure on the urethra and restrict the flow of urine, leading to bothersome symptoms such as:

• Frequent urination
• A weak urine stream
• Difficulty starting urination
• Waking up multiple times at night to urinate
• A feeling that the bladder does not empty completely
• In some cases, an inability to urinate at all

Who is a candidate for HoLEP?

 

Men may be candidates for HoLEP if their urinary symptoms are caused by prostate enlargement and medications have not provided adequate relief. A thorough evaluation by a urologist is necessary to determine whether HoLEP is the most appropriate treatment option. Patients diagnosed with prostate cancer may require different treatment approaches and may not be candidates for the procedure.

What evaluation is needed before surgery?

Before undergoing HoLEP, patients meet with a urologist for a comprehensive evaluation that may include:

• Review of medical history and symptoms
• Physical examination, including a prostate exam
• Laboratory testing
• Cystoscopy, a brief office procedure used to examine the urethra, prostate and bladder

During cystoscopy, a small flexible camera is inserted through the urethra, allowing the physician to evaluate the size and shape of the prostate and assess the bladder.

Because HoLEP is effective for prostates of all sizes, imaging to precisely measure the prostate is not routinely required. However, additional testing may be recommended in certain circumstances.

What happens during the HoLEP procedure?

HoLEP is performed in the operating room under anesthesia. During the procedure, the surgeon inserts a specialized scope through the urethra to reach the prostate. Using a holmium laser, the obstructing prostate tissue is carefully separated from the outer capsule of the prostate.

A useful analogy is removing the fruit from inside an orange while leaving the peel intact. By removing the enlarged tissue that is blocking urine flow, the procedure creates a wider channel for urine to pass through more easily.

The removed tissue is then collected and extracted through the scope. Most patients awaken with a urinary catheter in place, which is typically removed the following day.

Some patients may go home the same day, while others stay overnight for observation.

What can patients expect after surgery?

Most men experience little discomfort following HoLEP, although having a catheter in place overnight can be temporarily uncomfortable.

After catheter removal, it is normal for urine to appear pink or red for several days. Some intermittent bleeding may occur for a few weeks as healing continues.

Most patients are able to resume driving once the catheter has been removed. However, strenuous exercise, heavy lifting and other physically demanding activities should be avoided for approximately two to three weeks.

A follow-up appointment is typically scheduled about two weeks after the procedure to monitor recovery and ensure symptoms are improving.

Andrew Navetta, MD, is a urologist with the UT Health East Texas Urology Center in Tyler. To learn more about HoLEP or to schedule an evaluation, call 903-262-3900 or visit UTHealthEastTexas.com/services/urology.