Holmium laser Enucleation of the Prostate (HoLEP) in Cambodia

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Since Royal Phnom Penh hospital is the first ever hospital in Cambodia which succeed performing in HoLEP operation, so this topic I’m going to mentioning and classifying on the Pros and the Cons. First, we must start with Endoscopic TUR-P, that is the conventional operation in benign prostatic hyperplasia first (BPH). TUR-P is abbreviation from “Transurethral resection of the prostate gland”

The methodology of the conventional TUR-P is passing the scope via urethra and then use a small electrical surgical knife for scooping prostatic tissue. Imagine you’re now scooping an ice cream, there could be a hundred scoops in a single TUR-P operation which is any scoop possibly makes the surgical field bleeding, another con is, TUR-P can hardly handle with large prostate especially when the size is greater than 80 grams. That’s why HoLEP was invented.

HoLEP is an Endoscopic laser prostate operation which is using Holmium YAG laser technology. This surgical technique is also very interesting. By just not a small scooping one by one like conventional TUR-P. HoLEP can excise prostate adenoma in just one specimen, it’s lookalike we’re peeling off the apple shell from its inside at once without any injury to the apple shell (The apple shell will assume as the prostate capsule which cannot be broken, unless a tremendous bleeding is going to occur). Sound a lot better from conventional TUR-P and seeming like no cons at all, right? But let me show you the Pros and the Cons on this.

HoLEP’s Pros

1. Less bleeding when compared to the conventional TUR-P
   • Due to the Holmium laser can resect and secure the bleeding at the same time.
2. Easily dealing with enormous prostate size.
   • In general, if conventional TUR-P cannot be done due to the prostate size, patients must jump into the open abdominal surgery.
3. Longer re-treatment rate.
   • Since it is naturally for the prostatic tissue to be regrown, so the retreatment must always advice to the patients.
   • Bunch literatures showed that has only 1.4% of patients that need to do the retreatment after 7 years of HoLEP comparing with 17.7% in conventional TUR-P.
4. Better sexual functioning outcomes
   • 60.6% reporting on a better sexual functioning outcome after HoLEP operation, even better than the other kind of laser operations, PVP and Laser ablation of the prostate gland.
   • It is being thought that there could be starting from a lower total energy during HoLEP operation.
   • On the other hand, 13% of erectile dysfunction was reported after conventional TUR-P.
5. Be able to check the incidental prostate cancer in the same setting.
   • Unlike the other kind of laser method, HoLEP is the only laser approach which is we can get the prostatic tissue for pathologic study.
   • It was reporting for up to 13% incidentally finding prostate cancer from HoLEP.
6. Less urethral stricture rate.
   • Urethral stricture is a common long-term complication from endoscopic surgery.
   • 2.6% was reporting after HoLEP comparing to 4.4% in conventional TUR-P.
7. Shorter hospitalization.
   • 2 hospitalizations stay with HoLEP comparing to 3 in conventional TUR-P.

HoLEP’s Cons

1. Steep learning curve for surgeons.
   • At least 25 cases of learning curve are required for adequate HoLEP operation.
2. Special equipment in a well-equipped center
   • These bring out more medical expense on HoLEP comparing to the conventional TUR-P.
3. Longer operative time
   • Because it needs a tissue’s removing method with the morcellator.

In conclusion, HoLEP is considered as one of the best BPH operation which required a well-trained urologist. Any questions, you should’ve discussed with your trusted urologist or you can text me anytime. See you in next article!

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