Holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for benign prostate enlargement

Enlargement of the prostate is also known as benign prostatic hyperplasia. Treatment is carried out by an experienced urologist. If medication is unable to treat bladder emptying disorders caused by prostate enlargement, surgical prostate reduction is recommended. The surgical spectrum includes holmium laser enucleation, transurethral resection, or open incision surgery. The latter is usually for very large prostates with possible additional issues such as bladder stones or bladder diverticula.

Holmium laser enucleation of the prostate is a minimally invasive procedure to reduce the size of the prostate in cases of bladder emptying disorders caused by benign prostatic hyperplasia. The laser is used to detach the prostate tissue from the prostate capsule and relocate it to the bladder. There, the tissue is crushed and suctioned out of the bladder. Advantages to this method include the excellent long-term results and the removal of abnormal prostate tissue.

In transurethral resection of the prostate (TURP for short), the tissue of the prostate is removed via the urethra using an electric snare, resulting in a strong urinary stream. TURP also has very good long-term results.

TURP is considered the gold standard to which all new surgical methods are compared. However, a very large prostate can limit the procedure, making HoLEP the preferred method for prostate reduction. Both procedures make it possible to for a histological examination of the removed tissue, which detect any malignant cells indicating a prostate carcinoma.

Questions about diagnosis and treatment for benign prostate enlargement

The prostate gland enlarges with increasing age due to the male sex hormone. The prostate is located at the transition between the bladder and the urethra. An enlargement of the prostate can lead to discomfort when emptying the bladder due to a narrowing of the urethra.

Prostate enlargement leads to a narrowing of the urethra. Therefore, a typical symptom is weakening of the urinary stream. Since the bladder wall muscle, which generates pressure when emptying the bladder, has to overcome the increased outlet resistance of the bladder, some patients also suffer from an extreme and sudden urge to urinate. If prostate enlargement is pronounced or has been present for a while, it can also lead to complications such as acute urinary retention, urinary bladder stone formation, urinary tract infections, or hydronephrosis.

Diagnosis of prostate enlargement, based on problems with the prostate, is made by palpation of the prostate and an ultrasound examination. In addition, determining the PSA value is recommended to differentiate between benign prostate enlargement and malignant prostate enlargement. Further examination such as cystoscopy or X-ray examinations might be necessary in individual cases where other diseases are suspected.

Prostate specific antigen (PSA) is a protein that is produced in the prostate gland and occurs naturally in the ejaculatory fluid. Some PSA can also be detected in the blood. An increase in the PSA level in the blood can indicate the presence of a malignant prostate tumour.

The treatment of prostate enlargement depends on the patient’s symptoms and the results of the urological examinations. If the symptoms are mild and the bladder is emptying well, herbal medicines can be used for treatment. If symptoms do not improve despite medication, or if complications due to prostate enlargement occur, surgical treatment by reducing or removing the prostate is often recommended. This can be done through several different methods, for example by holmium laser enucleation or transurethral resection of the prostate.

Short info on TURP

Indication Enlargement of the prostate causing problems with bladder emptying
Procedure Minimally invasive surgical procedure via the urethra, removal of prostate tissue with an electric snare
Surgery time Depending on the size of the prostate, approx. 1 hours
Clinic stay 2-3 days
Note General anaesthesia or spinal anaesthesia

Short info on HoLEP

Indication Enlargement of the prostate causing problems with bladder emptying
Procedure Minimally invasive surgical procedure via the urethra, ablation of prostate tissue with the holmium laser
Surgery time Depending on the size of the prostate, approx. 1-2 hours
Clinic stay 2-3 days
Note General anaesthesia or spinal anaesthesia

Questions about HoLEP and TURP

If, due to the size of the prostate, bladder emptying is incomplete and can no longer be successfully treated by medication, it is recommended that HoLEP or TURP be performed. Once the surgical procedure has been performed, it is no longer necessary to take any medication for bladder emptying. It is necessary to carefully consider whether surgery is the appropriate measure at that time. It is usually performed when an enlarged prostate leads to complications in emptying the bladder (urinary retention, bladder stones, frequent urinary tract infections). However, it is important to remember that changes in the bladder muscle, which often lead to an increased urge to urinate, only regress slowly after HoLEP or TURP, and therefore intervention should not be delayed too long. HoLEP is more suitable for pronounced enlargements.  

HoLEP is a minimally invasive surgical procedure performed through the urethra. The prostate tissue is detached from the prostate capsule with the holmium laser and pushed into the bladder. There, the ablated tissue is crushed and removed from the bladder. A histological examination is performed on the removed tissue to check for the presence of malignant cells in the prostate. At the end of the surgical procedure, a urinary catheter is inserted, which can usually be removed on the second day after the operation. In general, the patient is discharged from inpatient treatment on the third day after the surgery.

TURP is a minimally invasive surgical procedure performed through the urethra. The prostate tissue is pulled out of the prostate and near the prostate using an electric snare. A histological examination is performed on the removed tissue to check for the presence of malignant cells in the prostate. At the end of the surgical procedure, a urinary catheter is inserted, which can usually be removed on the second day after the operation. In general, the patient is discharged from inpatient treatment on the third day after the surgery.

In the case of very large prostates, especially in combination with concomitant diseases such as bladder stones or bladder diverticula, a robot-assisted da Vinci excision of the prostate or open incision surgery may be possible. However, the best surgical method can only be determined in individual cases after consultation with the patient.