Most men with benign prostatic hyperplasia (BPH) who have evidence of bladder outlet obstruction and are healthy enough for surgery can benefit from a holmium laser enucleation of the prostate (HoLEP) operation, according to a literature review conducted by researchers at Vanderbilt University Medical Center in Nashville, Tenn.

The study “Holmium laser enucleation of the prostate: patient selection and perspectives” also indicates that patients who undergo HoLEP do not need additional anesthetics, thereby decreasing the cost of the therapeutic intervention.

For the study, published in the Journal of Research and Reports in Urology, the team led by urologist Nicole Miller, MD, reviewed the medical literature for all studies on HoLEP.

They found various studies reporting that men with large or small prostates, men receiving anti-thrombotic therapy, those with urinary retention, low bladder contractility, prostate cancer, as well as those undergoing treatment for BPH, or in need of surgery to remove bladder stones and other pathologies, do well with HoLEP.

The studies reviewed in the present report have shown that HoLEP led to excellent results in terms of functionality and in reducing or abolishing symptoms, and had low complication rates.

However, they also showed that HoLEP resulted in retrograde ejaculation, where semen enters the bladder instead of emerging through the penis, in 74% to 78% of cases. Techniques to preserve ejaculation following surgery were not able to achieve a significant improvement.

“Patients should be made aware of the risk of retrograde ejaculation following HoLEP and counseled on treatment alternatives if maintaining ejaculatory function is desired,” the authors wrote.

HoLEP is a minimally invasive surgical procedure where obstructive prostatic gland tissue is removed by enucleation with a laser. The cut tissue is then pushed into the bladder and sucked out using a morcellation device following grinding. The operation relieves pressure on the urethra, the tube through which urine drains. The procedure is a modern alternative to the standard transurethral resection of the prostate (TURP), where the prostate tissue is trimmed away.

HoLEP offers many advantages over TURP as it can be used to treat any size prostate gland, offers immediate or early symptom relief, is linked to fewer potential complications, and as demonstrated by this study, can be performed on a wide range of patients.