HoLEP – Laser prostate treatment

Regardless of where you had your initial consultation, all HoLEP procedures take place at KIMS Hospital in Maidstone. Most outpatient appointments, including follow up appointments with your Consultant, can take place at either KIMS Hospital or Sevenoaks Medical Centre.

Before your procedure, you will be asked to have no food for six hours and no drinks for four hours prior. The operation can be performed under general or spinal anaesthetic, the details of which will be discussed with you beforehand.

The operation takes approximately an hour, although this may be longer dependent on the condition of your prostate. Your Consultant will advise you of this before the procedure, so you know what to expect.

Using a laser, your Consultant will shell out the obstructing prostate tissue so that it moves into the bladder and then remove it with an instrument. A catheter will be left in place through the penis overnight to drain the bladder and is generally removed the morning after the procedure. You might need to go home with a catheter and return to hospital to have it removed a few days later. If this is required, our nurses will teach you how to look after the catheter at home.

Afterwards, patients have an intravenous infusion (drip), but you will be able to drink and eat on the evening of the operation. The drip is usually discontinued once normal eating and drinking is established.

Most patients experience some discomfort with the catheter in place, but severe pain is rare. Some patients experience bladder spasms with the catheter, and medication is available to control these.

Once the catheter is removed, most patients find that they do not get much warning about the need to pass urine, and it may be frequent. Often the flow is also relatively poor in the early stages as it often takes several weeks to obtain the full benefit from the procedure. Nonetheless, most patients are able to empty the bladder satisfactorily enough to go home by the afternoon of the first postoperative day.

Although the procedure does not harm the sphincter muscles which keep us dry, these can become a little bruised and some patients will experience temporary urine leakage in the very early stages of the recovery. This will improve, and the risks of permanent leakage are very low indeed (<1%).

You will be asked to wear compression stockings until you are fully mobile after the HoLEP procedure, which helps to reduce the risks of deep vein thrombosis.

You should avoid heavy lifting, intensive exercise or sport or straining to empty the bladder for the first two weeks following your procedure, but gentle exercise is encouraged. Your Consultant will be able to advise you around going back to work or driving again.

You may experience heightened frequency, urgency or poor flow to begin with, and it is likely you will notice blood in your urine after around two weeks but don’t worry, this is quite normal as this will just be the internal scab coming away.

Other complications that may occur as a result of the procedure include dry ejaculation (retrograde ejaculation) which, whilst not harmful, can reduce your fertility.

The risk of urethral scarring, sphincter muscle or bladder damage is very low with this procedure, although can occur in some instances. Your Consultant will advise you of any possible complications ahead of the procedure.