HoLEP

The "GOLD STANDARD"FOR PROSTATE SURGERY

Laser prostatectomy is gaining widespread acceptance amongst urologists worldwide due to its safety in treating patients with enlarged prostate. This surgery is mainly beneficial in high-risk patients with cardiac (heart) or pulmonary (lung) compromise, those having bleeding tendency and those on "Blood thinner" medications for heart diseases or stroke.

Of various laser procedures available for prostate treatment, the two which have gained wide spread acceptance are green light (KTP) laser and 100W Holmium laser (HoLEP). Both lasers have advantages over conventional TURP surgery for prostate in terms of less bleeding (almost blood less procedure) and no incidence of TUR syndrome (a rare but life threatening complications of TURP). The major difference in treating prostate by these lasers is the surgical technique. In green light (KTP) laser prostatectomy, prostate is vaporized, thereby relieving the blockage that it is causing to urinary flow. In Holmium laser prostatectomy (HoLEP), the entire enlarged inner part of the prostate is enucleated (removed) and then minced in small pieces to be removed from body. The advantage of ENUCLEATION (HoLEP) over VAPORIZATION (KTP) is that it provides prostate tissue for postoperative histopathological examination (biopsy). This can help in diagnosing occult or unsuspected cancer of prostate in approximately 2-10% patients undergoing surgery for enlarged prostate. In these patients, the cancer would otherwise be missed in an early and curable stage.

Another potential limitation of KTP prostatectomy is its long-term durability. Pfitzermaier J. et.al. recently in August 2008 issue of British journal of Urology(one of the most reputed journals) found that 23% patients  needed re-operation within 11.7 months of their initial surgery  after KTP laser prostatectomy, if their prostate weight was above 80gms. This reoperation rate was 10% for smaller prostates. This means that almost 1 in 4 patients undergoing KTP laser prostatectomy for large prostate will need another operation for prostate within a year of the initial surgery. In view of the same Dr.Mehmood Hai in his interview to Urology times said that larger prostate would probably be treated with open prostatectomy as KTP is not suitable. In a pioneering study published in June 2006 issue of British journal of Urology, M.A.Hai and co-workers found that the improvement after KTP laser prostatectomy is inferior in patients with higher PSA (prostate specific antigen - a marker for prostate cancer) and larger prostate than their counterparts.

HoLEP takes care of both these disadvantages of KTP laser prostatectomy. Its outcome is durable with re-operation rates of only 4% at 8 years follow-up. In addition it has all the advantages that KTP laser prostatectomy offers to its patients. Prof. Kuntz RM from Germany reviewed 6 years medical literature on laser prostatectomy and concluded that HoLEP appears to be a size independent new "Gold Standard" in surgical treatment of enlarged prostate. Dr. Hemendra Shah from R.G. Stone Urology and Laparoscopy Hospital, Mumbai, also published Indian experience in treating enlarged prostate by Holmium laser in June 2008 issue of British Journal of Urology. He concluded that "HoLEP is safe and effective procedure in treating enlarged prostate, independent of the size." 

KTP can effectively vaporize prostates only up to 60 grams, whereas size is not a limitation for the HoLEP technique. In KTP for larger prostate ideally two or more fibers are necessary, making the treatment more costly. However single Holmium laser fiber can be used for 20-50 patients, thus making it more cost effective. Also Holmium laser is truly a "universal laser" and can be used for stones, strictures, small tumors in addition to prostate. It can also be used by other specialist like orthopaedicians, gynecologist, and surgeons making it more cost effective. As against this, KTP laser is "Prostate only laser"
100W Holmium laser Enucleation of the prostate with transurethral tissue morcellation provides significant reductions in morbidity, bleeding and hospital stay for patients with large prostate adenomas. It does not produce impotence or incontinence as seen with conventional surgery. For smaller prostates the procedure can be carried out without the need of a catheter & with short duration of hospital stay less than 48 hrs. RG STONE has a proven record of having successfully carried out more than 5000 HoLEP surgeries throughout its various branches across India on patients from India & abroad, and blood transfusions are almost unheard of.