Holmium Laser

What is Holmium Laser?

Holmium laser enucleation of the prostate, also known as HoLEP (Holmium Laser Enucleation of the Prostate), is a minimally invasive surgical procedure indicated to treat Benign Prostatic Hyperplasia, one of the most common conditions in men.

Benign prostatic hyperplasia is the benign growth of the prostate gland compressing the urethra and blocking the passage of urine, thus causing difficulty in urination. In the worst cases, this pathology can lead to bladder stones and even kidney failure.

laser-holmium

This procedure is suitable for all sizes of adenoma and manages to eliminate it in its entirety, without leaving adenomatous tissue that can reproduce again, as it happens with other types of lasers that vaporize or fulgurate (burn) leaving residual adenomatous tissue that with the passage of time can grow again and cause obstruction. The patient recovers his quality of life from the voiding point of view.

Therefore, prostatic enucleation with Holmium laser is a minimally invasive, definitive and very effective solution that achieves the same excellent functional results as open surgery, but minimizing the complications and risks of the intervention. It also allows treatment of other concomitant pathologies such as bladder lithiasis, urethral stenosis or bladder tumors.

Also, unlike other types of lasers, it allows the removed tissue to be subjected to histopathological analysis to diagnose the presence of incidental prostate cancer in patients with no previous data of suspicion for this pathology.

Advantages Holmium Laser

Suitable for any prostate size
Removes all adenomatous tissue, therefore, it does not reproduce again.
No incision, therefore, no wound.
Bleeding is minimal
Lower blood transfusion rate
Shorter bladder catheterization time (24-36 hours)
Shorter hospital stay (36 - 48 hours)
Rapid incorporation into normal activities
Allows concomitant treatment of bladder tumor, urethral stricture and bladder lithiasis.
Tissue is available for histopathological analysis.

Disadvantages of the Holmium Laser

The surgeon's learning curve is longer than with other techniques.
Requires much more experience than with other lasers, at least 50 procedures have been performed.
The surgeon needs to have completed regular training programs that reduce the number of patients to be treated before mastering the technique.
Its price is higher

Comparison of laser techniques to treat Benign Prostatic Hyperplasia of the Prostate	ENUCLEATION (HOLMIUM AND THULIUM LASERS)	VAPORIZATION (GREEN LASER)
Prostate size	All sizes	Less than 60-80gr.
Amount of tissue removed	All	Only part
Functional results	Similar to open surgery (the best)	Similar to RTUp (lower)
Complications	Similar	Similar
Hospital stay	Similar	Similar
Probability of recurrence of BPH	Download	High
Possibility to obtain pathological anatomy	Yes	No
Treatment of bladder stones at the same time	Yes	No
Treatment of bladder tumor at the same time	Yes	No
Treatment of urethral stricture at the same time	Yes	No

Other Holmium Laser Applications

Holmium Laser for urinary calculi

The Holmium laser is also indicated for the fragmentation of urinary calculi. It is a minimally invasive endoscopic technique, without incisions in the skin, which makes it possible to break up bladder, ureter and kidney stones for their subsequent extraction.

The patient receives a solution to his problem in a safe way with a fast recovery of his activity, being able to reincorporate to his daily activity in a few days after the medical discharge. As it is a very minimally invasive surgery, bleeding is nil.

Since its first application in the 1990s, the holmium laser has offered many advantages for the endoscopic treatment of urinary lithiasis:

Applicable to all compositions of urinary calculi and in any location of the urinary tract.
Capable of highly efficient power generation through thin, flexible laser fibers.
Favorable safety profile due to short range and rapid energy absorption when operating in water.
Versatility with the possibility of soft tissue applications, such as incision and coagulation in the upper urinary tract, prostate and/or urethra, ranging from prostatic enucleation to tumor ablation and opening of strictures, among others.

The specialist must correctly adjust the energy, frequency and pulse duration of the holmium laser, whether high or low power, to optimize the efficiency of the lithotripsy and contribute to the success of the treatment.

In the Lithiasis Unit of ROC Clinic we perform annually more than 500 endourological procedures with Holmium laser lithofragmentation, with different types of power, achieving optimal results in accordance with the scientific literature, since more than 90% of patients are free of lithiasis in a single procedure, the transfusion rate is null and the average postoperative stay is 14 hours.

The clinical practice guidelines of the European Association of Urology recognize this technique as the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH).

Our experience with Holmium Laser

This technique requires great endoscopic skill and experience far superior to that of other types of lasers. At ROC Clinic we have performed more than 3,500 prostate enucleations since 2007 on patients with prostates between 40 and 300 grams. This figure makes us the Urology group with the highest number of interventions with this technique in Spain.

We are also accredited by Lumenis, the company that markets the Holmium Laser equipment, as teachers for other specialists who want to start and progress in this technique. Within our HoLROC project, we have developed the first training program with a realistic prostate phantom simulator for urologists and urology residents.

+4.000

prostatic enucleations

Group with the highest number of interventions with this technique in Spain

1st training program with a realistic prostate phantom simulator for urologists and residents.