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Holep “Laser Prostectomy” | Dr. Shyam Varma

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You will be offered a choice of dates for your surgery. You will need to attend pre
anaesthesia assessment clinic where we will assess your suitability for surgery under
anaesthetic.

You will be asked to undertake major surgical profile and cardiologist fitness for
surgery.

Please continue to take all your medicines unless you are told otherwise and
remember to bring them into hospital with you.

What happens during the procedure?

You will be anaesthetised so you will not feel any pain. You will then be taken through to
the operating theatre. The surgeon will insert a special tube (called a laser resectoscope)
down your urethra, through which a laser fibre will be passed. This fibre will be used to
enucleate or vapourise the overgrown portion of the prostate. Another instrument called
a morcellator, is then used to chop the prostate tissues into small pieces that are easily
removed. The morcellated pieces of removed prostate will also be looked at under a
microscope to check there are no abnormal cells.

The operation usually takes about 60–90 minutes. When it is finished, a catheter (thin
flexible tube) will be placed into your urethra and saline fluid (salt water) will be
inserted into your bladder via the catheter to flush out any blood clots or prostate tissue

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that have been removed. This solution will then be drained out of your bladder with
your urine, through the catheter.

Once you have recovered from the anaesthesia you will be shifted to ICU or ward
depending on surgeon’s advise. If you feel well after 6–8 hours you may oral sip. The
catheter will remain in your urethra and will be connected to two large bags of saline
fluid next to your bed. Your bladder will usually be flushed with the saline fluid for or
until the day after your surgery.

We encourage you to drink about two and a half liters per day while there is still blood in
your urine. You should not have any pain from the operation, but you may have some
discomfort from the catheter and your urethra may feel sore. Some men experience
bladder spasms (contractions) caused by the catheter rubbing against the trigone
(muscle) inside of your bladder. The spasms result in urine passing down the sides of the
catheter or make you have the urge to pass urine, which can be uncomfortable. If you
experience these spasms, please tell a duty doctor or staff, as they can often be relieved
in a number of ways. When your urine is suitably clear, your catheter will be removed.

What are the advantages of Laser prostectomy over TURP?

There is no upper size limit of prostate that can be removed.

There is often less bleeding than after a TURP.

Discharge is often quicker than after TURP.

The chance of recurrence requiring further surgery is very low.

Unlike greenlight laser operations, large quantities of prostate tissue are sent for
pathological analysis.

What are the disadvantages of Laser prostectomy?

The procedure takes slightly longer than a TURP and requires specialist training.

I am constipated. What should I do?

This can happen because of your altered diet and your decreased mobility while in
hospital. You should avoid straining to pass bowel motions as this may hurt or cause
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bleeding. However it may take up to seven days for your bowels to get completely back to
normal.

Drinking plenty of water

Eating food that is high in fibre such as fruit, vegetables and brown bread and rice
and bran based cereals

Taking laxatives if necessary, for example duphalac or lactulose

When can I return to normal activities?

You can return to work (if it involves no heavy lifting), and carry out normal household
chores (such as shopping) when you feel up to it. For other chores such as heavy lifting
and gardening you will need to wait for two weeks. You can drive again after seven days
unless otherwise directed by your doctor.

When should I start my pelvic floor exercises?

These are exercises to help you regain control of your bladder. You should start these on
the day you return home.

How much exercise should I be doing?

You gradually build up to your normal level of activity in the weeks following your
surgery. It is important to exercise daily and not to remain lying or sitting for long
periods of time. You should avoid heavy lifting for two weeks after your operation.

When will I be seen in clinic after my surgery?

You will be seen by your consultant team 2–4 weeks after your surgery. At this visit you
may need to undergo some of the investigations as flow rate. You will also be given the
results of the tissue we have taken.

You may experience a mild burning feeling or find it a little uncomfortable to pass urine
at first. This is because your urethra will be swollen and sore from the surgery and
having the catheter in place. This is normal and should not last long. Some men find that
they cannot pass urine when the catheter has been removed. If this happens, a new

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catheter will be inserted into your urethra and you may need to keep this in for several
weeks to allow your bladder to rest. If this happens to you, you will be taught how to
look after the catheter at home.

What should I expect when my catheter is removed?

Your catheter may or may not be removed before you go home. Once it has been taken
out you may have some of the following symptoms:

The need to pass urine often (less than every two hours)

A burning sensation when you pass urine

The urgent need to pass urine

You may not be able to reach the toilet in time and may leak urine

You may pass blood in your urine

You may have difficulty controlling your urine

It is common to have less control passing urine for a short time after surgery. If you
experience this, please tell your doctor, who will explain how to perform pelvic floor
exercises to improve your control.

Around 10–14 days after surgery you may have a 24 hour period of heavy bleeding,
which may include passing pieces of prostate tissue in your urine. If the heavy
bleeding lasts more that 24 hours, contact your doctor.

Originally published at https://www.drshyamvarma.com on December 14, 2019.

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