What is ThuFLEP/HoLEP?

HoLEP (Holmium Laser Enucleation of the Prostate) and ThuFLEP (Thulium Fibre Laser Enucleation of the Prostate) are both minimally invasive surgical techniques used to treat benign prostatic hyperplasia (BPH), when the prostate gland becomes enlarged. Here, the surgeon uses a laser to precisely remove the enlarged part of the prostate gland that is obstructing the urethra causing urinary symptoms.

During the ThuFLEP/HoLEP procedure, a surgeon inserts a small telescope called a resectoscope into the urethra and advances it to the prostate. The thulium laser is then used to precisely remove the obstructing prostate tissue, creating a wider channel for urine to flow through the urethra. While ThuFLEP and HoLEP are similar in many ways, there are differences between the two techniques, primarily in the type of laser used and their specific characteristics like wavelength and tissue vaporization capability.

Clinical outcomes: Both HoLEP and ThuFLEP are effective in relieving symptoms of BPH and improving urinary flow rates. Clinical studies have demonstrated comparable outcomes between the two techniques in terms of symptom relief, complication rates, and long-term durability.

When ThuFLEP is Needed?

• In HEART DISEASE PATIENTS: Patients, who had undergone CABG (OPEN HEART SURGERY) or who are on antiplatelet medications such as ASPIRIN, CLOPIDOGREL etc.
• Severe Symptoms: Urinary hesitancy, frequent urination (especially at night), weak urine stream, and incomplete bladder emptying become severe and significantly impact quality of life despite conservative measures like medications.
• Enlarged Prostate: Typically over 30 grams in size, where other treatments may be less effective or associated with higher risks of complications.
• Failure of Medications
• Acute Urinary Retention: A person is unable to urinate at all, necessitating emergency intervention to relieve the obstruction.
• Recurrent Urinary Tract Infections
• Avoidance of Open Surgery: HoLEP is a minimally invasive procedure that offers similar efficacy to open prostate surgery (prostatectomy) but with fewer risks of complications, less pain, shorter hospital stays, and quicker recovery times.

Procedure

Initial Examination

• The patient undergoes a comprehensive evaluation, encompassing a review of their medical history, physical examination, and uroflometry studies to evaluate the severity of BPH symptoms.

Day of the Procedure

• You will NOT be allowed to eat or drink anything for at least 6 hours before your surgery. An intravenous line will be secured to inject preoperative doses of antibiotics.

• The anaesthetist will take a detailed history to plan for either:

• General Anaesthesia: You will be fully asleep throughout the operation and remember nothing of it.

• Regional Anaesthesia (e.g. Spinal, Epidural): A needle is placed into your back to inject the anaesthesia drug. It will numb your body from the waist down. You will be awake but sleepy and you will not feel the pain of the operation.

Steps of Surgery: Introduction of Laser Fibre

• A thulium laser fibre is introduced through the cystoscope, positioned close to the prostate tissue that needs to be removed.
• Laser Enucleation: The thulium laser is used to precisely and selectively enucleate the excess prostate tissue. This involves separating the adenoma (enlarged part of the prostate) from the surrounding capsule. The laser energy is absorbed by the water in the tissue, leading to vaporization and cutting.
• Haemostasis (Control of Bleeding): The laser used in ThuFLEP provides excellent haemostasis, meaning it helps control bleeding during the procedure precisely.
• Removal of Enucleated Tissue: The enucleated prostate tissue is then morcellated (cut into smaller pieces) and the fragments are removed through the cystoscope or a separate instrument.

Will I be Awake During the Procedure?

• You will be awake but sleepy and you will NOT FEEL THE PAIN of the operation. Your body from the waist down will be numbed.

After the Procedure

• You are shifted to the recovery room with the catheter in situ. Dr. Raju R will check your progress. Subsequently, you are shifted to your room for at least one night within the hospital environment. The duration of catheterisation is typically 2 DAYS. It is crucial to maintain well-hydrated conditions post-surgery to aid in the healing process. You are advised to limit physical activity and avoid heavy lifting or strenuous exercise for some time after surgery.

Advantages of ThuFLEP/HoLEP

• HIGHLY EFFECTIVE IN RELIEVING SYMPTOMS of urinary hesitancy, frequent urination, weak urine stream, and incomplete bladder emptying.
• HIGHLY RECOMMENDED IN HEART DISEASE PATIENTS WITH BLOOD THINNER
• MINIMALLY INVASIVE: It involves smaller incisions, shorter hospital stays, and quicker recovery times.
• REDUCED BLOOD LOSS: It is a safer option for patients, particularly those with bleeding disorders or on blood-thinning medications.
• LOW RISK OF SEXUAL DYSFUNCTION
• SUITABLE FOR LARGE PROSTATE GLANDS
• It provides durable, long-term relief of BPH symptoms, with improvement in urinary function for years after the procedure.
• Lower Risk of Retreatment: Compared to other BPH treatments, such as medication or minimally invasive procedures like transurethral microwave therapy (TUMT), HoLEP/ThuFLEP has a lower likelihood of requiring retreatment in the future.

Side Effects of ThuFLEP/HoLEP

• Performing HoLEP requires specialized training and expertise.
• Surgeons may require significant experience to achieve proficiency and consistently excellent results.
• HoLEP typically takes longer to perform.
• Potential Complications: Bleeding, Infection, Urinary Incontinence, Urinary Retention, and damage to surrounding structures such as the urethra or bladder.

Is ThuFLEP/HoLEP Safe?

Indeed, there has been a marked improvement in the quality of life due to effectively alleviating symptoms associated with BPH and enhancing urinary function.

What Would Disqualify Me from ThuFLEP Surgery?

• Infection of the urinary tract
• Any medical disorder like uncontrolled Hypertension, Diabetes, and heart problems where anaesthesia is risky.

Why Choose Genesis Superspeciality Hospital for ThuFLEP/HoLEP Surgery?

• Genesis Superspeciality Hospital always prioritizes patient safety, comfort, and satisfaction throughout the treatment process.
• Dr. Raju R possesses a remarkable history of achieving successful results and holds substantial expertise in the treatment of prostate conditions.
• With exceptional surgical outcomes and competitive pricing, our facility offers prompt surgical scheduling, minimizing patient wait times.