Laser prostate surgery (HoLEP enucleation, vaporisation)

Laser prostate surgery treats benign prostatic enlargement (benign prostatic hyperplasia), the growth of the gland with age that obstructs the flow of urine. Like conventional resection, it is performed through the natural passages: an endoscope is passed through the urethra, with no skin incision at all. There are two main techniques. Holmium laser enucleation of the prostate (HoLEP) separates the enlarged tissue from its capsule, much like removing the stone from a fruit, then breaks it up and suctions it out of the bladder; it is also suitable for very large prostates, and the removed tissue is examined under the microscope. Vaporisation "melts" the prostate tissue layer by layer and is mainly suited to medium-sized prostates. The laser seals small blood vessels as it works, which limits bleeding. This is an advantage for patients taking anticoagulant or antiplatelet medication, whose continuation or adjustment is decided together with the cardiologist. The urinary catheter is usually kept for a shorter time than after conventional surgery. At Clinique Pasteur Tunis, the urologist chooses the technique after a full work-up (ultrasound, uroflowmetry, sometimes urodynamic testing) and discusses it with the patient. The procedure takes place in the operating theatre with a short hospital stay.