| CLINICAL
VISIT TO TAURANGA, NEW ZEALAND TO CONSOLODATE THE
TECHNIQES OF HOLIUM LASER ENUCLEATION OF THE PROSTATE
(HOLEP).
Freddie Banks (Consultant Urologist) West Hertfordshire NHS Trust |
 |
Benign Prostate Enlargement (BPE) with its clinical symptoms of reduced urinary flow in conjunction with reduced capacity to hold urine seems to have been forgotten in current times where the thrust of education and research is into Prostate cancer. The reality remains that that an individual with urinary symptoms is far more likely to have benign rather than malignant enlargement of the prostate. The medical treatment of urinary symptoms with alpha blockers to relax the bladder neck and aid flow often in conjunction with 5 alpha reductase inhibitors to globally shrink the prostate has resulted in a huge decrease in the need for benign prostatic surgery, principally trans-urethral resection of the prostate (TURP). Nonetheless TURP remains an extremely good operation capable of doubling flow rates instantaneously and durably. Unfortunately it remains a morbid operation with significant blood loss, post operative catheter irrigation, and the potential for metabolic complications due to absorption of the operative irrigating fluid. The development of HoLEP offers the opportunity to perform an anatomically better operation without any of these complications and the opportunity to go home the following day without a catheter.
The technique of HoLEP was pioneered in Tauranga by Peter Gilling and Mark Fraundorfer when it was realised that the anatomical plane between the enlarged prostate tissue and the capsule of the prostate could be dissected endourologically using a laser. By dissecting in this plane with a Holmium laser that instantaneously cauterises blood vessels as it dissects, it is possible to enucleate the enlarged prostate lobes from the inside of the prostate and drop them into the bladder from where they can be morcellated and sucked out. The entire operation can be carried out in saline irrigation avoiding the consequences of absorbing glycine as in conventional TURP.
The principle of the operation is simple and it is therefore surprising that it has not had wider take up. It would seem the cost of the laser and concerns over morcellating the detached prostate lobes within the bladder have limited its appeal. The visit to Tauranga offered me the opportunity to be taught be by the original pioneers of the technique and undoubted world experts and to this end I was able to witness 17 cases of varying size and difficulty by 5 different surgeons within the unit. This is the type of case density that can only be experienced by going to this unit. All the consultants within the unit were hugely experienced and freely passed on tips and advice on the technique. Furthermore I was able to spend significant time with the nurses who operate the laser and morcellator to gain valuable advice about running and maintaining the equipment to obtain optimum results.
The unit was extremely friendly, welcoming and sociable and I gained huge experience in a short period of time to give me the confidence to restart the technique at Watford hospital to offer my patients the safest and best method of operating on their benignly enlarged prostates.
Training report, 21 August 2008.
Project 2007/52