A laser procedure to treat enlarged prostate, the most common non-cancerous prostate medical condition to develop in men by the time they reach their 60s, has been introduced to South Africa for the first time at Netcare Parklands Hospital in Durban.
The procedure, the holmium laser enucleation of the prostate (HoLEP), was recently successfully performed for the first time in the country by urologist, Dr Amit Kalpee, and his team on a Durban man with a severely enlarged prostate, a condition known as benign prostatic hyperplasia (BPH).
“A severely enlarged prostate causes uncomfortable urinary symptoms. HoLEP involves using a special high-powered laser to remove the gland and any tissue that causes obstruction of the urethra, through which the urine drains,” explains Dr Kalpee, who completed the European HoLEP Masterclass and is the first HoLEP surgeon in South Africa.
“This resolves symptoms such as urine blockage, which can in turn cause bladder and urinary tract infections and potentially serious kidney complications if left untreated,” he adds.
“The procedure is done under anaesthetic with the assistance of a tiny camera which together with the laser instrument is mounted on a fine telescopic rod that is inserted into the urethra via the penis.”
Dr Kalpee says HoLEP is a modern alternative to the standard procedure known as transurethral resection of the prostate procedure (TURP) for bladder outflow obstruction due to enlarged prostate. HoLEP requires specialist training and takes slightly longer to complete than a TURP, but it is less invasive and has a number of advantages over this standard procedure.
“There is less bleeding than after a TURP, and patients are often ready to be discharged from hospital the day after the procedure, much sooner than if a TURP was performed. Because enucleation is a much more precise procedure with the entire gland removed, recurrence of the problem does not occur. With HoLEP there is also no size limit of the prostate that can be treated,” explains Dr Kalpee, who has to date performed more than a dozen of these procedures.
Mr Dhanapalan Pillay, a patient who recently underwent HoLEP at Netcare Parklands Hospital, says that he is most grateful to have had the benefit offered by the new procedure. The 74-year-old from Durban admitted that prior to the procedure he was “quite scared, as I really didn’t know what to expect”.
“I have previously had two TURP procedures to assist with bladder flow obstruction, both of which were quite uncomfortable and took quite some time to recover from,” added Mr Pillay.
“I was therefore most pleasantly surprised by my experience with HoLEP. I had very little pain and bleeding after the operation and was up and about the afternoon following the operation, which was way beyond my expectations.”
“Now my symptoms have largely been resolved, my life is back to normal and I am walking every morning. I am most grateful to Dr Kalpee and his team at Netcare Parklands Hospital for performing this procedure, which has made a great difference to my life.”
According to Dr Kalpee, it is normal for a man’s prostate to enlarge with age, as the cells of the prostate begin to swell. It is estimated that half of men over the age of 50 will suffer from at least some BPH symptoms. Medication is usually used initially to treat these symptoms but unfortunately has limitations.
In some cases the prostate becomes large enough to occlude, or obstruct, the urethra, making it difficult to pass urine, as occurred in Mr Pillay’s case. It may cause weak urine flow and prevent the individual from emptying their bladder completely, resulting in the need to go to the toilet much more often.
“HoLEP is particularly indicated in men with large non-cancerous prostates where medication is either proving ineffective or causes side-effects. It is also safe for older men on blood thinning medication such as warfarin, aspirin or clopidogrel,” points out Dr Kalpee.
“It is normal to have some blood in the urine after the HoLEP procedure, so it is advisable to drink plenty of water for a few days while it clears. A catheter [a tube which drains the bladder] is inserted for between 12 to 24 hours until the urine clears. Prostate fragments are sent for laboratory analysis to ensure that they are not cancerous.
“The procedure does not generally affect erectile function or continence, although the possible urinary symptoms may take a few weeks to settle down afterwards. Patients are advised to take it easy and to avoid straining or heavy lifting for four weeks after the procedure.”
Netcare coastal region director, Craig Murphy, says that the introduction of HoLEP at Netcare Parklands Hospital is a welcome development in urology and private medicine in KwaZulu-Natal.
“This procedure brings hope to those large numbers of older men who are looking for relief from debilitating BPH symptoms, and Dr Kalpee and his team at Netcare Parklands Hospital are to be congratulated for introducing it to the benefit of our patients,” he concluded.