What is Holmium Laser Endoureterotomy (HoLEP)?

Holmium Laser Endoureterotomy involves sophisticated surgical methods for treating ureteric strictures by carefully removing narrowed tissue obstructing urine flow. Procedure utilizes a high-powered holmium laser with flexible ureteroscope for targeting the affected area under direct visual supervision extremely accurately. This approach restores normal urinary function and minimizes damage surrounding healthy tissue thereby ensuring pretty optimal outcomes.

About HoLEP Procedure

1. Preparation:

• The procedure is performed under general or spinal anesthesia to ensure patient comfort.
• Antibiotics are administered preoperatively to minimize infection risks.

2. Access and Visualization:

• A flexible ureteroscope, a thin tube equipped with a camera and light, is inserted through the urethra and advanced into the ureter.
• The surgeon visualizes the stricture in real-time, assessing its extent and location.

3. Laser Treatment:

• A high-powered holmium laser is introduced through the ureteroscope’s working channel.
• The laser emits precise energy beams to incise or vaporize the strictured tissue, creating a wider passage for urine flow.
• The laser’s precision minimizes damage to surrounding healthy tissue.

4. Stent Placement:

• After the incision, a temporary Double-J stent is placed in the ureter to maintain patency and facilitate healing.
• The stent is usually removed after 4-6 weeks.

5. Completion:

• The surgeon monitors progress via the ureteroscope’s camera throughout the procedure to ensure effective treatment.
• Once completed, the instruments are carefully withdrawn, and the patient is moved to recovery.

Before HoLEP Surgery :

The lead-up to the procedure is all about getting your body and head in the right place. Here’s how it typically goes:

• The Consultation: Your urologist will walk you through why this is the best route—likely because of a ureteral stricture blocking urine flow. They’ll run tests like a CT scan, ultrasound, or ureteroscopy to pinpoint the problem. For me, this was when I first saw the narrowed spot on a screen, and it clicked why I’d been in so much discomfort.
• Pre-Op Instructions: A few days before, you’ll get the rundown: no food or drink after midnight the night before if you’re getting sedation or general anesthesia (I did, and it made the whole thing a breeze). They might ask you to stop certain meds—like blood thinners—so be upfront about everything you’re taking.
• The Day Of: You’ll show up at the hospital or clinic, probably feeling a mix of anxious and ready-to-be-done-with-it (I sure was). They’ll check your vitals, maybe start an IV, and explain the sedation or anesthesia plan. I got a light sedative, so I was out of it but not fully knocked out. If it’s local anesthesia only, you might be awake but numbed up—ask your doc what’s in store.
• Mental Prep: Honestly, this part’s big. I spent the night before googling the Holmium laser (it’s super precise, which calmed me down) and reminding myself this wasn’t open surgery—no big cuts, no long recovery. Pack a little courage and trust in the team; it helps.

During HoLEP Surgery :

1. Anesthesia

• The procedure is typically performed under general anesthesia, though regional anesthesia may be considered in select cases.
• The patient is positioned in a lithotomy position (lying on back with legs elevated) for optimal access.

2. Ureteroscopy and Access

• A ureteroscope (thin, flexible or rigid scope) is introduced through the urethra, bladder, and up into the ureter.
• Under fluoroscopic (X-ray) guidance, the site of the ureteral stricture is identified and assessed.

3. Incision of the Stricture

• A holmium:YAG laser fiber is passed through the ureteroscope to reach the narrowed segment.
• A precise incision (cutting) of the fibrotic stricture is made — usually in the 12 o'clock position to minimize vascular injury.
• The laser simultaneously cuts and coagulates, minimizing bleeding.

4. Balloon Dilation (Optional)

• In some cases, after the laser incision, the area may be dilated with a high-pressure balloon catheter to further widen the lumen.

5. Stent Placement

• A double-J (DJ) ureteral stent is placed across the treated area to maintain patency and allow healing.
• The stent remains in place for 4–6 weeks, depending on the stricture length and healing response.

6. End of Procedure

• The ureteroscope is withdrawn, and the procedure typically takes 30–60 minutes.
• The patient is moved to recovery for monitoring.

After HoLEP Surgery :

1. Immediate Postoperative Care

• The patient is monitored in a recovery room until fully awake.
• Mild burning during urination, urgency, or blood in urine can occur for 24–72 hours and usually resolves on its own.
• IV fluids and pain management are provided as needed.

2. Hospital Stay

• Most cases are day-care or 1-day stay surgeries.
• If complications (like infection or bleeding) occur, the hospital stay may be extended.

3. At-Home Recovery Instructions

• Resume daily activities within 2–3 days, but avoid heavy lifting or strenuous exercise for a week
• Drink plenty of fluids to flush the urinary tract.
• Complete the full course of prescribed antibiotics and pain medications.

4. Ureteral Stent Management

• The DJ stent remains for 4–6 weeks to allow proper healing of the incised stricture.
• It may cause mild back pain, urgency, or frequency, which usually resolves after stent removal.

A follow-up appointment is scheduled for stent removal.

Recovery Process after HoLEP Surgery

• Patients may experience mild discomfort for a few days post-surgery.
• The temporary stent ensures proper healing and prevents blockage during recovery.
• Follow-up appointments are scheduled to monitor progress and remove the stent.

Most patients report significant improvement in urinary function within weeks of the procedure.

Advantages of Holmium Laser Endoureterotomy

This innovative technique offers several benefits over traditional treatments like balloon dilatation or open surgery:

• Minimally Invasive: No external incisions are required, reducing recovery time and postoperative pain.
• Precision: The holmium laser allows controlled energy delivery, minimizing damage to surrounding tissues.
• High Success Rate: Studies show excellent outcomes with reduced recurrence of strictures.
• Shorter Recovery Time: Patients can resume normal activities within days of the procedure.
• Versatility: Effective for various types of strictures, including ureterointestinal stenosis.