Laser Prostatectomy (HoLEP, ThuLEP and ThuFLEP) - Doç. Dr. Serdar Yalçın

Laser Prostatectomy (HoLEP, ThuLEP and ThuFLEP)

A New Era in Modern Prostate Surgery and the Omega Technique with Assoc. Prof. Dr. Serdar Yalçın

Benign Prostatic Hyperplasia (BPH) is one of the most common urological conditions affecting men, particularly after the age of 50. As the prostate enlarges over time, it may lead to significant urinary symptoms, including weak urinary flow, frequent nighttime urination, incomplete bladder emptying, increased urinary frequency, urgency, and in advanced cases, bladder dysfunction.

The primary goal of modern laser prostate surgery is the complete anatomical removal of the enlarged prostate tissue that obstructs the urinary channel. Rather than simply widening the channel, these techniques aim to remove the adenomatous tissue from the capsule plane in an anatomically precise manner.

What Is Laser Prostatectomy?

Laser prostatectomy is a minimally invasive endoscopic procedure in which the enlarged inner portion of the prostate is removed using laser energy. The surgery is performed entirely through the natural urinary channel without any external incision.

Different laser technologies may be used during the procedure:

• HoLEP → Holmium laser
• ThuLEP → Thulium laser
• ThuFLEP → Thulium fiber laser

However, the fundamental surgical principle remains the same:

Anatomical enucleation of the enlarged adenomatous prostate tissue from the capsule plane.

For this reason, modern outcomes are determined not only by the type of laser used, but also by surgical technique, anatomical dissection quality, and preservation of urinary function.

What Is the Difference Between HoLEP, ThuLEP and ThuFLEP?

One of the most common questions patients ask is:

“Doctor, which laser is better?”

In reality, all three technologies provide excellent outcomes when performed by experienced surgeons.

HoLEP:

Uses Holmium laser technology. It has been performed for many years and is supported by extensive scientific evidence.

ThuLEP:

Uses Thulium laser technology. Its continuous energy delivery may allow smoother and more controlled tissue dissection.

ThuFLEP:

Uses next-generation Thulium fiber laser technology. It may provide efficient tissue separation at lower energy settings and represents one of the latest advancements in laser surgery.

The most important point is:

Successful outcomes depend not only on the device itself, but also on the surgeon’s anatomical understanding and surgical expertise.

What Is the Omega Technique?

One of the most important objectives in modern prostate surgery is preserving urinary continence after the procedure.

Temporary urinary leakage may occur in some patients following prostate enucleation surgery. This is often related to the delicate anatomy of the external urinary sphincter.

The Omega Technique is a specialized enucleation approach focused on preserving the anatomy of the external urinary sphincter.

The goals of this technique include:

• minimizing unnecessary trauma to the sphincter region,
• performing more controlled apical dissection,
• preserving urinary continence mechanisms as effectively as possible.

The Omega Technique is not a device;

it is a surgical philosophy based on anatomical preservation and refined dissection principles.

Therefore, it can be applied with different laser technologies, including:

• HoLEP,
• ThuLEP,
• ThuFLEP.

Published studies suggest that the Omega approach may contribute to improved early continence outcomes following prostate enucleation procedures.

Which Patients Are Suitable Candidates?

Laser prostatectomy may be an effective treatment option for patients with:

• significantly enlarged prostates,
• severely weakened urinary flow,
• recurrent urinary tract infections,
• bladder stones,
• urinary retention,
• insufficient response to medication,
• progressive bladder dysfunction.

These techniques are particularly valuable because they remain highly effective even in patients with large prostate volumes.

What Is the Recovery Process Like?

Most patients recover quickly following surgery. In general, the expected postoperative course includes:

• one night of hospitalization,
• short-term catheter use,
• significant improvement in urinary flow within several weeks.

During the early recovery period, temporary urinary frequency or mild burning during urination may occur. In most patients, these symptoms gradually improve as healing progresses.

Conclusion

Modern laser prostatectomy techniques such as HoLEP, ThuLEP, and ThuFLEP are among the most advanced and effective treatment options available today for benign prostate enlargement.

However, successful outcomes depend not only on the laser technology itself, but also on the surgeon’s experience, anatomical approach, and ability to preserve urinary function during surgery.

The modern philosophy of prostate surgery is no longer focused solely on removing obstructive prostate tissue; it also aims to preserve quality of life, urinary continence, and long-term functional outcomes whenever possible.

Assoc. Prof. Dr. Serdar Yalçın
Urology Specialist
Acıbadem Bodrum Hospital

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