Surgery Instructions

Marawan El Tayeb, MD, MSc.

Associate professor, Division of Urology

Administrative assistant: Brandi Amos 254-724-7573

Nurse: 254-724-8277

After hours emergency nurse line: 254-724-7037

Appointment: 254-724-2577

Holmium Laser Enucleation of the prostate Preoperative instructions

Please read very carefully

The following instructions are provided to help you understand and prepare for your upcoming surgery. This information may not answer all of your questions about your upcoming operation, so feel free to ask your doctor or nurse.

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive treatment for BPH. With the patient under general or spinal anesthesia, the surgeon uses the laser to enucleate the prostate gland tissue, leaving just the capsule in place. The surgeon pushes the excised prostate gland tissue into the bladder and then uses a morcellation device to grind up and remove the tissue.

HoLEP offers some distinct advantages:

· Treatment of any size prostate gland.

· Complete excision of the obstructing prostate tissue down to the prostate's encapsulating structures, resulting in a re-treatment rate of less than 2 percent.

· Early, immediate symptom relief and fast return to normal activity. Next-day catheter removal with limited swelling generally allows patients to void painlessly and immediately. Same-day or next-day hospital discharge is possible when the procedure is performed in a 23-hour observation setting.

· Tissue preservation for pathologic examination. Because adenomatous tissue is excised rather than ablated, surgeons can examine specimens for prostate cancer or other abnormalities. Cancer is found in about 10 percent of HoLEP procedures, even in patients previously screened. In many cases, the cancer identified is of low malignant potential.

· Fewer potential complications. The low depth of penetration of the holmium laser causes little damage to healthy tissue, and the risk of excessive bleeding and erectile dysfunction associated with traditional surgical approaches is reduced.

Some studies have shown that patients who underwent HoLEP actually had improved erectile function after surgery, but almost all had retrograde ejaculation. All patients experience hematuria for one to two weeks after the procedure, but the need for blood transfusion is low, around 1 percent. Since normal saline irrigation is used for the procedure, there is no risk of hyponatremia, regardless of prostate size. Transient urinary incontinence is common, but permanent incontinence at 3 months after the procedure occurs in approximately 1 percent of patients, depending on the definition and type of incontinence.

Surgery Scheduling

-we will begin the scheduling process with the hospital.

-My administrative assistant Brandi Amos (254)-724-7573 will verify your records and make an appointment for your pre-surgical evaluation.

-Your pre-surgical evaluation may either take place in person or by phone, depending on your physician's orders, we may require clearance from your primary care physician.

-Any pre-operative testing will be ordered during your evaluation.

-If you have not been reached by phone and your surgery is scheduled to occur within the next 48 hours, please call (254)-724-7573 between 7:30am and 5pm, Monday through Friday.

Medications

- Please take your prescribed preoperative antibiotics exactly as prescribed usually it starts 5 days preoperatively.

-Some medicine such as aspirin, aspirin containing compounds, Coumadin, Pradaxa or Plavix impair the body's ability to form a clot and stop bleeding. Based on your needs, specific details on these medications will be discussed at the time of your doctor visit, if there you are taking one of these medications and you didn't tell your doctor, please call the nurse line and let them know (254)-724-8277.

-If you are on any blood thinner or anticoagulants please let your doctor know, we will consult the Doctor who prescribed these medications in order to stop it.

-You will be instructed on what medicines you should and should not take in the days leading up to your surgery and on the morning of the surgery itself.

-Some vitamins and herbal medicine contain blood thinners, please be advised to stop any of these medications 1 week before the surgery

-If you have diabetes and take insulin or another diabetes medicine, instructions will be provided on how to adjust your medicine on the day of surgery when you will not be eating.

The Day Before Surgery

-Please contact your surgeon's office to validate your arrival time.

-Do not shave near your surgical site. Shaving can irritate your skin, which may lead to infection.

-Do not smoke on the day before surgery. This is irritating for your lungs.

The Day of Surgery

-If you've been asked to take routine or other medicines on the morning of surgery, please take them with a very small sip of water.

-Wear loose and comfortable clothing and flat shoes.

-Leave jewelry and valuables at home. If you wear contact lenses, please bring your glasses with you. Please remove any body piercings.

-Please arrive at the hospital at the specified time.

-Because of urgent cases, there may be a delay in the start of your surgery or, your start time could be earlier than expected if last minute cancellations occur. If possible, bring something to read and arrive early.

-If you receive general anesthesia, you will be taken to the Recovery Room for approximately one hour after your procedure.

-you will spend the night in the hospital.

-The next morning, a trial of voiding will be done and after you void twice, you will be allowed to go home.

-A nurse will review your post-operative instructions and prepare you for discharges from the hospital.

-You will not be allowed to drive yourself home. Please make arrangements for someone to take you home.

Post-operative Information for Patients Following Laser Prostatectomy

DIET:

· Return to the diet you were on before surgery.

· Continue to drink lots of fluids.

· Allow consumption of liquor in moderation only.

ACTIVITY:

· Lift nothing over 10 lbs. for the first 2 weeks following discharge.

· After 48 hours, you may gradually resume your usual activity.

· You can be up as much as you like. Going up and down stairs will not hurt you.

· No driving for 48 hours after your catheter has been removed.

· Short walks outdoors are fine.

· Build up your activity a little each day.

· No cycling, no running for at least 2 weeks.

THINGS TO LOOK FOR:

· Healing after transurethral prostate surgery takes 3 months.

· Some blood at the beginning or end of your stream, as well as urgency and frequency are normal.

· If you have blood throughout the stream or are passing clots, stay off your feet and drink plenty of fluids.

· Don't be alarmed by temporary urine leak in the first 2 weeks, that is normal.

· If you have trouble voiding, call the office.

WHEN TO CALL THE DOCTOR:

· If your temperature is 101° or higher, please call the office number. Have the telephone number of your pharmacy available.

· If you develop a rash (breaking out), stop your medicine and call the office number.

· If you feel like you need to urinate and are unable to.

A doctor is on emergency call 24 hours a day, 7 days a week to assist you (including after office hours and weekends). Please call if you have urgent concerns.

You may use milk of magnesia or another mild laxative as needed to keep your bowels moving and soft. Do not allow yourself to strain.

Make an appointment to see the doctor who performed your surgery about six weeks from the time of hospital discharge.