Dr. Amy Krambeck spent a year training to do Holmium Laser Enucleation of the prostate (HoLEP) . Now she's one of 100 urologists around the country able to perform this surgery on her patients at IU Methodist. She starts by inserting a tiny camera through the penis and then with the laser carefully cores out the three lobes of the enlarged prostate.
"It's like peeling an orange from the inside out," says Dr. Krambeck. "So I am taking all the pulp out down to the rine or capsule. But it's one solid mass. So we don't want our patients to have an incision or any sort. So it's through the natural orifice, the urethra."
The symptoms of an enlarged prostate can start as early as the late 40's. There's usually a frequent need to urinate, urinating at night, difficulty starting to urinate and an inability to completely empty the bladder.
Dr. Krambeck uses the attached scope to lift, cut and dissect the prostate. It's a technique which takes some time to perfect because all three functions are performed with the same instrument. Once the tissue is removed there is one more step. The material is emulsified so that it can pass through the urethra.
"We use another device called a morsilater which chews up the tissue and turns it into a paste. It's like a food processor," says Dr. Krambeck. The looming question for most men is always, will this procedure affect sexual function?
"It does not affect a man's ability to get an erection," says Dr. Krambeck. "So if they have good erections prior to surgery, they'll have good erections after surgery. That's a huge selling point."
HoLEP takes a little longer than other laser procedures. But the results have been positive with good urine flow for years after the procedure is completed. Some patients have reported some leakage after surgery, but Dr. Krambeck says it's temporary.
For more on HoLEP, click here.