Men who suffer from benign prostatic hyperplasia can return to regular activities within a few days after the Holmium Laser Enucleation of the Prostate (HoLEP).
As men get older, many will experience urination issues due to an enlarged prostate. The result is a common condition known as Benign Prostatic Hyperplasia (BPH).
A larger-than-normal prostate puts pressure on the urethra, which can result in painful symptoms like difficulties starting to urinate, increased frequency of nighttime urine, and an urgent or frequent desire to urinate.
Additional symptoms include the difficulty to fully empty the bladder, dribbling at the conclusion of urination, or a weak or intermittent urine stream. Your quality of life may suffer as a result, particularly if you have to get up multiple times during the night to urinate.
Drugs and surgery are two ways to treat BPH. Drugs are often the first line of treatment. They relax the prostate muscles, allowing urine to more easily flow but when stopped, the results stop as well. What is more, with the urination issues, there may also be other issues affecting sexual function.
HoLEP is one procedure to treat the obstruction of urine flow due to an enlarged prostate without it affecting sexual function.
The American Urological Association and the European Association of Urology both recommend HoLEP as the best option for prostates that are more than 80 to 100g in size.
In Nigeria, a specialist hospital in minimally invasive surgery, Kelina Hospital, Lagos State, has recorded a significant milestone in prostate cancer treatment, marking its 500th successful Holmium Laser Enucleation of the Prostate (HoLEP) surgery for Benign Prostatic Hyperplasia (BPH) in the last six years.
HoLEP uses laser technology to remove the prostate gland if it is obstructing the flow of urine or becoming a threat to the health of the individual in general or the kidneys in particular.
“By the next day after surgery, the patient is up and doing, and they are already eating on the day of surgery. It is recommended as the best appropriate approach to remove the prostate in this kind of situation, compared to other methods,” recounted Dr. Celsus Undie, Kelina Hospital’s Medical Director.
Undie, a consultant urological surgeon, who spoke during a media chat in Lagos recently, disclosed that Kelina Hospital had performed 6,000 surgical operations since its inception, including keyhole surgery for prostate cancer, HoLEP, robotic surgery, and minimally invasive surgery for kidney stones.
According to him, the hospital performs over 100 prostate surgeries per year, including benign and cancerous prostate surgeries.
He declared, “We are dedicated to excellence, innovation, and patient-centred care. This has driven us to continuously push boundaries and set new standards in surgical practice. April 2025 is a milestone in the life of Kelina Hospital as we mark six thousand (6,000) surgical operations since its inception.
“April 2025 is a milestone as Kelina Hospital marks 500 Holmium Laser Enucleation of the Prostate (HoLEP) surgeries in six years. Kelina hospital was the first hospital to do HoLEP in Nigeria. This started at the end of 2018. HoLEP is done for an enlarged prostate obstructing urine flow.”
Undie, who served as Head of Urology at the National Hospital for 10 years prior to joining Kelina Hospital, provided information about the advantages of HoLEP over open prostatectomy (open surgery) and the transurethral resection of the prostate (TURP), a minimally invasive procedure for removing an enlarged prostate.
“HoLEP is superior to TURP or open prostate surgery, as patients lose less blood, spend less time on catheters, spend less time on hospital admission, recover faster, and return to work earlier.
“The American Urological Association and the European Association of Urology both recommend HoLEP as the best for prostates that are more than 100g in size, which is what we see a lot in this country,” he said.
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However, Dr Undie said urinary catheterisation, a procedure used to drain the bladder and collect urine, through a flexible tube called a catheter, only offers a temporary solution.
According to him, “It is not safe. Every single patient we see in the hospital that has carried a catheter for more than a week, if you test the urine, there would be an infection there. So if you cannot pass your urine without a catheter, what is the big issue about getting the prostate removed?
“If they will not have surgery and the catheter comes out and they cannot pass it, you will have to put it back. They just have to have surgery. So, catheters shouldn’t be carried on anybody for such a long time. By the way, the penis is not only for passing urine for men. It serves other purposes, including procreation.”
Moreover, Dr Undie assured that it is a misconception that the testes are removed during a prostate enlargement surgery.
“Taking out of the testes is only for prostate cancers that have spread. Prostate cancer depends on testosterone for growth. If the cancer is in its early stage, it’s completely unnecessary to remove the testes.
“In the 54 prostate cancer surgeries we performed last year, all patients maintained normal urinary control, and many experienced normal erections,” Dr Undie said.
Undie also debunked a popular myth, saying that “Frequent sex is not scientifically proved to prevent prostate cancer.”
He assured that HoLEP will also not prevent men from fathering a child.
“We will remove the part of the prostate that is critically blocking urine flow; he will still go ahead to have erections and normal ejaculation. Normal ejaculation could be affected when the entire adenoma of the prostate is removed.
“Even if they have an erection and don’t ejaculate, they can still have children because they can opt for IVF. The sperm cells are retrieved from the urine for IVF,” Dr Undie said.
The urologist observed that Kelina Hospital’s cutting-edge medical services decreased the need for Nigerians and citizens of nearby nations to travel overseas for prostate treatment, keeping healthcare costs in the local economy and drawing in foreign patients.
“Nigerians should be encouraged to take treatment at home. It is disheartening to see people fly abroad for routine procedures like appendicectomy, hernia repair, lipoma excision, or prostate biopsy – procedures that typically take less than an hour.
“Travelling 12 hours for such minor surgeries not only reflects poorly on us, but it also exposes patients to unnecessary risks. Several patients have returned from overseas with complications, including infections after minor procedures like prostate biopsy,” he said.
An anaesthetist and critical care physician, Dr Vincent Obiwuru, declared that HoLEP is very useful in individuals with severe comorbidities who, before now, would have had to fly abroad to get the best care for their prostate.
“With minimally invasive techniques like HoLEP, the patients have less time to stay in the hospital, whereby they recover faster. Complications are quite fewer. So, it’s the selling points to anybody who wants to advance healthcare in Africa,” he added.
A renowned robotic surgeon based in France but licensed to practise in Nigeria and by the American Medical Council, Dr Bertin Njinou, said HoLEP is the future for Africa when it comes to enlarged prostate treatment, citing its many proven advantages.
According to Njinou, compared to other conventional and more invasive surgeries, HoLEP is marked by lower risks, shorter hospital stays, faster recovery times, and less problems like bleeding and blood transfusions.
“Now, the advantage of the HoLEP over these other methods is that the patient is already eating on the day of surgery and is up and doing by the next day,” Njinou explained.
Dr Njinou also declared increase in cases of prostate cancer and the importance of early detection through Prostate-Specific Antigen (PSA) blood tests starting at age 40 for all men.
He stated that being Black, being obese, and having a family history of prostate cancer were the three main risk factors for prostate enlargement and prostate cancer.
He said that people should consume food items like broccoli, cucumber, garlic, green tea, and cooked tomatoes to reduce their risk of prostate cancer.
Also speaking, the Head of Corporate Relations, Kelina Hospital, Omada Idoko, said the hospital, as part of its policy, periodically sends its staff for training abroad to consistently provide world-class healthcare services to patients locally.
The hospital has collaborated with surgeons from all over the world throughout the years, provided that they have a Nigerian surgical licence.
“We are particularly proud to have Dr Bertin Njinou with us, as we look forward to welcoming more world-class robotic surgeons this year, 2025, Dr Njinou is in charge of the African Urology Training Centre at IRCAD, Kigali, Rwanda. Several Nigerian urologists have benefitted from the IRCAD training,” Idoko said.
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