University Hospitals Urology Institute Among Leaders in Minimally Invasive Treatment for Enlarged Prostate

Innovations in Urology | Summer 2024

Nearly 14 million men in the United States experience symptoms of benign prostatic hyperplasia (BPH), a normal part of aging that can cause disruptive and bothersome urinary symptoms. The incidence of BPH increases from about 50 percent in men aged 60 and younger, to 90 percent by age 85. Treatment typically starts with medical therapy, but often progresses to removal of a portion of the prostate.

Irina Jaeger, MD

Michael Zell, MD

Holmuim laser enucleation of the prostate (HoLEP) offers a minimally invasive way to treat BPH. HoLEP requires extensive training with a prolonged learning curve, and few surgeons have the expertise and experience required to perform this procedure. However, University Hospitals has two prolific HoLEP surgeons, making it a leader in treating this significant and common condition in men.

Together, Irina Jaeger, MD, an endourologist at University Hospitals Urology Institute, and Michael Zell, MD, endourologist at UH Urology Institute and Director of Urologic Surgery at University Hospitals Ahuja Medical Center, have performed hundreds of HoLEP procedures.

“I learned HoLEP about three years ago and have performed about 500 to date,” Dr. Jaeger says.

Along with Dr. Zell, who has performed more than 800 HoLEP procedures, UH offers the most experience in this procedure in the state of Ohio. Currently, Drs. Jaeger and Zell perform more than 400 of these procedures annually, placing University Hospitals as one of the top HoLEP programs in the country.

Benign Prostatic Hyperplasia

The prostate is located between the bladder and urethra and its enlargement can interfere in normal urinary function. While there are several zones (layers) of the prostate, BPH arises in the transition zone, which surrounds the urethra. The growth may be caused by proliferation of the epithelial and stromal cells, or the lack of normal apoptosis — or both. An enlarged prostate can impinge upon the bladder, leading to obstruction, reduced urinary flow or retention, a sense of urgency or urinary tract infections, and may negatively affect kidney function.

Before HoLEP, the standard of surgical care for BPH for moderately enlarged prostates was an incomplete transurethral resection that often carried a prolonged recovery and frequent need for reoperation. For larger prostates, treatment involved an invasive, often highly morbid surgery, to remove part of the prostate. As with any surgical procedure, there is a higher risk of complications, restrictions and discomfort during recovery.

HoLEP Advantages

Holmium is a rare-earth metal with strong magnetic and optical properties. The optical properties allow exacting precision and manipulation of light signals. It’s also stable and has low toxicity.

HoLEP uses a precise holmium laser to completely resect the benign prostate tissue. Instead of an incision through the skin, HoLEP goes through the urethra, making it minimally invasive and renders the size of the prostate — which is normally walnut size but can be much larger — irrelevant, another advantage over traditional resection. The small sections of resected tissue can also be used for pathological examination.

“The advantages of HoLEP are significant,” Dr. Zell says. “There’s little risk of needing another operation, so it’s a one-and-done procedure. Because it is minimally invasive, patients recover fairly quickly. We generally remove the catheter within 24 to 48 hours. Complications, such as bleeding, infection or permanent urinary leakage, are rare. Patients who take blood thinners can continue to do so following HoLEP.”

Dr. Jaeger says they may also use HoLEP prior to radiation therapy in patients who have prostate cancer, resulting in a significant improvement in urinary symptoms.

Results of clinical trials show that HoLEP provides better outcomes than other treatments.

UH is a Leader in HoLEP Nationwide

“Few institutions perform a high volume of HoLEP procedures because of the complexity of the procedure,” Dr. Jaeger says. “There’s a steep learning curve, and it’s unusual to have two surgeons in the same institution who perform so many HoLEP surgeries.”

Dr. Jaeger celebrates her 400th successful H0LEP procedure at UH in March 2024.

Dr. Zell adds, “HoLEP is efficient and cutting edge and has become the gold standard for treating enlarged prostates. It’s an outpatient procedure, so it’s relatively easy on patients, and we have been getting great outcomes. Alleviating the symptoms of enlarged prostate can make a substantial improvement in the lives of men. UH is in the top three institutions nationwide in performing HoLEP.”

For more information about HoLEP, contact Dr. Jaeger or Dr. Zell at 216-844-3009.

Contributing Experts:
Irina Jaeger, MD
Endourologist
University Hospitals Urology Institute
Clinical Assistant Professor
Case Western Reserve University School of Medicine

Michael Zell, MD
Endourologist
University Hospitals Urology Institute
Director, Urologic Surgery
University Hospitals Ahuja Medical Center
Assistant Professor
Case Western Reserve University School of Medicine