Holmium Laser Enucleation of the Prostate (HoLEP) is a modern and minimally invasive surgical technique used to treat benign prostatic hyperplasia (BPH), a common condition affecting older men. Since its introduction in the late 1990s, HoLEP has gained global recognition for its efficacy, safety, and durability as a solution for prostate enlargement. In this article, we will provide a detailed look into HoLEP — what it is, how it works, its advantages, risks, outcomes, and how it compares to alternative treatments.
What is BPH (Benign Prostatic Hyperplasia)?
Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland that commonly affects men over the age of 50. As the prostate grows, it can compress the urethra and restrict the flow of urine, causing lower urinary tract symptoms (LUTS). These symptoms may include:
- Frequent urination, especially at night (nocturia)
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Urgency to urinate
- Incomplete bladder emptying
If left untreated, BPH can lead to complications such as urinary retention, bladder stones, recurrent urinary tract infections, or even kidney damage.
What is HoLEP?
Holmium Laser Enucleation of the Prostate is a procedure that uses a high-powered holmium laser to remove the excess prostate tissue blocking the flow of urine. Unlike traditional transurethral resection of the prostate (TURP), HoLEP removes the entire portion of the prostate gland that is causing obstruction, which leads to more durable long-term results.
The procedure involves two main steps:
- Enucleation: The surgeon uses the laser to separate the enlarged prostate tissue (adenoma) from the surrounding prostate capsule.
- Morcellation: The detached tissue is then morcellated (cut into smaller pieces) and removed through the urethra using a specialized instrument.
How is HoLEP Performed?
The HoLEP procedure is typically performed under general or spinal anesthesia. Here is a step-by-step breakdown of the surgical process:
- Preparation: The patient is positioned, and sterile techniques are used to prepare the surgical area.
- Cystoscopy: A camera is inserted through the urethra to visualize the prostate and bladder.
- Laser Enucleation: The holmium laser is inserted and used to carefully dissect the overgrown prostate lobes from the capsule.
- Morcellation: A morcellator is inserted to fragment and remove the enucleated tissue.
- Catheterization: A catheter is usually placed in the bladder to allow urine to drain and to monitor for bleeding.
The entire procedure usually takes 60 to 120 minutes, depending on the size of the prostate.
Benefits of HoLEP
HoLEP offers several key advantages over other surgical treatments for BPH:
1. Minimally Invasive
- Performed through the urethra; no external incisions are required.
- Less blood loss due to precise laser coagulation.
2. Effective for All Prostate Sizes
- One of the few techniques effective for very large prostates (>100 grams), where open surgery was previously required.
3. Durable Results
- Lower risk of reoperation over time, compared to TURP or laser vaporization.
- Complete removal of obstructive tissue ensures long-term symptom relief.
4. Shorter Hospital Stay
- Most patients can be discharged within 24 hours.
- Catheter duration is usually shorter than in other procedures.
5. Lower Complication Rates
- Reduced risk of bleeding, particularly in patients on anticoagulants.
- Lower incidence of TURP syndrome (fluid absorption-related complication).
Risks and Potential Complications
Although HoLEP is generally safe, like all surgical procedures, it carries some risks. Possible complications include:
- Bleeding: Minimal but may require catheter flushing or rarely transfusion.
- Urinary incontinence: Usually temporary; persistent cases are rare.
- Retrograde ejaculation: Common side effect, where semen enters the bladder during ejaculation.
- Urethral stricture or bladder neck contracture: Rare but possible narrowing of the urethra.
- Urinary tract infection (UTI): Treatable with antibiotics.
- Temporary irritative symptoms: Burning sensation during urination, urgency, or frequency in the weeks following surgery.
Most of these complications are temporary and resolve within a few weeks to months.
Recovery and Aftercare
Immediately Post-Surgery
- A catheter will remain in place for about 1 to 2 days.
- Mild hematuria (blood in urine) is normal and usually resolves quickly.
At Home
- Patients are encouraged to drink plenty of fluids.
- Avoid heavy lifting or strenuous activity for 2 to 4 weeks.
- Resume sexual activity after 3 to 4 weeks or as advised by the urologist.
Follow-Up
- A follow-up appointment is typically scheduled within 4 to 6 weeks.
- Uroflowmetry and symptom score questionnaires may be used to assess outcomes.
HoLEP vs. Other BPH Treatments
| Treatment | Suitable for Large Prostates? | Reoperation Risk | Hospital Stay | Catheter Duration | Blood Loss |
| HoLEP | Yes | Very Low | 1 Day | 1–2 Days | Minimal |
| TURP | Limited (<80g) | Moderate | 2–3 Days | 2–3 Days | Moderate |
| Laser Vaporization | Moderate | Higher | 1 Day | 1–2 Days | Low |
| Open Prostatectomy | Yes (>100g) | Low | 3–5 Days | 5–7 Days | Higher |
Who is a Candidate for HoLEP?
Ideal candidates for HoLEP include men with:
- Moderate to severe urinary symptoms due to BPH
- Large prostate size
- Failed medical therapy (e.g., alpha blockers, 5-alpha reductase inhibitors)
- Urinary retention requiring catheterization
- Recurrent urinary tract infections or bladder stones caused by BPH
- Willingness to undergo surgical treatment
It is also suitable for patients on blood thinners, as the laser minimizes bleeding risks.
Conclusion
HoLEP is a highly effective, safe, and durable treatment for benign prostatic hyperplasia, particularly suitable for large prostates and patients seeking a long-term solution. As surgical techniques continue to evolve, HoLEP stands out as a gold standard in the management of BPH due to its minimally invasive nature, reduced complication rates, and impressive functional outcomes.
While it may require a learning curve for surgeons, the patient benefits are clear. If you are experiencing symptoms of BPH and are considering surgical options, discussing HoLEP with a qualified urologist may help determine whether it is the best option for you.
Why Erdem Hospital is the Best Choice for HoLEP Treatment
When it comes to Holmium Laser Enucleation of the Prostate (HoLEP), Erdem Hospital stands out as one of the leading centers for advanced urological care. With a team of highly experienced urologists, state-of-the-art laser technology, and a patient-centered approach, Erdem Hospital offers safe, effective, and personalized HoLEP procedures.
Patients benefit from:
- Minimally invasive surgery with rapid recovery
- Short hospital stays and reduced catheter time
- Comprehensive pre- and post-operative care
- Multilingual medical staff and international patient services
Whether you’re struggling with severe BPH symptoms or looking for a long-term solution with minimal complications, Erdem Hospital combines medical excellence with comfort and trust—making it the ideal destination for HoLEP treatment.