How to Find Doctors Who Perform HoLEP Surgery

Finding a surgeon who performs HoLEP (holmium laser enucleation of the prostate) takes more effort than finding one who does a standard prostate procedure, because the operation requires specialized equipment and a long learning curve that relatively few urologists have completed. The procedure has been called a gold standard for surgical treatment of enlarged prostates, yet most urologists still do not offer it. That gap between the procedure’s reputation and its availability is the central frustration for patients trying to get it, and understanding why the gap exists is the first step toward closing it for yourself.

Why HoLEP Surgeons Are Hard to Find

HoLEP works for prostates of any size, which is a major advantage over the more common TURP (transurethral resection of the prostate), whose effectiveness drops as the gland gets larger.¹ It also produces tissue specimens that can be examined under a microscope, has durable long-term results, and allows many patients to go home the same day. Despite all of that, the procedure has a notoriously steep learning curve. One recent study found that surgeons continued to improve beyond 200 cases, with complication rates not fully stabilizing until around 350 procedures.² An earlier systematic review estimated that a surgeon could perform the procedure safely after about 50 cases with careful patient selection, and that number could drop to fewer than 25 with structured mentorship and simulation training.³ Either way, the investment in training is substantial, and many urologists and hospitals have simply not made it.

The holmium laser system itself is expensive and not universally available in operating rooms. A hospital needs to purchase the laser, the morcellator (a device that chops up the enucleated tissue so it can be removed through the urethra), and maintain the fiber optics. Smaller community hospitals often lack this equipment entirely. The combination of steep capital costs and a long training pipeline means HoLEP tends to concentrate at academic medical centers, large urology group practices, and a scattering of high-volume community surgeons who made the investment independently.

Practical Steps to Locate a HoLEP Surgeon

There is no single registry of HoLEP-trained urologists, which is part of the problem. But several strategies reliably turn up qualified surgeons:

Academic medical centers: University-affiliated urology departments are the most likely places to find experienced HoLEP surgeons. Many of these programs train fellows who then spread the technique to other institutions. Look at the faculty pages of urology departments at major research hospitals in your region. Surgeons who list endourology, BPH, or laser prostate surgery among their clinical interests are the ones to contact.
Professional society directories: The American Urological Association (AUA) and the Endourological Society both maintain member directories. Searching for urologists who specialize in BPH or minimally invasive prostate surgery can narrow the field. Neither directory explicitly filters by “HoLEP,” but it gives you a starting list of names to research further.
Published research: Surgeons who publish on HoLEP are almost certainly performing it regularly. A quick search on PubMed for “HoLEP” plus your city or state can reveal which local surgeons have contributed to the literature. High-volume surgeons often appear as authors on studies about outcomes, techniques, or learning curves.
Lumenis and other laser manufacturers: Companies that make holmium laser systems sometimes maintain lists of centers that use their equipment. Contacting the manufacturer’s sales or patient-resources division can occasionally point you toward nearby surgeons.
Patient forums and advocacy groups: Online communities focused on BPH (such as forums on Reddit, BPH-specific Facebook groups, or patient advocacy sites) frequently share surgeon recommendations by region. These are anecdotal, but they can surface names you would not find through official directories.
Referral from your current urologist: Even if your urologist does not perform HoLEP, they likely know who does in the area. Ask directly. Some urologists will refer you out of network if no one in their practice offers the procedure.

Be prepared to travel. Depending on where you live, the nearest experienced HoLEP surgeon could be one or two hours away, or in another state entirely. Many patients treat this as a one-time trip: the surgery itself is short, catheter time is brief, and same-day discharge is increasingly common at high-volume centers.

What to Ask a Prospective Surgeon

Once you have a name, your next job is figuring out whether that surgeon has the experience to give you a good outcome. Surgeon volume matters more for HoLEP than for many other urologic procedures, precisely because of the long learning curve. Here are the questions worth asking at a consultation:

How many HoLEP procedures have you performed? This is the single most important question. A surgeon past the 50-case threshold has cleared the initial learning curve, but research suggests improvements in efficiency and complication rates continue well beyond that.² A surgeon with hundreds of cases under their belt is ideal. Do not be shy about asking; experienced surgeons are typically proud of their volume.
How often do you perform HoLEP each month? A surgeon who does two or three per week stays sharp in a way that someone doing two per month may not. Ongoing volume keeps skills current and allows the surgical team (nurses, anesthesiologists, technicians) to stay familiar with the setup.
What is your complication rate? At a high-volume center, overall complication rates around 28–30% at one year have been reported, though the vast majority of those complications are minor (low-grade fever, temporary urinary retention) and resolve without further surgery.⁴ Serious complications requiring additional procedures are uncommon. A surgeon who tracks and openly shares their outcomes is a good sign.
What laser technology do you use? Newer pulse-modulation systems have shown meaningful improvements in enucleation speed and energy efficiency compared to older platforms.⁵ You do not need to become an expert in laser physics, but a surgeon using current-generation equipment is likely keeping up with the field.
What is your typical hospital stay? Many experienced HoLEP surgeons now discharge patients the same day as surgery, and studies of national data suggest same-day discharge is safe when patients are properly selected, with lower unplanned readmission rates compared to overnight stays.⁶ If a surgeon routinely keeps patients overnight, that is not necessarily a red flag, but it is worth understanding their reasoning.

Red Flags and Green Flags During the Search

A surgeon who is vague about their case numbers or deflects the question entirely should give you pause. HoLEP outcomes are closely tied to experience, and any surgeon who has invested the time to master the technique will have no trouble telling you how many cases they have done. Similarly, be cautious if a surgeon describes themselves as “trained in HoLEP” but does not regularly perform it. Training without ongoing practice is a poor predictor of outcomes.

On the positive side, look for surgeons affiliated with institutions that have formal endourology fellowship programs. Research has shown that HoLEP adoption rises sharply at institutions when a fellowship-trained endourologist is present, and drops when that surgeon leaves.⁷ A department with multiple HoLEP surgeons is more likely to maintain the infrastructure and institutional knowledge needed for good outcomes than one where a single surgeon is the lone practitioner. Another encouraging sign is when the surgeon or their institution participates in HoLEP research or training courses, as this signals an ongoing commitment to the technique.

If You Cannot Find a HoLEP Surgeon Nearby

If travel is not feasible, other laser enucleation techniques produce very similar results. Thulium laser enucleation (ThuLEP) uses a different type of laser but follows the same basic surgical approach of shelling out the inner portion of the prostate. A systematic review and meta-analysis of randomized trials found that ThuLEP and HoLEP offer comparable symptom improvement and voiding outcomes, with ThuLEP showing small advantages in blood loss and temporary incontinence, though the certainty of that evidence was low.⁸ A propensity-matched study comparing HoLEP, ThuLEP, and a thulium fiber variant found no significant differences in complications or incontinence at six and twelve months.⁹ In large prostates over 100 mL, both lasers performed safely and effectively, though ThuLEP showed some advantages in operative time and enucleation speed.¹⁰ The practical takeaway is that a skilled ThuLEP surgeon may be easier to find in your area, and the outcomes are comparable enough that you would not be settling for an inferior procedure.

For patients with very large prostates who cannot access any laser enucleation, robotic-assisted simple prostatectomy (RASP) is another option. Preliminary comparisons suggest RASP and HoLEP produce similar improvements in urinary flow and symptom scores, though HoLEP patients tend to have shorter catheter time, shorter hospital stays, and less blood loss.¹¹ RASP may have an edge in early continence recovery, and it can address coexisting bladder stones or diverticula in the same operation.¹² Robotic surgery platforms are far more widely available than holmium lasers, so RASP is often accessible in regions where HoLEP is not.

Patients on Blood Thinners

One of HoLEP’s practical advantages is that it can be performed in patients taking antiplatelet or anticoagulant medications. Many older men with enlarged prostates also have heart conditions that require blood thinners, and stopping those medications for surgery carries its own cardiac risks. A retrospective analysis found that HoLEP could be performed safely whether blood-thinning medications were held or continued, with low blood transfusion rates in both groups.¹³ If you are on blood thinners, mention this to your surgeon early. It may actually strengthen the case for choosing HoLEP over TURP, which carries more bleeding risk.

What Recovery Looks Like

Knowing what to expect after surgery helps you have a more productive conversation with your surgeon and set realistic expectations. The most commonly discussed side effect is temporary stress urinary incontinence, meaning some leakage with coughing, sneezing, or physical effort. In one study of nearly 600 patients, about 9% experienced transient stress incontinence, and the vast majority of those cases resolved within six weeks. Long-term stress incontinence occurred in roughly 1.5% of patients.¹⁴ Another single-center study found a somewhat higher transient incontinence rate of about 16%, with most cases recovering within three months.¹⁵ The variation between studies likely reflects differences in how incontinence is defined and measured, as well as surgeon experience and patient population.

Patients in qualitative research have also described aspects of the surgical experience that surgeons rarely discuss upfront: unexpected sounds from the laser during the operation, cold operating room temperatures, unfamiliar surgical staff, and a desire for more detailed pre-operative information about what to expect.¹⁶ These are not medical complications, but they shape how patients feel about the experience. Asking your surgeon in advance what the procedure will sound and feel like (most patients receive spinal anesthesia and are awake) can reduce anxiety on the day.

Sexual Function After HoLEP

Erectile function generally does not change after HoLEP. Two separate studies using validated questionnaires found no significant decline in erectile function scores after surgery.¹⁷ ¹⁸ Ejaculation, however, is a different story. Retrograde ejaculation, where semen travels backward into the bladder instead of out through the penis, occurs in the large majority of patients. One study of over 500 patients found that roughly 93% reported retrograde ejaculation afterward.¹⁹ This is not harmful, but it does affect the sensation of orgasm and obviously matters if you are trying to conceive. The same study found that retrograde ejaculation alone was not independently associated with lower satisfaction with sex life overall, though patients who said they were specifically bothered by it did report lower sexual satisfaction. Men with good erectile function tended to tolerate the change better. This is a conversation worth having with your surgeon before the procedure, not after.

Long-Term Durability and Incidental Cancer Detection

One of HoLEP’s strongest selling points is that results hold up over time. A ten-year follow-up study found that urinary flow rates, symptom scores, and residual urine volumes remained improved a decade after surgery. About 5% of patients needed a repeat procedure during that follow-up period, mostly for bladder neck narrowing or urethral scarring rather than regrowth of prostate tissue.²⁰ A systematic review comparing HoLEP to GreenLight laser vaporization found HoLEP had a mean reoperation rate of about 4% at an average follow-up of over seven years.²¹ That durability is worth emphasizing because some competing treatments, particularly those that vaporize tissue rather than removing it, cannot be evaluated pathologically and may have higher retreatment rates.

Because HoLEP removes the prostate tissue intact rather than burning it away, the tissue is sent to a pathologist. This means HoLEP can incidentally detect prostate cancer that was not suspected beforehand. In a large series, about 20% of HoLEP patients were found to have incidental prostate cancer in their specimens, most of which were early-stage and low-grade.²² A matched comparison found HoLEP detected incidental cancer at a significantly higher rate than TURP, likely because HoLEP removes more tissue from the transition zone.²³ For patients, this is an underappreciated side benefit: you go in for symptom relief and come out with a thorough pathological assessment of tissue that might otherwise have harbored undetected cancer for years.