Holmium Laser Enucleation of the Prostate, or HoLEP, is an advanced, minimally invasive surgical procedure used to treat an enlarged prostate. This technique utilizes the precise energy of a holmium laser to completely remove the excess prostatic tissue that obstructs the flow of urine. By operating through the natural urinary channel, HoLEP offers a treatment option that avoids external incisions and provides durable relief for men experiencing urinary symptoms.
Why the HoLEP Procedure is Necessary
The primary medical condition requiring HoLEP is Benign Prostatic Hyperplasia (BPH), the non-cancerous enlargement of the prostate gland. As the gland grows, it presses inward on the urethra, causing a blockage known as bladder outlet obstruction that impairs urinary function. This compression results in symptoms such as a weakened urine stream, frequent or urgent urination, and the sensation of incomplete bladder emptying.
When these symptoms interfere with daily life or fail to improve with medication, surgical intervention is considered. Surgery is also necessary if the obstruction leads to complications such as recurrent urinary tract infections, the formation of bladder stones, or damage to the kidneys from chronic back-pressure. HoLEP offers a highly effective method to remove the obstructive tissue and restore proper urinary flow.
How Holmium Laser Enucleation is Perform
The HoLEP procedure is performed entirely through the urethra using a specialized endoscope. The patient receives general or spinal anesthesia while the surgeon inserts the instrument, called a resectoscope, to access the prostate. This instrument carries a flexible fiber that delivers the holmium laser energy directly to the target tissue.
The laser performs the enucleation, separating the enlarged inner portion of the prostate (the adenoma) from the outer surgical capsule. This technique removes the entire obstructing tissue as a single, intact piece or a few large pieces. The holmium laser also provides excellent hemostasis by coagulating blood vessels as it cuts, minimizing blood loss during the process.
Once separated, the tissue is pushed into the bladder cavity. A second instrument, called a morcellator, is introduced through the same channel. The morcellator mechanically chops the large pieces of tissue inside the bladder into tiny fragments. These fragments are then suctioned out of the body, completing the removal of the enlarged gland.
Comparing HoLEP to Other Prostate Treatments
HoLEP is often compared to the traditional standard, Transurethral Resection of the Prostate (TURP). Unlike TURP, which shaves off small chips of tissue, HoLEP removes the entire adenoma, resulting in a much lower rate of symptom recurrence. The laser’s ability to seal blood vessels results in significantly less intraoperative bleeding compared to the electrical cutting loop used in TURP.
This reduced bleeding risk is beneficial for patients who must remain on blood-thinning medications. Furthermore, HoLEP is effective for prostates of virtually any size, including very large glands that traditionally required open surgery. TURP, by contrast, is typically reserved for moderate-sized prostates.
HoLEP has largely replaced open prostatectomy for BPH, offering complete tissue removal similar to open surgery but with the benefits of a minimally invasive approach. Patients generally experience shorter catheter times and a reduced length of hospital stay compared to those treated with TURP.
What to Expect During Recovery
Immediately following the HoLEP procedure, a temporary urinary catheter is placed to drain urine. This catheter allows the surgical site to begin healing and manages initial swelling. Most patients require the catheter for only 24 to 48 hours before it is removed.
The typical hospital stay is brief, with many patients discharged within 24 hours. It is common to observe blood in the urine (hematuria), which can persist intermittently for several weeks as the prostate heals. Patients may also experience temporary urinary frequency, urgency, or mild burning sensations.
A return to light activities is usually possible within one to two weeks. Patients should avoid heavy lifting and vigorous exercise for at least a month to prevent delayed bleeding. A common and likely permanent side effect after HoLEP is retrograde ejaculation, where semen enters the bladder during orgasm instead of exiting the penis.