HoLEP is a minimally invasive surgical treatment for men with urinary symptoms caused by an enlarged prostate, also known as benign prostatic hyperplasia (BPH). It uses a high-powered holmium laser to remove excess prostate tissue that is blocking urine flow, offering long-term relief from symptoms.

When is HoLEP Recommended?

HoLEP is typically recommended for men who:

• Have moderate to severe lower urinary tract symptoms (LUTS) caused by BPH
• Have not responded adequately to medication
• Have a very large prostate (often >80cc), where other treatments may be less effective
• Wish to avoid more invasive open surgery

It can also be considered when urinary retention, recurrent infections, or bladder stones are present due to BPH.

Benefits of HoLEP

• Effective for all prostate sizes, including very large glands
• Complete removal of the obstructing tissue, reducing the chance of symptom recurrence
• Shorter hospital stay and faster recovery compared to traditional surgery
• Low risk of bleeding, making it suitable for men on blood-thinning medication
• Improved urinary flow and symptom relief often seen within days

What Does the Procedure Involve?

HoLEP is usually performed under general anaesthetic. A telescope is passed through the urethra (the natural urinary channel), and the laser is used to carefully enucleate (shell out) the central part of the prostate that is causing obstruction. The removed tissue is then pushed into the bladder and removed using a special instrument called a morcellator.

The operation typically takes 60 to 120 minutes, depending on the size of the prostate.

Recovery and Aftercare

• A urinary catheter is usually placed during the procedure and removed within 1-7 days after the operation
• Most patients go home the next day.
• Mild burning during urination and occasional blood in the urine are common for a few days.
• Avoid heavy lifting and strenuous activity for two weeks.

Full recovery usually takes 2–4 weeks, and most men notice a significant improvement in urinary symptoms soon after the catheter is removed.

Potential Risks and Side Effects

As with any surgical procedure, there are potential risks, although HoLEP is considered very safe:

• Retrograde ejaculation (dry orgasm) is common and permanent but harmless
• Temporary urinary incontinence
• Rarely, urethral stricture or bladder injury
• Urinary infection
• Very low risk of needing a blood transfusion

Your consultant will discuss these in more detail before your procedure.

Long-Term Outcomes

HoLEP has excellent long-term results. Studies show durable symptom relief and low re-treatment rates, even many years after the procedure. It is now considered the gold standard treatment for large prostates.