Is the HoLEP procedure the best operation for a big prostate gland?
Written in association with:
Urologist
Published: 08/01/2025
Edited by: Karolyn Judge
Holmium Laser Enucleation of the Prostate (HoLEP) is a highly effective surgical treatment for men with benign prostatic hyperplasia (BPH), a common condition in which the prostate enlarges and causes urinary problems by obstructing bladder emptying. HoLEP is considered a minimally invasive procedure that removes ALL the central prostate tissue blocking urine flow. Despite being a surgical procedure, it is generally safe, very effective and well-tolerated by most patients.
HoLEP is an ideal procedure for men with bothersome urinary symptoms or catheter-dependent urinary retention, caused by a prostate gland greater than 80 cc volume. It replaced a major open surgical procedure (the Millin’s retropubic prostatectomy) when it was developed about 25 years ago. Compared to alternatives (like Transurethral Resection of the Prostate (TURP), REZUM and Aquablation), HoLEP has the best chance of relieving bladder outflow obstruction for the longest duration because it removes much more of the prostate. In fact, only 1% of patients need any further prostate surgery during their lifetime after a HoLEP. All tissue is removed from the bladder at the end by a process called morsellation; tissue is then submitted for pathological examination.
Preparation and anaesthesia: The procedure is performed under general or spinal anaesthesia, requiring preparation and a short hospital stay (usually one night).
Potential risks: As with any surgery, there are risks, including: Temporary urinary incontinence, which usually resolves within a few weeks. Mild bleeding during or after the procedure. Rare cases of infection, urethral stricture or erectile dysfunction.Retrograde (dry) ejaculation is common after HoLEP; it is harmless and usually doesn’t affect the sensation of orgasm, though it is best to avoid the procedure if fertility is still important.
Recovery time: Most patients can return to normal activities within 1–2 weeks. However, strenuous activity or heavy lifting should be avoided during the recovery period.
Is the HoLEP procedure worth it?
For men experiencing significant urinary symptoms or have a catheter due to BPH, HoLEP offers numerous benefits that often outweigh the risks.
Long-term effectiveness: HoLEP removes the obstructive prostate tissue entirely, reducing the likelihood of recurrence compared to other procedures. Improved quality of life: Patients (typically 80% at least) experience a dramatic improvement in urinary symptoms, including: Reduced frequency and urgency of urination. A much faster urine flow and improved bladder emptying. Decreased need for nocturnal urination (nocturia). Reduced bleeding: The laser technology allows for precise tissue removal while sealing blood vessels. Precautions are still taken for patients on blood thinners or those with bleeding disorders.
Who is the ideal candidate for HoLEP?
HoLEP is particularly suited for:
Men with significantly enlarged non-malignant prostates, volume above 80cc; With bothersome lower urinary tract symptoms, who haven’t responded to BPH medication; Or men encumbered with a urethral catheter inserted because of urinary retention; Men looking for a durable solution with virtually no risk of needing repeat procedures.
HoLEP is a modern and highly effective treatment for BPH, offering significant improvements in urinary symptoms and quality of life with relatively low risks. Discussing the procedure with a urologist will help determine if it is the best option based on individual health and treatment goals.