Holmium laser enucleation of the prostate (HoLEP), also called holmium laser prostate surgery, is a minimally invasive treatment for patients diagnosed with benign prostatic hyperplasia (BPH).

During the procedure, the holmium laser is used to remove maximum obstructing tissue that is blocking the urine flow through the prostate. The surgeon then uses a separate instrument through an endoscope, to avoid an incision, and to remove the large volume of prostate tissue by converting it into smaller removable fragments.

HoLEP is similar to open prostate surgery but does not require any incisions. HoLEP removes the entire portion of the prostate blocking urine flow. Patients with very large prostate glands who need surgical intervention may significantly benefit from this procedure.

After HoLEP, the removed tissue is sent to pathology so it can be examined in the laboratory for other conditions, including prostate cancer.

Benefits of HoLEP

Compared with traditional prostate surgery, HoLEP can offer faster recovery and symptom relief. Since the maximum volume of tissue is removed, patients who undergo a HoLEP procedure rarely need a second procedure to treat their urinary symptoms.

HoLEP is the only size independent endoscopic option for the surgical management of BPH. Compared to TURP or open prostatectomy, HoLEP has shorter catheter times, shorter hospital stay, long term durability, and better clinical outcomes.


Development of HoLEP

The procedure is typically performed under general anesthesia. The surgeon accesses the prostate internally (endoscopically), through the urethra, without making any cuts on the skin.

The Holmium laser is used to completely remove the obstructive core of the prostate. This leads to maximal relief of prostate obstruction, and a male patient will usually only require one HoLEP procedure in his lifetime. It is highly unlikely that the prostate will regrow after HoLEP. Less than one percent of patients need a second procedure up to 10 years after HoLEP, compared to 10-15% of patients after TURP, and more after green light laser surgery.

After HoLEP, the portion of the prostate that has been removed will be sent for microscopic analysis. Prostate cancer that would otherwise be undetected is found in eight percent of cases. HoLEP is one of the most extensively researched procedures for treatment of benign prostatic hyperplasia.

Advantages of HoLEP

HoLEP has replaced TURP as the gold standard for BPH treatment. Advantages of the procedure include:

  • Less bleeding
  • Fewer blood transfusions
  • Shorter time with a catheter in place after surgery
  • Shorter hospital stay (90% of men who undergo HoLEP are able to leave the hospital without a catheter the day after surgery; in some cases, an overnight hospital stay isn’t required)

Meta-analyses suggest that HoLEP improves urinary flow rates and relieves urinary symptoms more effectively than all other endoscopic procedures treating BPH. The average symptom score improvement after HoLEP is 70-80%. Patients have also experienced flow rate improvements of up to 600%.

Research has shown that HoLEP is extremely effective in the treatment of urinary retention in men. 98% of men using catheters before surgery are freed from their catheter dependence after HoLEP. This is compared to 70% of men with green light laser and TURP surgery. Unlike all other endoscopic procedures for BPH, HoLEP is an effective procedure for men with any size prostate.