Holmium laser enucleation of the prostate (HoLEP)

Holmium laser prostate surgery (HoLEP) is a procedure that is minimally invasive as opposed to open surgery to treat enlarged prostate that blocks the flow of urine. It is also called Holmium Laser Enucleation of the prostate (HoLEP).

The surgeon utilizes a laser to cut off the enlarged tissue of the prostate in this procedure so that it can be easily removed as smaller fragments. It is useful in treating an extremely enlarged prostate.

What are the Advantages of Holmium laser enucleation of the prostate (HoLEP)?

The benefit of Holmium laser prostate surgery (HoLEP) is that it uses laser and does not require incisions as in case of open surgery, thereby serving as a conservative method to treat enlarged prostate. 

This alternative helps to preserve surrounding important structures and promotes quicker recovery. The chances of re-treatment required are also less concerning HoLEP. It provides a beacon of hope in long term management of a condition called Benign Prostatic Hyperplasia (BPH).

Who may require Holmium laser prostate surgery (HOLEP)?

Holmium laser prostate surgery (HOLEP) is recommended in individuals with enlarged prostate like in case of BPH (Benign Prostatic Hyperplasia) who are over the age of 60 and have problems like difficulty in passing urine. 

It is particularly useful to avoid the potential complications of the disease (if left untreated or advances) like urinary tract infections, urinary stones, and urine retention.

Potential complications of this procedure include:

  • Urinary frequency and urgency.

  • Urinary infection.

  • Retrograde ejaculation.

  • Erectile dysfunction.

  • Bleeding.

  • Prostate regrowth

  • Deep vein thrombosis (DVT)

  • Injury to the urethra can cause scar formation

What is Preparations for Holmium Laser Enucleation of the Prostate (HoLEP)?

The doctor will conduct a series of tests and complete physical evaluation to determine the status of the disease and its progress. They help to decide whether the patient is suitable to undergo this procedure. It is done through the following:

Detailed medical history and physical assessment including a digital rectal exam and urinary flow rate measurement.

Laboratory tests including blood and urine work as well as PSA (prostate-specific antigen) level. For elevated PSA levels, a tissue sample may be sent to rule out cancer.

In some cases, the doctor may advise a transrectal ultrasound.


To look at the affected tissue with a flexible instrument-the scope with a camera attached to it.


A diagnostic test involving a catheter in the bladder and pressure sensors.

Before the surgery is performed, the dosages of certain medicines may need to be adjusted (especially in case of blood thinners). It is necessary to seek advice from the doctor on this matter to prevent abnormally excessive bleeding because of the procedure.

The patient will have to follow the instructions as given by the physician for the day of the surgery regarding eating, drinking, and taking certain medications. 

It is recommended to stop smoking and drinking as this may increase the chances of chest infection and DVT after the surgery. A urine culture is done 2 to 4 weeks before surgery to reduce the risk of infection after the surgery.


What are the Procedure for Holmium Laser Enucleation of the Prostate (HoLEP)?

The surgery is performed under general anesthesia during which the patient is asleep or using spinal anesthesia in which the patient is awake but numb from the waist down. 

The patient's leg is kept in an elevated position. An injection of antibiotics is given as a prophylaxis against infection.

An instrument called the resectoscope is inserted into the urethra (through which urine is passed down from the urinary bladder) that enables the surgeon to look within the prostate to evaluate the location for performing the incisions. 

The laser inserted through this resectoscope helps to free up the enlarged prostate tissues from the outer part of its capsule and the nearby blood vessels. 

The laser is then switched with a device called the morcellator to suction the tissue left behind within the bladder. This is again switched with a urinary catheter and the surgery is finished.

What is the Post-surgery care for Holmium Laser Enucleation of the Prostate (HoLEP)?

The patient is required to stay overnight for observation and post-operative care. The patient may be able to leave the same day after the procedure but it varies. If a catheter is placed then you may need to come back to the clinic to remove it.

Some bleeding is to be expected after the surgery. It may last about 12 hours. The catheter helps to flush the fluid to clear blood from the urine after the surgery.

The catheter is usually removed the morning after surgery if there isn't abnormally excessive bleeding. If the patient can urinate comfortably 2 to 3 times after the catheter is removed, then he/she can go home without the catheter. 

If he/she is unable, then the catheter is replaced. It is removed again in the following week. In certain cases, the catheter may just be left in for one week after surgery and then removed (If scar tissue is present in the urethra).

Initially, you may have difficulty passing urine but it will be relieved in two weeks after the surgery.

Painkillers prescribed can help manage pain, if any after the surgery which is rare after this procedure. Maintaining an adequate intake of fluids daily is recommended.

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