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Holmium Laser Enucleation of the Prostate (HOLEP)

What is HoLEP?

The prostate gland is an organ found in men, surrounding the neck of the urinary bladder. The gland grows with age, but if it grows too big, it can exert pressure on the urethra (tubes that drain urine), and may obstruct the flow of urine. This condition is called benign prostatic hypertrophy (BPH) and causes urinary problems, such as difficulty in emptying the bladder and frequent urinary infections.

Holmium laser enucleation of the prostate (HoLEP) is a surgical procedure that uses laser beams to remove the enlarged area of the prostate gland. HoLEP is a minimally invasive procedure that is used to improve the flow of urine. It is used as an alternative to the standard transurethral resection of the prostate (TURP) technique, to prevent certain complications associated with TURP.

How is the procedure performed?

HoLEP is performed under general anaesthesia or spinal anaesthesia. The complete surgical procedure takes about 45 to 90 minutes, depending on the size of your enlarged prostate. You may be given an antibiotic injection before the surgery to prevent infection.

Your doctor inserts a narrow telescope-like instrument into your penis and advances it through the urethra. A high-powered laser is passed through this instrument. The obstructing prostate tissue is carefully separated from its surrounding tissue using the laser and pushed into the bladder. A surgical instrument is then inserted through the telescope to suction out the excised prostate from the bladder.

Your doctor may insert a catheter (thin tube) to drain the urinary bladder and leave it in place for a few days until recovery. Sterile saline fluid may be passed through the catheter to irrigate the bladder of any blood in the urine and prevent the formation of clots.

You may have to stay overnight in the hospital after the surgery. You may be advised to drink more fluids for a week to help flush blood out of the urine more quickly. You can resume your daily activities within a week.

What risks or complications are associated with the procedure?

Like all surgical procedures, HoLEP may be associated with certain risks that include:

  • Bleeding
  • Infection
  • Retrograde ejaculation (semen does not ejaculate out of the penis, but instead flows into the bladder)
  • Pain or difficulty in urination
  • Increased frequency of urination
  • The Royal College Of Surgeons of England
  • University of Cambridge
  • British Association of Urological Surgeons
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