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Overview of Holmium Laser Enucleation of the Prostate HoLEP Procedure

Medically reviewed by Roger Bielinski, MD, Urology — By Daniel Yetman on October 19, 2022

What is the HoLEP procedure

Holmium laser enucleation of the prostate (HoLEP) is a procedure where a doctor uses a laser to remove prostate tissue from an enlarged prostate that’s restricting urine flow. Benign prostatic hyperplasia (BPH), or an enlarged prostate, is one of the most common health conditions experienced by older men. It affects about 80% of men by the age of 70. It can cause symptoms like:frequent need to urinateincreased urination at nighttrouble initiating urinationweak urine streamdribbling at end of urinary streaminability to empty the bladder Studies have found that anywhere from 3.5% to 10% of men require surgical treatment for BPH. Traditionally, BPH was treated with transurethral resection of the prostate (TURP) or open prostatectomy. HoLEP is a newer procedure that offers more benefits than the traditional methods, such as a shorter hospital stay and less bleeding. Keep reading to learn more about the HoLEP procedure, including its benefits, risks, and effectiveness.

HoLEP procedure steps

Here’s what you can expect before, during, and after the HoLEP procedure.

Before the procedure

Your surgeon may recommend stopping blood-thinning medications before your procedure, but HoLEP can still be performed safely even if you need to continue taking these medications. You may undergo baseline testing, such as uroflowmetry or pressure flow urodynamics before your surgery to assess your level of urinary obstruction. Imaging tests may be used to determine your prostate size. You’ll likely be told to stop eating at least 6 hours before your surgery.

During the procedure

Here’s a general idea of what you can expect during your procedure:You’ll receive general anesthesia through an IV that’s attached to your wrist or arm to put you asleep. If you can’t receive anesthesia, you may receive spinal anesthesia that blocks feeling from the waist down.You’ll be placed on your back with your legs raised.The surgeon will insert a tool called a resectoscope into your urethra, the tube that leads from the tip of your penis to your bladder. The resectoscope has a camera that allows your surgeon to see your prostate.They will then insert a laser into the resectoscope and use it to break up the prostate tissue that’s blocking your urine flow.The surgeon will push the removed tissue into your bladder. They will then replace the resectoscope with another tool called a morcellator that’s used to suction out the tissue from your bladder.You’ll usually receive a catheter at the end of your procedure to allow your bladder to drain.

After the procedure

You’ll likely stay in the hospital overnight. Your catheter will be removed before you leave the hospital. Some bleeding is to be expected after the surgery. Usually, your urine will be clear of blood after about 12 hours. Drinking a lot of fluids during this time can help clear the blood quicker. You may find that it’s painful to pass urine in the beginning and that you need to urinate more frequently. Some symptoms may not improve for several months due to overactivity or underactivity of your bladder. Your surgeon can give you the best idea of what to expect.

How long does a HoLEP procedure take

The length of time of your surgery depends on the size of your prostate. On average, the procedure takes between 60 to 120 minutes.

HoLEP procedure recovery time

HoLEP generally requires a shorter hospital stay and less time with a catheter than TURP or an open prostatectomy. It may take up to 2 weeks before you can return to work. Doctors usually advise avoiding:heavy lifting or activity for a weeksexual intercourse for 2 weeksactivities that involve straddling for a month If blood thinners were paused, they can be resumed after 4 to 7 days after urine is clear of blood.

Effectiveness of the HoLEP procedure

HoLEP can be highly effective at reducing symptoms of BPH. In a 2022 review of studies, researchers found that it was more effective and safer for treating large-volume BPH than:bipolar transurethral enucleation of the prostate bipolar TURPthulium laser enucleation of the prostate In a 2021 study, researchers found the success rate was 80.5% among 266 people who went home on the same day of their surgery between 2013 and 2019. The success rate was 87% for people who had surgery after 2017.

HoLEP procedure side effects and risks

Temporary urinary incontinence, or accidental urine leaking, has been reported as a side effect of 16% to 44% of people within 3 months of surgery. Other potential complications include:blood in urinegeneral surgical risks like anesthesia reaction or bleedingbladder or urethra injuryprostate injurybladder infectionerectile dysfunction The risk of post-treatment erectile dysfunction is similar to that of open prostatectomy and TURP.

Who s a candidate for HoLEP

You may be a candidate for HoLEP if you have BPH that hasn’t responded to medications. It may be a good option for men taking blood-thinning medications who may not be able to undergo other surgeries. HoLEP is also a potential option for men with large-volume BPH who may not be able to be treated with other noninvasive surgeries.

HoLEP procedure cost

HoLEP is associated with a lower cost than TURP. The cost of the procedure can vary widely depending on factors like:where you livethe experience of your surgeon whether you need to be re-admitted to the hospital As it’s a medically necessary procedure, it should be at least partially covered by insurance.

Alternative treatments for an enlarged prostate

Other treatments for an enlarged prostate include:

Lifestyle changes

Mild BPH may be manageable with lifestyle changes like:going to the bathroom more oftenminimizing alcohol and caffeine intakeurinating as soon as you need to

Medications

If lifestyle changes aren’t effective, a doctor may recommend medications like:alpha-1 blockersphosphodiesterase-5 inhibitors5-alpha reductase inhibitors Learn more about BPH medications here.

Surgery

Your doctor may recommend surgery if you don’t respond to medications. Open prostatectomy and TURP are two of the most common options.

Open prostatectomy

Open prostatectomy is the surgical removal of your prostate through an incision either in your abdomen or between your scrotum and anus. Your doctor may recommend this procedure if your prostate is very large.

Transurethral resection of the prostate

TURP has traditionally been the gold-standard surgical option for BPH before the development of HoLEP. It involves removing part of your prostate through your penis with a special tool to avoid making any incisions outside your body. It’s not an option for very large BPH.

Herbal treatments

The evidence to support the use of herbal supplements to treat BPH is weak. It’s a good idea to speak with a doctor before taking any herbal supplements. Some herbs under investigation include:beta-sitosterolpygeumrye grass pollen extractstinging nettle Learn more about herbal supplements for BPH here.

Takeaway

HoLEP is a treatment option for an enlarged prostate that’s causing problems with urine flow. It involves removing part of your prostate with a laser. It’s a fairly new treatment option that offers an alternative to other surgeries like open prostatectomy or TURP. Your doctor can help you decide if you require surgery for your BPH. They can also help you decide if HoLEP is the best treatment option or if you may benefit from a different procedure. Last medically reviewed on October 19, 2022

How we vetted this article

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Abedi A, et al. (2020). Is holmium laser enucleation of the prostate a good surgical alternative in benign prostatic hyperplasia management? A review article.
ncbi.nlm.nih.gov/pmc/articles/PMC7118502Akhil DK, et al. (2019). Holmium laser enucleation of the prostate (HoLEP): A review and update.
canjurol.com/abstract.php?ArticleID=&version=1.0&PMID=3148114Asaf S. (2021). HoLEP: The new gold standard for surgical treatment of benign prostatic hyperplasia.
canjurol.com/abstract.php?ArticleID=&version=1.0&PMID=34453422Assmus MA, et al. (2022). Understanding holmium laser enucleation of the prostate (HoLEP) recovery: Assessing patient expectations and understanding.
ncbi.nlm.nih.gov/pmc/articles/PMC8937596/Holmium laser enucleation of the prostate. (n.d.).
endourology.org/education-articles/holmium-laser-enucleation-of-the-prostateHolmium laser enucleation of the prostate (HoLEP). (n.d.). (
ouh.nhs.uk/urology/services/documents/holep.pdfJiang DD, et al. (2021). Misaligned incentives in benign prostatic enlargement surgery: More complex and efficacious procedures are earning fewer relative value units.
liebertpub.com/doi/10.1089/end.2020.0941Klein C, et al. (2021). Evolution of day-case holmium laser enucleation of the prostate success rate over time.
pubmed.ncbi.nlm.nih.gov/32935563/Masucci L, et al. (2018). Cost analysis of Greenlight photoselective vaporization of the prostate compared to transurethral resection of the prostate for benign prostatic hyperplasia.
ncbi.nlm.nih.gov/pmc/articles/PMC6261731/Sun J, et al. (2019). Comparison between 1-day and inpatient procedure of holmium laser enucleation in patients with benign prostate hyperplasia.
ncbi.nlm.nih.gov/pmc/articles/PMC6913051/Sun F, et al. (2022). The efficacy and safety of HoLEP for benign prostatic hyperplasia with large volume: A systematic review and meta-analysis.
journals.sagepub.com/doi/full/10.1177/15579883221113203Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 19, 2022 By Daniel Yetman Edited By Roman Gokhman Medically Reviewed By Roger Bielinski, MD Copy Edited By Megan McMorris Share this articleMedically reviewed by Roger Bielinski, MD, Urology — By Daniel Yetman on October 19, 2022

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