HoLEP

An enlarged prostate, known medically as benign prostatic hyperplasia (BPH), is a common condition in men. It disrupts urinary function and daily life for millions as they age. When medications fail to provide relief or symptoms become increasingly disruptive, Holmium laser enucleation of the prostate (HoLEP) may help. This treatment is an advanced surgical option that delivers lasting results.

HoLEP is a minimally invasive procedure that removes the overgrown portion of the prostate. This excess tissue presses on the urethra and blocks urine flow. Removing this tissue restores urine flow and function and relieves the frustrating symptoms of BPH, such as:

• Weak stream
• Frequent urination
• Incomplete bladder emptying

This treatment addresses the core problem behind BPH, often providing permanent symptom relief.

Several factors make it an appealing choice for managing BPH symptoms. HoLEP:

• Is effective for prostates of all sizes, including very large glands
• Utilizes precise laser technology, which reduces the bleeding risk
• Offers a low chance of needing retreatment
• Requires a shorter catheterization and hospital stay compared to traditional surgeries
• Has proven, durable outcomes backed by long-term data

The HoLEP procedure is done through the urethra using a specialized scope and laser. It is performed under general or spinal anesthesia. No external incisions are needed.

Using a specialized laser, the surgeon removes the excess prostate tissue blocking urine flow. A tool called a morcellator is used to break it into small pieces for removal.

HoLEP eliminates only the prostate tissue causing the blockage. It does not remove the entire prostate. Most procedures take between one and two hours.

The post-surgical plan and recovery depends on several factors, such as:

• The size of your prostate
• Your general health
• How well you can urinate after the procedure

Recovery after treatment is generally quicker than with older surgical options. However, temporary side effects are common as the body adjusts and heals.

During the First Week

• A catheter is typically left in place for 12 to 24 hours
• Light bleeding or pink-tinged urine is common and usually resolves on its own
• Some men experience burning or stinging during urination for several days

Short-Term Effects

Frequent trips to the bathroom and a sense of urgency may continue for a few weeks as the bladder relearns normal function. Temporary leakage of urine, especially with coughing or sneezing, is not uncommon and usually improves with time.

Light activities can usually be resumed within a few days.

Strenuous exercise, heavy lifting, and sexual activity should be avoided for about two weeks or until your doctor clears you.

While HoLEP has a strong safety record, possible risks and long-term effects exist as with any medical procedure.

• Retrograde ejaculation. Also known as dry orgasm, this is a common outcome after HoLEP. It means semen flows backward into the bladder during orgasm rather than out through the urethra. While this does not affect sexual pleasure or erections, it can impact fertility and the experience of climax.
• Temporary urinary incontinence. Some men experience leakage after surgery. With bladder training and pelvic floor exercises, this typically improves within weeks or months.
• Infection and bleeding. Significant bleeding risk is low, but mild bleeding in the urine is expected. Some men may develop a urinary tract infection, which needs to be treated with antibiotics.
• Scar tissue formation. Though rare, urethral strictures or bladder neck contractures can occur and may require additional treatment.

HoLEP is often recommended for men with moderate to severe BPH symptoms, particularly when:

• Medications are no longer effective or well-tolerated
• Prostate size is large, making other minimally invasive options less effective
• A long-term solution is preferred to avoid future surgeries

HoLEP is highly effective. If an enlarged prostate is disrupting your life, HoLEP may offer the relief you’ve been waiting for. Your urologist will perform a complete evaluation to determine if this is the best option for your condition and symptoms.

With durable results and fewer long-term complications, it’s a procedure that allows many men to improve their symptoms.

Can HoLEP be repeated if symptoms return?

HoLEP has one of the lowest retreatment rates among BPH procedures. However, a small number of men may develop recurrent symptoms years later. In such cases, HoLEP can be repeated if needed. Alternative treatments may also be considered depending on the remaining prostate tissue.

Does HoLEP improve overactive bladder symptoms?

HoLEP is primarily designed to relieve obstruction from an enlarged prostate. But some men also experience improvement in OAB symptoms, such as sudden urges to urinate and frequent nighttime urination. This happens because the bladder no longer has to work as hard to push urine past the obstruction. However, if OAB symptoms persist following HoLEP, additional treatments may be needed for relief.

Is HoLEP used to treat prostate cancer?

No, HoLEP is not a treatment for prostate cancer. It is specifically designed to relieve urinary symptoms caused by BPH, which is non-cancerous. However, in some cases, men with a history of treated, low-risk prostate cancer may undergo HoLEP to manage urinary issues caused by BPH.