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HoLEP — Holmium Laser Enucleation of the Prostate

Size-independent gold-standard surgery for benign prostatic enlargement

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is HoLEP — Holmium Laser Enucleation of the Prostate?

HoLEP uses a 100-watt holmium:YAG laser through a continuous-flow resectoscope to dissect the adenoma along the surgical capsule plane.

After enucleation, the freed adenomatous lobes are pushed into the bladder and morcellated with a tissue morcellator for removal.

Compared with TURP, HoLEP enables larger tissue removal in a single session with less bleeding and shorter catheterization.

Considered size-independent: equally suitable for prostates 30 grams and 300 grams with similar outcomes.

Long-term durability is excellent, with retreatment rates under 1 percent at 10 years for benign disease.

Symptoms

Surgical indication: moderate-to-severe BPH symptoms unresponsive to medication, urinary retention, recurrent UTI, bladder stones, hematuria of prostatic origin
Preoperative voiding symptoms: weak stream, hesitancy, intermittency, incomplete emptying, frequency, urgency, nocturia
Postoperative course: short hospital stay (often 1 day), catheter removal in 24–48 hours
Initial 6–12 weeks: temporary urgency, frequency, occasional stress incontinence (usually transient)
Long-term outcomes: marked symptom improvement, very low retreatment rates
Most patients preserve antegrade ejaculation only partially; retrograde ejaculation is common

Risk Factors

Higher technical complexity than TURP — requires surgeon experience for optimal outcomes
Anticoagulation can usually be continued in HoLEP — a unique advantage
Risk factors for complications: pre-existing detrusor weakness, neurogenic bladder, severe stricture
Very large median lobe or prior pelvic radiation may complicate the case
Generally not chosen if fertility preservation is paramount given retrograde ejaculation rate

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent BPH symptoms despite optimal medical therapy
  • Episodes of acute or chronic urinary retention
  • Recurrent UTI, gross hematuria, or bladder stones from BPH
  • Renal insufficiency related to bladder outlet obstruction
  • Postoperative warning signs: high fever, gross hematuria with clots, urinary retention, severe perineal pain

Treatment Methods

01
Preoperative urodynamics in selected complex cases; PSA, urine culture, prostate volume by TRUS
02
General or spinal anesthesia; perioperative antibiotic prophylaxis; lithotomy position
03
Three-lobe enucleation technique with hemostasis along the prostatic capsule
04
Tissue morcellation through the resectoscope sheath after enucleation
05
Catheter for 24–48 hours; pelvic floor exercises start at catheter removal to support continence
06
Histopathology of resected tissue to exclude incidental prostate cancer
07
Long-term follow-up at 3, 6 and 12 months with uroflowmetry, residual urine and symptom score

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.