Holmium laser enucleation of the prostate (HoLEP) is a treatment for people with benign prostatic hyperplasia (BPH). The laser surgery removes blockages that prevent your pee from flowing. This type of surgery involves no incisions and little downtime.
Holmium laser enucleation of the prostate (HoLEP) is a type of laser surgery that treats benign prostatic hyperplasia (BPH). BPH is a condition that causes your prostate to get larger (enlarged prostate). It makes your prostate press against your urethra, which prevents pee from passing through freely. HoLEP is a minimally invasive procedure that uses a laser beam to remove the tissue from your prostate that’s blocking the flow of pee.
HoLEP was developed in the 1990s as a more effective and potentially less costly surgery for urinary obstruction due to BPH. HoLEP offers faster recovery times and requires no incisions (cuts).
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The holmium laser is a surgical laser that surgeons use to remove the bulky prostate tissue that’s blocking the flow of pee. The most common cause of urinary obstruction (blocked pee) is BPH. BPH causes your prostate to enlarge. Your prostate pushes against your urethra and blocks pee from leaving your bladder.
Some common signs of BPH are:
BPH occurs in more than 60% of men and people assigned male at birth (AMAB) over 60. As you age, the likelihood of developing BPH increases. Symptoms of BPH can also worsen over time. Not everyone with BPH needs surgery. Many people find success with medication and other treatments. But, if your symptoms are bothersome or you’re at risk for complications like urinary tract infections (UTIs) and bladder stones, your healthcare provider may recommend HoLEP.
HoLEP is minimally invasive and carries a low risk of complications compared to other surgeries that treat the same condition. But, as with most surgeries, there are risks. Be sure to talk to your healthcare provider about any concerns you have about the procedure and your recovery afterward.
Your healthcare provider will take your medical history and perform a physical examination to assess the severity of your condition. This could involve things like a prostate exam and tests to see how much pee remains in your bladder after you use the bathroom. Laboratory tests could include blood work, like the PSA (prostate-specific antigen) test and urinalysis.
Some other tests that may happen before HoLEP surgery include:
Let your healthcare provider know what medications you take. They may ask you to stop using certain medications up to 10 days before surgery. You won’t be allowed to eat or drink after midnight before your surgery.
HoLEP requires general anesthesia (you’re asleep throughout the procedure). If you can’t have general anesthesia for some reason, you may get a spinal anesthetic to block all feeling from your waist down. Your healthcare provider may also give you an injection of an antibiotic to reduce your risk of infection.
HoLEP surgery generally follows these steps:
You can expect HoLEP surgery to take from one to three hours, but this varies depending on your condition.
Most people go home after spending a few hours in a recovery room. A few people may need to stay in the hospital if there are concerns for bleeding or other issues.
Here are some things you can expect after HoLEP surgery:
Your healthcare provider will want to see you after surgery to monitor your recovery and to repeat tests, such as urinary flow rate, bladder scan and others. These tests gauge the effectiveness of the surgery and possible complications.
Your provider may also recommend doing pelvic floor exercises (Kegel exercises) as early as the day after surgery to improve symptoms of urinary incontinence. Performing Kegel exercises can help decrease leakage from stress maneuvers such as coughing, sneezing or lifting.
The most common side effects include:
How much of your prostate your surgeon removes depends on how large the blockage is or how much your prostate is pressing on your urethra. Typically, your surgeon removes about 50% to 60% of the total prostate volume.
HoLEP is a safe and effective procedure with a quick recovery when compared to similar types of surgery. Although there are many procedures to treat BPH, HoLEP offers the following advantages:
As with most surgeries, HoLEP has some risks. Some of the most common risks include:
About 5% to 15% of people learn they have prostate cancer after HoLEP. Having HoLEP doesn’t affect your ability to get treated for prostate cancer if you have it or develop it in the future. Less than 2% of people have symptoms of urinary obstruction in the future and require a second surgery.
You can walk and drive starting the day after surgery. You should avoid strenuous activities (running, lifting heavy objects, etc.) for at least two weeks and straddle activities (riding a bicycle, lawnmower, motorcycle, etc.) for six weeks. Most people can go back to work in one to two weeks. People with physically strenuous jobs may need longer. You shouldn’t lift anything heavier than 10 pounds for at least two weeks.
Your healthcare provider will let you know what to expect while you recover. Some symptoms are normal and expected in your recovery. After HoLEP surgery, you should contact your healthcare provider if you:
TURP stands for transurethral resection of the prostate (many people consider this like a roto-rooter). Like HoLEP, it’s a surgery to remove part of your prostate if you have BPH. The main difference between the two procedures has to do with how the prostate tissue is removed, which then affects recovery time, risks and costs. For example, HoLEP is less likely to require a blood transfusion or additional surgery in the future because your prostate grows back. Only you and your healthcare team can decide which type of prostate surgery is best for you, depending on your condition.
A note from Cleveland Clinic
HoLEP is an effective treatment for BPH or an enlarged prostate. It uses a laser to gently remove the prostate tissue that’s causing an obstruction. If your healthcare provider recommends this procedure, be sure to discuss the risks and benefits with them as well as what you can expect. Everyone is different. Your healthcare provider is the best person to discuss your questions and concerns with based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 08/17/2023.
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