What are the advantages of holmium laser enucleation of the prostate (HoLEP)?

Use of HoLEP in many different parts of the world has shown it to be a safe and effective procedure. Although there are many types of BPH surgeries available, HoLEP offers a unique advantage in being able to remove a large amount of tissue without any incisions on the body, even in very large prostates, while decreasing the risk of bleeding and providing tissue for pathology (to look for cancer). This decreases the need for blood transfusions during surgery, minimizes the time of stay in the hospital to one or two days, and reduces the risk of needing repeat treatment.

What are the side effects of holmium laser enucleation of the prostate (HoLEP)?

The most common side effects include:

  • Temporary burning and bleeding during urination. Some blood may be seen in the urine for weeks after surgery. This is usually not an indication of anything serious, only that the healing process is not yet finished.
  • Urinary incontinence (inability to control urine flow) is expected in all patients immediately after surgery and they should wear pads for the first few days/weeks. This typically improves over the course of several weeks. Performing Kegel exercises can help decrease leakage from stress maneuvers such as coughing, sneezing, or lifting. The rate of long term leakage from stress maneuvers is low. Patients may also have leakage with urgency and this may be treated with medication. The risk of urge incontinence can be dependent on several factors including age, prostate size, symptoms, and other medical problems.
  • Retrograde ejaculation or “backwards ejaculation.” In 75 percent of cases, the patient will not see any fluid during ejaculation during sexual activity after surgery.
  • Erectile function is generally not significantly affected. A small percentage of patients have reported improved erectile function while a small percentage have reported decreased erectile function.

What are the risks or potential complications of holmium laser enucleation of the prostate (HoLEP)?

  • Injury to the urethra or development of scar tissue at a later date.
  • Injury to the capsule of the prostate (typically treated with longer catheterization).
  • Injury to the bladder or ureteral orifices (where urine from the kidneys drains out).
  • Infection of the bladder, testes or kidneys.
  • Return of urinary obstruction at a later date requiring another operation (1 to 2 percent).
  • Need for transfusion or reoperation due to bleeding.
  • Failure to relieve all symptoms and/or need for prolonged catheterization after surgery.
  • Five to 15 percent of patients are found to have previously undiagnosed prostate cancer in their prostate specimen. Prostate cancer can be treated after HoLEP.
  • Standard risks of anesthesia including blood clots, heart attacks, etc.

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