HoLEP explained: How laser prostate surgery works

Holmium Laser Enucleation of the Prostate (HoLEP) is an advanced procedure used to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate.

In this article, consultant urological surgeon Mr Ata Jaffer explains how HoLEP works, who it is suitable for, and what you can expect before and after the procedure.

What is HoLEP and why is it performed?

As men age, the prostate can enlarge and press against the urethra, causing urinary symptoms such as:

Difficulty urinating.
Weak urine stream.
Frequent urination, especially at night (nocturia).
Incomplete bladder emptying.

HoLEP is a minimally invasive laser procedure used to remove excess prostate tissue that blocks the flow of urine. It is often recommended when medications have failed or symptoms are significantly affecting quality of life.

How does HoLEP work?

The procedure can be divided into two main steps:

1. Laser enucleation of the prostate tissue

The procedure is performed under general or spinal anaesthetic. A small telescope (resectoscope) is passed through the urethra, so no external incisions are needed. Using a holmium laser, the surgeon carefully separates the overgrown prostate tissue from its capsule.

This step allows for complete removal of the obstructing tissue, which is more thorough than techniques like TURP (Transurethral Resection of the Prostate), where tissue is shaved away.

2. Tissue removal (morcellation)

Once the tissue has been detached, a device called a morcellator is inserted to break the tissue into small pieces that can be safely removed. This ensures that the entire obstructing portion of the prostate is extracted.

Advantages of HoLEP

Durable outcomes: lower risk of needing repeat surgery over time.
Effective for large prostates: HoLEP can treat glands of any size, including very large ones.
Minimal bleeding: the laser seals blood vessels as it cuts, reducing bleeding risk.
Shorter catheter time and hospital stay: most patients are discharged within 24 to 48 hours.

What is the recovery like?

After surgery, a urinary catheter is placed temporarily to allow the bladder to drain and to reduce irritation. This is typically removed the next day.

Most men experience significant improvement in urinary flow within days. It’s common to feel some burning or urgency to urinate in the early days, but these symptoms usually improve quickly. Most patients can return to light activities within a week, and resume full activity (including exercise) in 2–3 weeks.

Are there any risks or side effects?

As with any surgery, HoLEP carries some risks. These may include:

Temporary urinary incontinence (usually improves within weeks).
Blood in the urine.
Retrograde ejaculation (where semen enters the bladder).
Strictures or infections (rarely).

Is HoLEP right for you?

HoLEP is particularly suited to men who:

Have moderate to severe urinary symptoms
Have a very large prostate
Are on blood thinners
Want a long-term solution with low retreatment rates

Your urologist will assess your prostate size, medical history, and treatment goals before recommending HoLEP.

HoLEP is a highly effective laser procedure for relieving urinary symptoms caused by an enlarged prostate.

If you're struggling with urinary symptoms, a consultation with Mr Jaffer via his Top Doctors profile can help determine whether HoLEP is the best approach for you.