HoLEP procedure: how it is performed, risks and advantages

What is the aim of the HoLEP procedure?

HoLEP (Holmium laser prostate surgery) is an alternative to conventional transurethral resection of the prostate for the treatment of bladder outflow obstruction.

As men get older, the prostate increases in size. This can cause obstruction to the bladder. HoLEP is a modern way of treating this condition.

How is it performed?

Similar to turp (transurethral resection of the prostate) HoLEP is performed either under a general anesthetic or spinal anesthetic.  An instrument is inserted down the penis and a laser is used to shell out the middle section of the prostate.

Is HoLEP surgery risky?

The main advantage of HoLEP over conventional turp is that it is less risky. The risk of bleeding is much reduced, which generally makes for a safer procedure and also translates into a shorter hospital stay.

Afterwards, most men have some burning and stinging for a few days. This usually settles within the first few weeks but it can take up to three months to get the benefit from the operation.

In the long term, the only real complication is a 5% chance of a stricture, which is where a scar tissue forms in the urthera, which in turn results in a restricted flow at a later stage, usually within the first year.

What are the advantages of this type of procedure?

The main advantage is that it is a safer procedure because of the reduced risk of bleeding.

Secondly, doctors usually remove more of the central part of the prostate compared to other operations which are designed to do the same. This signifies that HoLEP tends to be more durable in the long term and the risk of requiring a redo at a later stage is much less.

Some men become concerned about incontinence due to the procedure. Although in the early stages some people find that the sphincter muscles do get bruised, in the long term, HoLEP is not an operation which has any effects on continence and doesn’t make people leak.

Additionally, some men also get concerns about erections but again the risk of erections is much less with HoLEP than there is with conventional turp. This is because there is no heat generated during the procedure with the laser.

What is the recovery period like following HoLEP treatment?

Most men need to take it easy for the first week or two because in the early stages there is often some stinging and burning and passing urine relatively frequently.

However, it is unusual for men to need anything in terms of pain relief and those symptoms will settle on their own.

By a month after the operation, doctors expect patients to be able to do most things but it is someway between three and six months for men to get the maximum benefit from the procedure.