Holmium Laser Enucleation of the Prostate (HoLEP)

Holmium laser enucleation of the prostate, or HoLEP, is a minimally invasive surgery performed by our urology team to treat a common urological condition called benign prostatic hyperplasia (BPH), which causes the prostate to enlarge.

Our skilled urologists use a precise laser beam to carefully enucleate prostate tissue — surgically removing it from its surrounding capsule — easing urinary flow and relieving associated symptoms. The procedure is performed through a cystoscope or camera that is inserted through the urethra. This is a minimally invasive procedure requiring no incisions but still allowing maximal benefits for patients.

HoLEP is the only size-independent surgical procedure to treat BPH. Patients with small prostates as well as extremely large prostates can have significant improvement in their urinary symptoms after a HoLEP procedure.

HoLEP is effective for patients who have previously had other BPH treatments such as transurethral resection of the prostate (TURP) or other minimally invasive treatments. The risk of significant blood loss requiring a blood transfusion is minimal with the HoLEP procedure, making it a great treatment option for patients on blood thinners.

What Is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia is an enlargement of the prostate gland, a common condition in older men. It is important to understand that BPH is an entirely different disease process from prostate cancer and that an enlarged prostate does not mean you are at a higher risk of developing prostate cancer. Overgrown tissue in the prostate puts pressure on the urethra and narrows the tube, preventing urine from passing through. This condition often leads to troublesome symptoms that can significantly affect daily life, such as:

  • Frequent urination
  • Difficulty starting or maintaining a stream
  • A persistent feeling that it is hard to empty the bladder

The Benefits of HoLEP

HoLEP is an advanced, minimally invasive treatment that can alleviate the symptoms of BPH. HoLEP alleviates the symptoms of BPH and restores the ability to urinate normally. Compared to traditional open surgery, this minimally invasive procedure offers:

  • Reduced blood loss
  • Shorter hospital stays
  • Faster recovery

HoLEP also offers long-term results, minimizing the need for further interventions.

What to Expect Before the HoLEP Procedure

Preprocedure Testing

Before undergoing holmium laser enucleation of the prostate, you may need to have one or more of the following tests:

  • Prostate exam
  • A blood test to check PSA levels to confirm there is no undetected prostate cancer
  • Imaging tests (ultrasound, CT scan or MRI) to gauge the size of the prostate or the rate of urine flow
  • Cytoscopy to examine the inside of the urinary tract

To Do List

Before the procedure, you may need to:

  • Stop taking specific medications
  • Obtain medical clearance from your primary care doctor
  • Fast for a certain period of time before the procedure
  • Arrange for someone to drive you to/from the hospital

What to Expect During the Procedure

The HoLEP procedure usually takes between 2 and 4 hours. Here’s what to expect during the procedure:

  • General anesthesia is administered at the beginning of the procedure. You will be completely asleep and will not feel or remember the procedure.
  • A camera is inserted through the urethra and a high-powered laser is used to carefully separate prostate tissue from the outer capsule of the prostate. The tissue is then pushed into the bladder and safely removed using a suctioning device.
  • A temporary foley catheter is inserted at the end of the procedure to ensure emptying of the bladder.
  • The prostate tissue is then collected and sent to the pathology lab where the pathologist checks the tissue.

Recovery: What to Expect After the HoLEP Procedure

You will stay overnight in the hospital to ensure you are comfortable and pain free. You will have a foley catheter when you wake up from surgery. The foley catheter is then removed on the morning after surgery in the hospital. Most patients are able to void on their own after the catheter is removed.

After the procedure, patients will experience a brief recovery period. The urology team provides comprehensive postoperative care instructions to ensure a smooth recovery process. Here’s what to expect after the HoLEP procedure:

  • You will stay overnight in the hospital.
  • You will need someone to pick you up from the hospital the day after surgery
  • Pain may be managed with over-the-counter medications.
  • Typically, patients can walk and drive the day after surgery.
  • Avoid strenuous activity, such as lifting anything over 10 pounds for at least 2 weeks or until cleared by your urologist.
  • Avoid activities in which you have to straddle a seat, such as riding a bicycle or motorcycle, for 6 weeks.

What Are the Side Effects of HoLEP?

Like any medical procedure, HoLEP may present some side effects. Patients may experience temporary issues such as:

  • A burning sensation
  • Blood in the urine
  • Frequent urination, feeling urgency to go, waking at night to urinate
  • Temporary lack of control over urination which may include dribbling of urine or urinary incontinence
  • Urinary tract infections
  • Retrograde ejaculation, in which ejaculate flows to the bladder instead of down the urethra and out of the body during ejaculation; this is a harmless side effect, and the ejaculate is usually flushed out by urine during the next void

Our urology team ensures comprehensive consultations to discuss potential side effects and address any concerns.

Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place
New Brunswick, NJ 08901
(732) 828-3000

Holmium Laser Enucleation of the Prostate-HoLEP Treatment & Care

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