Holmium Laser Enucleation of the Prostate

Overview

What is an enlarged prostate (Benign Prostatic Hyperplasia – BPH)?

The prostate is a small gland located below the bladder. It helps make semen, the fluid that carries sperm. The prostate surrounds the tube (urethra) that carries urine from the bladder out through the penis, so if it becomes enlarged, it can make passing urine more difficult.

As men get older, the prostate commonly becomes enlarged. This non-cancerous enlargement is called Benign Prostatic Hyperplasia (BPH). BPH is common after the age of 50 and is not the same as prostate cancer.

Signs and symptoms

Common symptoms of an enlarged prostate include:

• Difficulty starting to pass urine
• A weak or slow urine stream
• Stopping and starting while passing urine
• Taking longer to empty the bladder
• Feeling that the bladder has not emptied completely
• Dribbling urine after finishing
• Needing to pass urine more often or urgently
• Waking up during the night to pass urine

What treatments should I expect?

Treatment depends on the severity of symptoms and how much they affect daily life.

Treatment options may include:

• Lifestyle changes (reducing caffeine and evening fluids)
• Medicines to relax or shrink the prostate
• Transurethral Resection of the Prostate (TURP) for moderate to severe symptoms or urinary obstruction
• Holmium laser enucleation of the prostate (HoLEP) which involves removing or destroying part of the prostate using lasers

Holmium laser enucleation of the prostate (HoLEP)

What is HoLEP and why is it done?

HoLEP is a minimally invasive operation used to treat urinary problems caused by an enlarged prostate. A special laser is used to remove the enlarged prostate tissue that is blocking the flow of urine. No cuts are made on the outside of the body.

Your doctor may recommend HoLEP if:

• Medicines have not relieved your symptoms
• You have repeated urinary retention
• You develop repeated urinary tract infections
• You have bladder stones or bleeding caused by an enlarged prostate
• Your bladder or kidneys are being affected by urinary obstruction
• Your prostate is large and needs surgical treatment

Before the procedure

Before the procedure the doctor will:

• Review your medical history and medicines
• Perform a physical examination
• Carry out blood tests, including a prostate-specific antigen (PSA) test
• Perform urine tests to check for infection
• Check how well your bladder empties
• Measure the flow of your urine
• Arrange an ultrasound scan (Transrectal Ultrasound – TRUS) or a Computed Tomography (CT) scan to check the size of your prostate, if required
• Perform a cystoscopy (a thin tube with a tiny camera) to examine the urethra, prostate and bladder, if needed
• Carry out bladder function tests (urodynamic tests), if required
• Ask you to stop blood-thinning medicines or certain other medicines before surgery
• Advise you not to eat or drink after midnight before the procedure

Procedure

Step-by-step overview

• The procedure usually takes 1–3 hours
• You will receive general anaesthesia (you will be asleep) or spinal anaesthesia (the lower half of your body will be numb)
• You may be given antibiotics to help prevent infection
• You will be positioned comfortably on the operating table
• A thin instrument with a tiny camera (resectoscope) is passed through the penis into the urethra
• No cuts are made on the outside of the body
• A laser is used to separate and remove the enlarged prostate tissue that is blocking the flow of urine
• The removed tissue is pushed into the bladder
• A special instrument (morcellator) breaks the tissue into small pieces and removes it from the bladder
• The removed tissue may be sent to a laboratory to check for any abnormalities
• A temporary soft tube (catheter) is placed into the bladder to drain urine
• Most people stay in hospital for 1–2 days After the procedure

After HoLEP:

• You will be monitored in the recovery area
• Most people go home the same day or after an overnight stay
• A temporary soft tube (catheter) is placed in the bladder to drain urine
• The catheter is usually removed the next day, but it may stay longer if needed
• It is normal to have mild burning while passing urine for a few weeks
• You may notice small amounts of blood in your urine for several weeks
• You will be encouraged to drink plenty of fluids to help clear the blood from your urine
• You may need to pass urine more often or urgently for a few weeks while your bladder recovers
• Pain is usually mild and can be controlled with medicines
• Your doctor will arrange follow-up appointments to check your recovery
• You may be advised to do pelvic floor (Kegel) exercises to help improve bladder control

Benefits and risks of HoLEP

Benefits

• Removes enlarged prostate tissue without any cuts on the outside of the body
• Suitable for small and large enlarged prostates
• Short or no hospital stay
• Lower risk of bleeding and blood transfusion
• Lower chance of needing another procedure
• Faster and long-lasting relief of urinary symptoms

Possible risks

Like any surgery, HoLEP carries some risks like:

• Injury to the prostate, urethra, bladder or ureters.
• Urinary leakage (incontinence) lasting more than 3 months
• Infection of the bladder, testicles, or kidneys
• Risks from anaesthesia (such as blood clots, heart attack or food/liquid entering the lungs (aspiration))
• Excessive bleeding that may require a blood transfusion
• Need to keep the urinary catheter in place for more than 24 hours

Recovery

• You can walk and drive the day after surgery
• Avoid heavy exercise and lifting for at least 2 weeks
• Avoid cycling, motorcycles, or similar activities for 6 weeks
• Most people return to work in 1–2 weeks
• If your job involves heavy physical work, recovery may take longer
• Do not lift anything heavier than about 4.5 kg for at least 2 weeks

When should I contact my doctor?

Contact your doctor if you:

• Pass large blood clots or have bright red urine (looks like tomato soup)
• Have fever above 38°C
• Have pain that does not improve with medication
• Are unable to urinate

Myths and facts

Myth 1: HoLEP is an open surgery. Fact: HoLEP is a minimally invasive procedure performed through the urethra with no external cuts.

Myth 2: HoLEP is only suitable for small prostates. Fact: HoLEP is suitable for both small and large enlarged prostates.

Myth 3: Recovery after HoLEP takes several months. Fact: Most people return to work within 1–2 weeks, although those with physically demanding jobs may need longer.

Myth 4: Seeing blood in the urine after HoLEP means something is wrong. Fact: It is normal to notice small amounts of blood in the urine for several weeks after the procedure.

Myth 5: HoLEP always requires a long hospital stay. Fact: Most people go home the same day or after an overnight stay, although some may stay in hospital for 1–2 days if needed.

References

1. National Health Service. Enlarged Prostate. [Online] Available from: https://www.nhs.uk/conditions/enlarged-prostate/. Accessed on: 15 July 2026.
2. Cleveland Clinic. Holmium Laser Enucleation of the Prostate (HoLEP)

[Online] Available from: https://my.clevelandclinic.org/health/treatments/17917-holmium-laser-enucleation-of-the-prostate-holep. Accessed on: 15 July 2026.

1. Mayo Clinic. Holmium Laser Enucleation of the Prostate [Online] Available from: https://www.mayoclinic.org/tests-procedures/holmium-laser-prostate-surgery/about/pac-20384871. Accessed on: 15 July 2026.