HoLEP: a promising surgical treatment of BPH

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive treatment for BPH. With the patient under general anesthesia, the surgeon uses the laser to enucleate the prostate gland tissue, leaving just the capsule in place. The surgeon pushes the excised prostate gland tissue into the bladder and then uses a morcellation device to grind up and remove the tissue.

According to Johns Hopkins Health Alerts, a recent study published in BJU International found that HoLEP has better long-term results than TURP as well as some other positive results. For the study, researchers followed up with 31 of 61 men who had participated in an earlier evaluation that compared HoLEP vs TURP. Fourteen of the men in the follow-up study had been treated with HoLEP and seventeen with TURP.


The Holmium laser is used to peel out the obstructive core of the prostate in its entirety. The area of the prostate that is removed is sent for microscopic analysis.

The HoLEP procedure is considered a minimally invasive alternative to TURP for treatment of BPH. On average during the 7.6 years, virtually no men in the HoLEP group needed to repeat the procedure, compared with three men having to repeat in the TURP group. Men who received HoLEP had less time using a catheter and reported shorter hospital stays and minimal blood loss. Side effects and symptoms after the first year were similar between the two groups, and both procedures caused retrograde ejaculation, or dry climax.

The advantages of HoLEP:

  • Treatment of any size prostate gland.
  • Complete excision of the obstructing prostate tissue down to the prostate’s encapsulating structures, resulting in a re-treatment rate of less than 2 percent.
  • Early, immediate symptom relief and fast return to normal activity. Next-day catheter removal with limited swelling generally allows patients to void painlessly and immediately. Same-day or next-day hospital discharge is possible when the procedure is performed in a 23-hour observation setting.
  • Tissue preservation for pathologic examination. Because adenomatous tissue is excised rather than ablated, surgeons can examine specimens for prostate cancer or other abnormalities. Cancer is found in about 10 percent of HoLEP procedures, even in patients previously screened. In many cases, the cancer identified is of low malignant potential.
  • Fewer potential complications. The low depth of penetration of the holmium laser causes little damage to healthy tissue, and the risk of excessive bleeding and erectile dysfunction associated with traditional surgical approaches is reduced.

Find out if HoLEP is right for you

Walsh Urology is one of the few surgical groups to offer HoLEP to patients in the United States. Contact us today to see if this new treatment option is right for you.