Holmium laser enucleation of the prostate (HoLEP)

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Holmium laser enucleation of the prostate (HoLEP)

Holmium laser enucleation of the prostate (HoLEP) is a procedure used to treat an enlarged prostate. The prostate is a small gland in the male reproductive system located below the bladder. HoLEP is considered the “gold standard” for treating an enlarged prostate.

When the prostate becomes enlarged, it can block the flow of urine by pressing on the urethra. The urethra is the tube that connects the bladder to the outside of a man’s body where urine is released.

The most common cause of enlarged prostate is benign prostatic hyperplasia (BPH). BPH is a noncancerous, age-related growth of prostate tissue that affects about half of men over age 50 and more than 80% of men over 80.

Some symptoms of BPH include hesitancy or straining to urinate, a weak urine stream, and trouble emptying the bladder completely. If left untreated, BPH can lead to urinary tract infection (UTI), acute urinary retention (being unable to urinate), bladder stones, blood in the urine, and kidney damage.

How HoLEP works

With HoLEP, the patient is put to sleep using anesthesia. A scope (a small tube with a tiny camera and tools at the end) is passed up the urethra to reach the prostate. A small laser is then passed through the scope and used to remove the excess tissue. Next, another instrument called a morcellator is used to break up this tissue into small pieces before they are suctioned out.

Finally, a tube called a Foley catheter is inserted to temporarily drain the bladder during recovery. The entire procedure usually takes 1-3 hours.

HoLEP is considered to be a safe, nearly lifelong cure for prostate blockage and BPH, as the risk of prostate tissue growing back after the procedure is very low. HoLEP does not usually affect a man’s erections or his ability to have intercourse.

Recovery and follow-up

Recovery time varies from patient to patient. It may be affected by age, preexisting urinary symptoms, other health conditions, and any medications you may take.

Most patients are able to go home the same day. The patient will then return to the clinic in 1-3 days to have the Foley catheter removed.

In some cases, the patient may stay in the hospital overnight, and the catheter is removed the next day before discharge. All patients will be scheduled for a follow-up visit about 4 weeks after surgery. This appointment may be in person or through an online telehealth checkup.

During recovery, patients can expect better urine flow and greater ease with urination and bladder emptying. Patients may experience:

A burning sensation during urination. This can be managed with over-the-counter medications such as Tylenol and URISTAT.
Some blood and blood clots in the urine for up to 8-12 weeks
Roughly 20-33% of patients may have temporary urinary leakage, which can last weeks to months. Over time, this leakage goes away in nearly all patients.
Most patients will develop retrograde ejaculation, which is when semen travels backward into the bladder during orgasm. This is not harmful or painful to the patient or his partner.

Patients will be instructed to avoid certain activities and follow specific guidelines during recovery. An in-person follow-up visit with your surgeon will be scheduled for about three months after the procedure, to do a urine flow rate study and a bladder ultrasound. Patients should arrive to this visit with a full bladder.

Why choose UAB Medicine

The UAB Department of Urology is staffed by an experienced team of physicians and surgeons. Our HoLEP surgeons have over 30 years of combined experience with the procedure and are recognized internationally as experts. Our urology program is ranked among the top 50 of its kind nationally by U.S. News & World Report, and we often receive patient referrals from hospitals across Alabama and the Southeast.

HoLEP appointments are available within 30 days, and we are committed to putting you back in control of your health and helping you regain any lost confidence. We encourage you to ask your doctor if HoLEP may be right for you.