HoLEP is a new and highly specialised surgical procedure for BPH. It is particularly useful for very large prostates that are not suitable for Greenlight Laser Prostatectomy.


HoLEP is similar to Greenlight Laser Prostatectomyin that it is an incredibly safe way to “rebore” the prostate for men with obstructive symptoms that have not responded to medication. It avoids the metabolic complications of the older TURP procedure and causes much less bleeding. It also obliviates the need for traditional open surgery, which was reserved for very large prostates too big for a TURP.


Which patients are suitable for HoLEP?

HoLEP is best suited to patients with very large prostates in excess of 80 grams. Like Greenlight Laser Prostatectomy, it may also be safely used on patients taking blood thinning medications.


How is HoLEP performed?

HoLEP may be performed under either a spinal anaesthetic or a full general anaesthetic. A telescope is placed through the penis to prostate, where a high powered holmium laser is used to cut away the prostate lobes. A morcellator is used to cut the resected prostate lobes into very small pieces which are then removed with a suction device. Finally, a catheter is placed in the penis to drain the bladder overnight. This is demonstrated in the video at the bottom of the page.


How long will I stay in hospital?

Usually 1-2 days. Most men will have their catheter removed the morning after surgery and go home the that day. Patients on blood thinning medication usually stay for two days to allow for a longer period of observation before the catheter is removed.


What are the advantages of HoLEP?

HoLEP holds several advantages over the traditional TURP or open prostatectomy operations:

  • Less bleeding
  • Shorter hospital stay
  • Rapid recovery
  • Lower complication rate
  • No metabolic or electrolyte complications
  • Ability to destroy bladder stones if present
  • May be performed on patients taking blood thinning medications


What are the possible complications?

The frequency and nature of complications are very similar to Greenlight Laser Prostatectomy. It is normal to have burning, stinging and urinary frequency for a period of time after the procedure. Other complications may include:

  • Retrograde ejaculation (dry orgasm). This is harmless and happens in most cases.
  • Urine infection <10%
  • Bleeding <5%
  • Erectile dysfunction <5%
  • Urethral stricture <5%
  • Incontinence <2%
  • Bladder or ureteric injury <2%