Doctor performing a procedure

Is BPH Keeping You Up at Night? HoLEP Procedure Might Help


  • A HoLEP procedure is a minimally invasive surgery that allows doctors to treat benign prostatic hyperplasia (BPH).
  • Doctors may recommend HoLEP to patients whose BPH does not respond to medication.
  • HoLEP has been found to be superior to other surgical treatment options, including transurethral resection of the prostate (TURP).
  • HoLEP offers lasting relief to around 87% of surgery patients.

Benign prostatic hyperplasia (BPH) is the most widespread health condition among older men. After the age of 70, 80% of men experience BPH. We can treat mild BPH with drugs and supplements, but severe cases require surgery. Surgery is invasive and results in long hospital stays, recovery times, and complications.

The holmium laser enucleation of the prostate, or HoLEP procedure, is a revolutionary surgery method that is much less invasive and allows for fast recovery. 

What Is HoLEP?

HoLEP is a minimally invasive surgical procedure that uses a laser to remove the prostate tissue obstructing or compressing the urethra, the tube that carries urine to the outside of the body. The HoLEP procedure is quicker and less invasive than other surgical procedures, like the transurethral resection of the prostate (TURP). 

Here’s a step-by-step guide to the HoLEP procedure.

  • Anesthesia. The doctors administer general anesthesia through an IV or spinal anesthesia that blocks pain from the waist down.
  • Position. Doctors place the patient on his back, with the legs raised.
  • Cystoscope or resectoscope. The main surgery tool is a tube called a resectoscope or cystoscope that doctors insert through the penis, all the way up to the bladder.
  • Camera and laser. Doctors insert a laser through the resectoscope. The resectoscope has a camera that allows doctors to see what they’re doing.
  • Enucleation. The laser cuts away the tissue blocking or restricting urine flow into small pieces.
  • Pushing the tissue into the bladder. To unblock the urethra, the surgeon uses the resectoscope to push the removed tissue into the bladder. 
  • Morcellation. The surgeon will use another tool called a morcellator to grind up and suction the removed prostate tissue from the bladder.
  • Catheter. The patient receives a temporary catheter that allows the bladder to drain after surgery. 

Cystoscopy graphic

HoLEP Procedure Benefits

From the perspective of the patient, HoLEP is a less invasive procedure with a smaller physical and emotional impact. 

Patients Recover Faster Following HoLEP

Recovery following a HoLEP procedure is relatively swift. While some patients may have to stay in the hospital overnight, most can leave the following day after doctors remove the catheter. Some bleeding may occur after surgery, but urine should be free of blood 12 hours later. 

HoLEP is Safer

HoLEP is safer than other surgical options. It is more efficient than other therapies, like TURP, and at least as effective.  

HoLEP Produces Better Outcomes

Comparing HoLEP to TURP makes sense, given that the latter is the gold standard of surgical BPH treatments. Because research is finding HoLEP to be superior, however, it may soon supplant TURP as the top option. 

HoLEP causes recurrent symptoms in just 1% of patients, compared to 7.4% for TURP.

HoLEP Requires Shorter Catheterization

The postoperative catheterization time is significantly shorter for HoLEP patients than for TURP patients. HoLEP patients also spend less time in the hospital. 

HoLEP Requires Fewer Transfusions

For patients whose prostates are extremely large, doctors often recommend open prostatectomy. When performing an OP, surgeons make an incision to gain direct access to the prostate. Because OP is highly invasive, it’s considered a risky surgery. Doctors use it to treat prostate cancer. 

When compared with OP, HoLEP requires fewer transfusions. It results in less blood loss and shorter hospital stays and catheterization times. 

HoLEP May Be the New Gold Standard

HoLEP also compares favorably with other surgical prostate treatment options like laser photo-vaporization (PVP), and thulium laser enucleation (ThuLEP). 

HoLEP relieves the symptoms of BPH in almost 75% of surgery recipients up to 10 years after surgery. Some medical sources claim that HoLEP’s success rate is as high as 80.5%.

As surgeons adopt the procedure and perfect their skills, the success rate may climb higher. After 2017, doctors reported success rates of over 87%. 

HoLEP Procedure Side Effects

Despite being a low-risk and high-reward intervention, HoLEP may cause some side effects. 16% to 44% of HoLEP patients may experience urinary incontinence or leakage. 

Other possible postoperative health problems are: 

  • Adverse reactions to anesthetics and bleeding
  • Injury to the prostate
  • Urethra injury
  • Bladder injury
  • Blood in the urine that does not clear up 12 hours after the operation
  • Bladder infection
  • Erectile dysfunction 

Although it is superior to OP and TURP, HoLEP is just as likely to cause ED. Fortunately, FDA-approved drugs like Viagra and Cialis are effective treatments for postsurgical erectile dysfunction. 

Recovery From a HoLEP Procedure

The average duration of a HoLEP procedure is one to two hours. HoLEP patients may leave the hospital on the day of the surgery or the day after. Recovery after a HoLEP is faster than after other surgical prostate treatment solutions.

Following the procedure, patients can generally resume their daily routines in about two weeks. Doctors recommend that patients avoid lifting anything heavier than 10 pounds for at least a week and abstain from sexual intercourse for at least two weeks. 

Activities involving straddling are off-limits for a month. 

Patients on anticoagulants (blood thinners) can resume their medication five to seven days after surgery. 

To hasten recovery, doctors recommend drinking plenty of fluids. By flushing the bladder, fluids help the body eliminate bloody urine faster. Frequent and painful urination may occur for several months after the procedure.

Should You Consider HoLEP?

If your BPH does not respond to medications and alternative treatments, HoLEP may be an option for you. HoLEP may be an option even if you’re taking blood thinners because the laser cauterizes the wounds it makes when cutting, which results in less bleeding than other prostate-reducing procedures.

eDrugstore Can Help

Over time, in addition to urinary problems, BPH can cause erectile dysfunction. We carry FDA-approved medications, like Viagra and Cialis, for the treatment of erectile dysfunction

We offer consultations with U.S.-licensed doctors to establish the optimal course of treatment for your ED. Our doctors can also provide you with prescriptions. We deliver your orders quickly and discreetly. 

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