Holmium Laser Enucleation of Prostate (HoLEP)

What is HoLEP?

Holmium Laser Enucleation of the Prostate (HoLEP) is the gold-standard surgical treatment for benign (non-cancerous) enlargement of the prostate. It is a minimally invasive laser procedure that removes the enlarged prostate tissue, without needing any external incisions or cuts on the skin.

Unlike older procedures such as Green Light laser or TURP, which remove or vaporise only part of the prostate, HoLEP removes the entire obstructing portion of the gland. This provides more complete relief of obstruction, better outcomes and a much lower risk of needing future surgery. HoLEP also has significantly less bleeding risk that TURP and the urethral catheter can be removed faster with earlier discharge from hospital.

Who may benefit?

HoLEP is suitable for men with bothersome urinary symptoms caused by an enlarged prostate, including:

• Slow urinary stream

• Difficulty emptying the bladder

• Waking up at night multiple times to urinate

• Frequent or urgent urination

• Urinary retention

• Recurrent urinary tract infections or bladder stones

HoLEP is also suitable for men who are taking medications to help them to urinate better (e.g. Tamsulosin/Silodosin/Dutasteride/Finasteride) but are experiencing side effects from medications, no longer wish to continue taking medications or the medications are no longer working.

HoLEP can be performed for prostates of any size, but is particularly advantageous for larger prostates.

What happens during surgery?

A telescope is passed through the urethra (within the penis). Using a specialised, high-powered laser, the enlarged prostate tissue is carefully separated from the prostate capsule, removed from the bladder and sent for pathological examination. No incisions or cuts on the skin are required.

Recovery

Most patients stay in hospital overnight, with the catheter usually removed the following morning. Most men return to normal daily activities within 1–2 weeks.

Benefits

• Gold-standard treatment for enlarged prostate

• Suitable for all prostate sizes but particularly effective for large prostates

• More effective at removing tissue than Green Light laser or TURP

• Lower risk of prostate regrowth and needing repeat surgery

• Better long-term outcomes

• Less risk of bleeding, shorter catheter time and shorter hospital stay

• Removed tissue is analysed to exclude unsuspected prostate cancer (prostate tissue is not able to be analysed with Green Light laser)

Risks

• Temporary burning, urgency or blood in the urine

• Urinary tract infection

• Temporary urinary leakage

• Retrograde ejaculation ("dry orgasm")