SURGICAL OPTIONS
What is HoLEP?
Men with large prostates usually report symptoms of a weak urinary stream, difficulty urinating, and incomplete emptying of the bladder. For men with enlarged prostates who are not interested in taking medications—or whose symptoms do not improve with medication—an advanced option exists: Holmium laser enucleation of the prostate, also known as HoLEP. This specialized laser procedure removes the exact portion of the prostate causing urinary blockage.
To understand the procedure, it helps to compare the prostate to an orange. The prostate tissue is like the flesh, and the outer capsule is like the orange peel. The laser uses precise energy to cleanly separate the flesh from the peel. The removed tissue is then sent to the lab to verify no cancer is present. Crucially, there are no incisions made on the body; surgery takes place entirely through the urinary channel (the urethra).
Benefits of HoLEP
- Suitable for large glands: Highly effective for men with very large prostates who might otherwise require open simple prostatectomy.
- Safe on blood thinners: Ideal for patients taking medications like aspirin, Plavix, warfarin, or apixaban who face elevated bleeding risks with traditional TURP procedures.
- Low re-treatment rate: HoLEP features a very low re-treatment rate of less than 2%.
Day of Surgery & Recovery Expectations
Surgery length depends on gland size. While some patients stay overnight for observation, most are discharged the same day with a Foley catheter to drain the bladder (typically removed after one day). Patients should avoid aggressive physical activity, heavy straining, and sexual activity for at least three weeks.
Drinking plenty of fluids (5 to 6 bottles of water per day) is critical during recovery to minimize blood clots and bladder irritation. Temporary urge-related urinary leakage or mild temporary erectile changes may occur as the area heals, but these resolve over time.
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