"HoLEP" stands for Holmium Laser Enucleation of Prostate.  The aim of the HoLEP procedure is to create a better path for the urine to flow through the prostate. 

Here is an information leaflet from the British Association of Urological Surgeons which explains the procedure in detail.

The end result often transforms the way you pass urine from a very slow to a much faster stream and enables the bladder to empty properly. Most patients will experiences a substantial improvement in their quality of life once fully recovered.

What does the procedure involve?

We use a type of laser called Holmium laser to remove the inner region of the prostate known as the "transition zone".  

The transition zone enlarges as men get older, leading to a condition known as benign prostatic hyperplasia (BPH). This leads to narrowing of the water passage, causing restriction in urine flow and incomplete bladder emptying. The result is that one will only be able to pass small amounts of urine each time, leading to urinary frequency, urgency, and nocturia (waking multiple times at night to pass urine). This may lead to other complications such as recurrent urine infections, or in severe cases, kidney failure. Occasionally the urine flow may stop completely resulting in a condition known as urinary retention.

During the procedure, the transition zone is 'peeled away' and removed from the prostate using a laser. This is called "enucleation", where entire inner part of the prostate is shelled out, leaving the outer layer of the prostate intact. HoLEP is particularly suited to those with large prostates and is now the gold standard for such cases with excellent long term outcomes.

Once enucleation is complete, the tissue is retrieved in a process known as morcellation, where a thin instrument will grab and 'nibble' at the tissue until all is removed. All pieces of tissue are sent for further analysis.

Will I have any any scars on my skin?

No, the procedure is carried out entirely through the urethra.

What type of anaesthetic will I require?

Treatment will usually be performed under general anaesthesia although you may be offered a spinal anaesthesia as an alternative.  You will need to stay overnight in hospital during which we will observe you with a catheter in place. You can go home after your catheter has been removed, usually the next morning.

What are the common symptoms immediately after the operation?

It may be sting to pass urine for several days following surgery.  

You may experience a small amount of urinary leakage which may occur when you cough or laugh. This will typically resolve after the first several weeks.

You might also notice a temporary increase in urinary urgency for several few months after surgery.  These urinary symptoms will fade in time although one could choose to take medication to reduce these symptoms.

Bleeding is a common symptom which can come and go for several weeks.  This is usually due to healing 'scabs' falling off from inside the prostate.

It would be rare to experience any major problems but please contact the Hospital where the surgery had been carried out for advice during recovery, or attend the emergency department if urgent.

Are there any serious risks with HoLEP?

Please refer to the leaflet above for information on possible complications related to the surgery. 

Our own data on HoLEP surgery show the chances of severe complications to be very rare. We have experienced one case of severe infection in the last 5 years which settled with antibiotics.  No other major complications are reported (returns to theatre, major haemorrhage, conversion, organ injury etc). Cases of persistent incontinence have been very rare (less than 1%).

When will I be followed up?

You will receive a follow up appointment at 3-4 weeks after your operation. This allows for discussion of your symptoms and results of the tissue analysis.