Benign prostatic hyperplasia (BPH), often called an enlarged prostate, is a common cause of urinary symptoms in men as they get older. When the prostate grows, it can narrow the urine channel and make it difficult to empty the bladder properly. Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive surgical treatment designed to remove the part of the prostate that is blocking urine flow, helping to relieve symptoms and protect bladder and kidney health.

Understanding what HoLEP is designed to treat

In BPH, the inner portion of the prostate enlarges and presses on the urethra, which runs through the prostate. This can lead to symptoms such as:

• A weak urine stream or stopping and starting
• Straining to pass urine
• Feeling that the bladder does not empty fully
• Urgency and frequency, including waking at night to urinate
• Urinary tract infections, bladder stones, or visible blood in the urine in some cases

HoLEP is an endoscopic procedure, meaning it is performed through the natural urinary passage without external cuts. A holmium laser is used to separate the enlarged prostate tissue from the outer prostate shell (capsule). The removed tissue is then broken into smaller pieces inside the bladder and taken out. By removing the obstructing tissue rather than simply widening a channel, HoLEP can provide long-lasting relief for many patients.

Who may benefit most from this procedure

HoLEP may be recommended when BPH symptoms are significantly affecting quality of life or when BPH is causing complications. It is often considered when:

• Symptoms have not improved enough with medication
• There is recurrent urinary retention (difficulty passing urine, sometimes requiring a catheter)
• There are repeated urinary tract infections related to poor bladder emptying
• Bladder stones have developed
• There is ongoing bleeding thought to be related to the prostate
• Tests show high residual urine after voiding or changes affecting the kidneys

HoLEP is suitable for a wide range of prostate sizes, including medium and large prostates where other techniques may be less effective.

When HoLEP may not be the right option

Not everyone with urinary symptoms needs surgery. Symptoms can also be caused by overactive bladder, urethral narrowing, infection, bladder problems, or prostate cancer. HoLEP may be deferred or adapted if there is an active urinary infection, certain bleeding risks that need optimisation, or other medical conditions that make anaesthesia unsafe. A careful assessment is essential to confirm the diagnosis and choose the most appropriate treatment.

Assessment and planning before treatment

Before recommending HoLEP, a structured urology assessment is carried out to confirm that BPH is the main cause of symptoms and to understand how severe the blockage is. This typically includes:

• A detailed symptom review and medical history, including current medications
• Physical examination, usually including a prostate examination
• Urine testing to check for infection or blood
• Blood tests, often including PSA (prostate-specific antigen) where appropriate
• Ultrasound to assess prostate size, bladder emptying, and sometimes the kidneys
• Urine flow testing (uroflowmetry) and measurement of residual urine
• Cystoscopy in selected cases to look inside the urethra and bladder

If PSA is raised or there are other concerns, further investigations may be advised to rule out prostate cancer before proceeding. Planning also includes a review of blood-thinning medication and overall fitness for anaesthesia.

What happens during HoLEP

HoLEP is performed in an operating theatre. Anaesthesia is usually spinal (numbing from the waist down) or general, depending on clinical factors and patient preference.

The key steps, in patient-friendly terms

• A slim camera instrument (endoscope) is passed through the urethra.
• Laser energy is used to separate the enlarged prostate tissue from the outer capsule.
• The freed tissue is moved into the bladder.
• A special device is used to break the tissue into small pieces (morcellation) and remove it.
• A urinary catheter is usually placed at the end of the procedure to help drainage and allow bladder irrigation if needed.

The removed tissue is routinely sent for laboratory analysis (histology). This is standard practice and can occasionally identify unexpected findings.

Hospital stay and early recovery

Most patients stay in hospital for around 1 to 2 nights, although this can vary depending on prostate size, other health conditions, and how quickly urine clears after surgery.

A catheter is commonly kept in place for a short period. Once urine is clear enough and you are passing urine safely, the catheter is removed. It is normal to notice:

• Burning or stinging when passing urine for a short time
• Increased frequency and urgency initially
• Small amounts of blood in the urine, especially after activity

These symptoms usually improve steadily over days to weeks.

Results you can expect and how improvement progresses

Many patients notice a stronger urine stream and easier bladder emptying soon after catheter removal. Urgency and frequency can take longer to settle, particularly if the bladder has been overworked for a long time.

Follow-up is typically arranged to check recovery and symptom improvement. This may include:

• Symptom review and medication review
• Urine flow testing and residual urine measurement
• Ultrasound when needed
• PSA testing when clinically appropriate

If temporary leakage occurs, pelvic floor exercises and, in some cases, short-term medication may be recommended.

Important risks, side effects, and limitations

All surgical procedures carry risks, and individual risk depends on factors such as prostate size, age, general health, and medications.

Potential risks and side effects after HoLEP can include:

• Bleeding: usually mild, but occasionally may require additional treatment or transfusion
• Urinary infection
• Temporary difficulty controlling urine (stress incontinence), which often improves over time
• Temporary urgency or frequency
• Narrowing (scar tissue) in the urethra or bladder neck, which may require further treatment
• Urinary retention after catheter removal, sometimes requiring re-catheterisation

Sexual function considerations

Erections are usually preserved, but ejaculation commonly changes. Many men experience retrograde ejaculation (semen goes into the bladder rather than out through the penis). This is not harmful but can affect fertility and can be an important consideration for some patients.

HoLEP treats the blockage caused by BPH but does not prevent other urinary conditions from developing later. Ongoing prostate health monitoring may still be advised based on age, PSA history, and individual risk.

Practical guidance after discharge

Recovery advice is tailored to the individual, but commonly includes:

• Avoid heavy lifting and strenuous exercise for around 2 to 3 weeks
• Drink enough fluids to keep urine a pale colour, unless advised otherwise
• Manage constipation with fibre, fluids, and stool softeners if needed, as straining can worsen bleeding
• Avoid sexual intercourse for a period advised by the treating team, often around 3 to 4 weeks

If you develop fever, worsening pain, inability to pass urine, heavy bleeding or clots, or feel unwell, urgent medical review is needed.

Your consultation and ongoing support at our specialist clinic

Care is coordinated through our dedicated urology clinic, with assessment, treatment planning, surgery, and follow-up organised as one continuous pathway. During your consultation, our specialists will:

• Confirm whether symptoms are due to BPH and how severe the obstruction is
• Review medication options and alternative procedures where appropriate
• Explain what HoLEP can realistically achieve for your symptoms
• Discuss anaesthesia choices, recovery expectations, and potential effects on ejaculation and continence
• Provide a clear plan for follow-up and symptom monitoring

If HoLEP is recommended, you will be supported throughout the process, including pre-operative preparation, inpatient care, catheter management if needed, and structured follow-up to help you recover confidently and safely.