Guide to Know About Our High Power Holmium Laser Management Enlarged Prostate
Learn about high-power holmium laser enucleation of the prostate (HoLEP), a minimally invasive, precise, and effective treatment for BPH. Explore procedure details, benefits, recovery, risks, and FAQs.
Written by Dr. Rohinipriyanka Pondugula
Reviewed by Dr. M L Ezhilarasan MBBS
Last updated on 26th Sep, 2025
Introduction
If you’re one of the millions of men struggling with the frustrating symptoms of an enlarged prostate, like frequent trips to the bathroom, a weak urine stream, or feeling like you can’t fully empty your bladder, you’ve likely heard about various treatment options. While medications can help, they often come with side effects and may not be a permanent solution. For many, surgery is the most effective path to long-lasting relief. But the thought of traditional prostate surgery can be daunting. This is where advanced technology, specifically the high-power holmium laser, comes in.
This guide provides a comprehensive look at Holmium Laser Enucleation of the Prostate (HoLEP), a groundbreaking procedure that has revolutionised the management of Benign Prostatic Hyperplasia (BPH). It explains how it works, who it is suitable for, and why its precision and power make it a leading choice for treating even the largest prostates, offering a safer and quicker recovery than before.
Understanding Benign Prostatic Hyperplasia (BPH)
Before looking at the solution, it’s important to understand the problem. BPH is a common, non-cancerous condition where the prostate gland enlarges as men age.
What is an Enlarged Prostate?
The prostate is a walnut-sized gland located below the bladder and surrounding the urethra, the tube that carries urine out of the body. As men get older, the prostate often grows larger. This enlargement squeezes the urethra, like pinching a straw, and obstructs the flow of urine. It is not typically linked to prostate cancer, but its symptoms can significantly impact quality of life.
Common Symptoms You Shouldn’t Ignore
The symptoms of BPH, often called Lower Urinary Tract Symptoms (LUTS), can range from mild to severe. They
include:
- Frequent urination, especially at night (nocturia)
- Urgency, or a sudden strong need to urinate
- Weak or intermittent urine stream
- Straining to urinate
- A feeling of incomplete bladder emptying
- Dribbling at the end of urination
If you are experiencing these symptoms, it’s crucial to consult a healthcare professional. If your condition is affecting your sleep and daily activities, consulting a urologist online with Apollo24|7 can be a good first step for an initial evaluation.
Consult Top Doctors for Your Symptoms
What is the Holmium Laser (HoLEP) Procedure?
Holmium Laser Enucleation of the Prostate, or HoLEP, is a minimally invasive surgical technique that uses a high-
powered laser to remove obstructive prostate tissue.
The Technology Behind High-Power Holmium Lasers
The holmium:YAG laser is a pulsed laser that delivers high energy in very short bursts. This “high-power” capability is key. It allows the laser to cut and vaporise tissue with exceptional precision while simultaneously sealing blood vessels. This dual action—cutting and cauterising—makes the procedure both effective and safe, with minimal blood loss.
A Step-by-Step Look at the HoLEP Surgery
The procedure is performed under spinal or general anaesthesia.
- The urologist inserts a thin, lighted scope (resectoscope) through the tip of the penis into the urethra. No external incisions are made.
- The holmium laser fibre is passed through the scope.
- Using the laser, the surgeon carefully peels away (enucleates) the enlarged prostate tissue blocking the urethra, layer by layer, down to the prostate’s outer capsule.
- The removed tissue is then cut into manageable pieces within the bladder and flushed out using a specialised instrument called a morcellator.
- A catheter is typically placed for a short period to help the bladder heal.
Who is an Ideal Candidate for HoLEP Surgery?
HoLEP is an excellent option for a wide range of patients. It is particularly beneficial for:
- Men with moderate to severe BPH symptoms not relieved by medication
- Men who wish to stop long-term medication
- Men with a very large prostate (over 80–100 grams), where other minimally invasive treatments may be less effective
- Men who are on blood-thinning medications that cannot be easily stopped, since HoLEP’s bleeding risk is very low
- Men who have developed complications from BPH, such as urinary retention, bladder stones, or kidney damage
Key Benefits of Choosing a High-Power Holmium Laser
The advantages of HoLEP over older surgical methods are significant and well documented.
Superior Precision and Minimal Bleeding
The laser’s accuracy allows urologists to remove obstructive tissue while preserving healthy surrounding structures. Because the laser seals blood vessels instantly, the risk of major bleeding or needing a blood transfusion is extremely low—often less than 1%.
Effective for Very Large Prostates
Unlike some other procedures whose effectiveness declines with prostate size, HoLEP is equally effective for small, medium, and very large prostates. This makes it a versatile and reliable treatment.
Quick Recovery and Short Hospital Stay
Most HoLEP procedures are performed as outpatient surgeries or require only an overnight hospital stay. The catheter is usually removed within 24 hours. Patients typically return to normal activities much faster than with traditional surgery, often within a week.
HoLEP vs. Traditional Surgery: What’s the Difference?
Comparing HoLEP to older treatments helps highlight its benefits.
HoLEP vs. TURP (Transurethral Resection of the Prostate)
TURP has long been considered the “gold standard.” However, HoLEP offers improvements:
- Less bleeding, with significantly lower risk
- Shorter catheter time, often removed sooner after surgery
- More effective for very large prostates
- Longer-lasting results, as HoLEP removes more tissue with less chance of regrowth
HoLEP vs. GreenLight Laser PVP
GreenLight (Photoselective Vaporisation of the Prostate) vaporises tissue instead of enucleating it. While effective, it does not provide a tissue sample for pathology. HoLEP removes tissue intact, allowing for lab analysis to rule out
undiagnosed prostate cancer, which is an important added benefit.
What to Expect: The HoLEP Recovery Journey
Recovery is usually smooth, but knowing what to expect can ease concerns.
Immediately After the Procedure
You will wake up with a catheter in place. Blood-tinged urine may appear initially, which is normal. Most patients can go home the same day or the following morning after the catheter is removed.
The First Few Weeks at Home
You will be advised to drink plenty of fluids to flush the bladder. Avoid heavy lifting, strenuous exercise, and driving for about one to two weeks. Most men notice dramatic improvement in urine flow almost immediately. Some irritation, such as mild burning while urinating, may occur but usually resolves quickly.
Potential Risks and Side Effects of HoLEP
While HoLEP is very safe, all surgery carries some risks. The most common side effect is retrograde ejaculation (“dry orgasm”), where semen flows backward into the bladder. This is harmless but may affect fertility. Other rare risks include urinary tract infection, temporary urgency or incontinence, and a very low risk of urethral stricture. Erectile dysfunction is uncommon. It is essential to discuss these possibilities thoroughly with your surgeon.
Conclusion: Is HoLEP the Right Choice for You?
Living with an enlarged prostate can cause stress and discomfort, but modern treatments have advanced remarkably. The high-power holmium laser used in the HoLEP procedure offers precision, safety, and suitability for prostates of all sizes, combined with a recovery that is much faster than traditional surgery.
If you are tired of managing BPH symptoms with medication or are concerned about the risks of older surgical methods, HoLEP is a powerful option to explore with a urologist. It provides a long-term, often permanent, solution to restore your urinary function and quality of life. If your symptoms persist, you can book a physical visit with a urologist at Apollo24|7 to determine whether you are a candidate for this advanced treatment.
Consult Top Urologists
Consult Top Urologists
Dr. Dipjyoti Payeng
Neurologist
7 Years • "MBBS, MD, DNB (Neurology) "
Guwahati
Apollo Excelcare Hospital, Guwahati
Dr. Dipti Ranjan Tripathy
Neurologist
15 Years • MBBS, MD (GENERAL MEDICINE ),DM (NEUROLOGY)
Rourkela
Apollo Hospitals, Rourkela, Rourkela
Dr. Sushant Aildasani
Neurologist
4 Years • M B B S , M D MEDICINE ( GOLD MEDAL) D M ( NEUROLOGY )
Indore
Apollo Hospitals Vijay Nagar, Indore
(25+ Patients)
Dr Chennareddy Preetham
Neurologist
10 Years • MBBS,MD (GEN.MED) DM(NEUROLOGY)
Chennai
Apollo First Med Hospitals P H Road, Chennai
Dr. Sanket Patel
Neurologist
4 Years • MBBS, DNB Medicine, DrNB Neurolgy
Ahmedabad
Apollo Hospitals - Gandhinagar, Ahmedabad, Ahmedabad
Consult Top Doctors for Your Symptoms
Dr. Dipjyoti Payeng
Neurologist
7 Years • "MBBS, MD, DNB (Neurology) "
Guwahati
Apollo Excelcare Hospital, Guwahati
Dr. Dipti Ranjan Tripathy
Neurologist
15 Years • MBBS, MD (GENERAL MEDICINE ),DM (NEUROLOGY)
Rourkela
Apollo Hospitals, Rourkela, Rourkela
Dr. Sushant Aildasani
Neurologist
4 Years • M B B S , M D MEDICINE ( GOLD MEDAL) D M ( NEUROLOGY )
Indore
Apollo Hospitals Vijay Nagar, Indore
(25+ Patients)
Dr Chennareddy Preetham
Neurologist
10 Years • MBBS,MD (GEN.MED) DM(NEUROLOGY)
Chennai
Apollo First Med Hospitals P H Road, Chennai
Dr. Sanket Patel
Neurologist
4 Years • MBBS, DNB Medicine, DrNB Neurolgy
Ahmedabad
Apollo Hospitals - Gandhinagar, Ahmedabad, Ahmedabad
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Frequently Asked Questions
Q1. Is HoLEP a permanent cure for BPH?
HoLEP is considered a definitive treatment. Because it removes the obstructive tissue down to the capsule, regrowth rates are extremely low. For most men, it provides a permanent solution.
Q2. What is the typical success rate of HoLEP surgery?
HoLEP has a very high success rate, with over 90–95% of patients experiencing significant, long-term improvement in their urinary symptoms and flow rate.
Q3. How long does the HoLEP procedure take?
The surgery time varies with prostate size but usually takes between 60 and 90 minutes.
Q4. Will HoLEP affect my sex life?
HoLEP rarely causes erectile dysfunction. The most common change is retrograde ejaculation, which alters ejaculation but not libido or orgasm.
Q5. Are there any activity restrictions after HoLEP?
Yes. Heavy lifting, vigorous exercise, and cycling should be avoided for about 4–6 weeks to allow for complete internal healing.