HoLEP (Holmium Laser Enucleation of the Prostate)
Enucleation of the obstructing prostate tissue with a holmium laser — the enucleation method with the largest body of long-term follow-up data.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
In our clinic ThuLEP is the enucleation technique used first. HoLEP and ThuLEP work on the same principle; the difference lies in the type of laser used. Go to the ThuLEP page
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- Procedure time
- 60–150 minutes
- Anesthesia
- General or spinal anesthesia
- Hospital stay
- 1 night
- Stay in Türkiye
- 5–7 days
- Catheter duration
- 1–2 days
- Return to work
- 2–3 weeks
- Flight clearance
- From day 7
About the condition
The prostate is a gland that sits just below the bladder and surrounds the urinary channel. As it enlarges with age it compresses that channel from outside, and the bladder has to work progressively harder to push urine out. Symptoms usually build slowly: first a thinner stream and waking at night, then a sense of incomplete emptying, and at an advanced stage inability to pass urine or dependence on a catheter.
HoLEP is a closed operation in which this obstructing tissue is separated from its capsule with a holmium laser and removed as a whole. The holmium laser is pulsed: it cuts tissue with energy delivered in very short bursts while controlling bleeding at the same time. The entire procedure is performed through the urinary channel, with no incision in the body.
What distinguishes HoLEP most is that it can be used INDEPENDENTLY OF PROSTATE SIZE. In the guidelines of the European Association of Urology it appears as an alternative to TURP in small prostates and to open (simple) prostatectomy in large ones. HoLEP is also the enucleation technique with the broadest long-term follow-up data.
The removed tissue is reduced inside the bladder with a morcellator and sent in full for pathology. Methods that vaporise tissue make this examination impossible; with HoLEP, an unexpected focus of cancer can still be diagnosed.
A known feature of HoLEP is that the learning curve is steep for the surgeon. Outcomes are directly related to the experience of the operating team, which makes the choice of centre as important as the choice of method.
Who is it suitable for?
May be suitable
- Prostates of any volume — especially glands above 80 ml that are not well suited to TURP
- Patients who do not benefit from medication or who stop it because of side effects
- Patients who have become catheter-dependent or who experience recurrent urinary retention
- Patients with bladder stones or recurrent infection caused by prostate enlargement
- Patients who have been offered open prostatectomy but are looking for a closed option
May not be suitable
- Patients with an active urinary tract infection — the infection is treated first
- Patients with confirmed prostate cancer — the treatment plan differs; HoLEP is considered only in limited situations for obstruction
- Patients whose bladder muscle has largely lost its contractile strength may not see full relief even once obstruction is removed
- Patients at high anesthetic risk with severe comorbidities
- Patients planning to father children — the possibility of retrograde ejaculation must be discussed beforehand
Technology used
- Holmium laser system (pulsed energy)
- Enucleation technique applicable independently of prostate volume
- Removal of tissue from the bladder with a morcellator
- Full pathological examination of the removed tissue
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remote
File assessment
Prostate volume (ultrasound or MRI), uroflowmetry, IPSS score, PSA and post-void residual are reviewed. Where the volume is large, the particular advantage HoLEP offers is assessed separately.
- Day 1
Arrival and preparation
Examination, completion of any missing tests and anesthesia assessment. If you take blood thinners, their management is planned at this stage.
- Day 2
Surgery
HoLEP is performed under general or spinal anesthesia. The duration is proportional to prostate volume; in large glands the procedure can take longer.
- Day 3
Catheter removal and discharge
The catheter is removed once the urine is clear. You are discharged after you are seen to pass urine on your own.
- Day 7–10
Review and pathology
Follow-up examination, review of the pathology result and clearance for the return flight.
Method comparison
| Criterion | HoLEP | TURP | Open prostatectomy |
|---|---|---|---|
| Prostate volume limit | Independent of volume | Usually below 80 ml | Large volumes |
| Incision | None (via urinary channel) | None (via urinary channel) | Lower abdominal incision |
| Average catheter time | 1–2 days | 2–3 days | 4–7 days |
| Hospital stay | 1 night | 1–2 nights | 3–5 nights |
| Tissue sent for pathology | Yes | Yes | Yes |
| Surgeon’s learning curve | Steep — experience is decisive | Established, widespread | Established |
This table is for general information. The method is chosen individually after assessing prostate volume, comorbidities, clotting status and the patient’s priorities.
Risks
- Burning and sudden urgency when passing urine in the early period after surgery
- Temporary stress-type leakage — it can occur in the first weeks after enucleation and settles in most patients
- Retrograde ejaculation: common, harmless to health, but it affects fertility
- Urinary tract infection
- Urethral stricture or bladder neck contracture — uncommon; treated with an additional procedure if needed
- Bleeding; bladder injury during morcellation (rare)
- General risks related to anesthesia
Alternatives
- ThuLEP — enucleation with a thulium laser (same principle, different laser)
- TURP — classic endoscopic resection (in small and medium volumes)
- Rezūm — volume reduction with water vapour (in small prostates, less invasive)
- Medication (alpha blockers, 5-alpha reductase inhibitors)
- Open (simple) prostatectomy — the classic option HoLEP is increasingly replacing
Recovery
First 48 hours
The catheter is in place and bladder irrigation may be used. A pink tinge in the urine is an expected finding; plenty of fluids are advised.
Week 1
The catheter has been removed. Urinary flow clearly eases, although burning and urgency may persist for a while. Heavy lifting and straining are not advised.
Weeks 2–3
Returning to desk work is usually possible. Pelvic floor exercises support the recovery of any leakage.
Weeks 4–6
Urinary control largely settles. Heavy physical activity and sexual intercourse await your physician’s approval.
Month 3 onwards
The IPSS score and uroflowmetry are repeated so the improvement is measured objectively. Long-term follow-up is advised to monitor durability.
Frequently asked questions
Why is HoLEP described as an alternative to both TURP and open surgery?
Because it can be used independently of prostate volume. TURP is limited in large glands by operating time and safety, while open surgery requires an incision and a longer recovery. HoLEP overcomes both constraints by removing the obstructing tissue as a whole. The European Association of Urology guidelines place the method in exactly this position.
How is the choice made between HoLEP and ThuLEP?
Both follow the same enucleation principle; the difference is the laser. Holmium is pulsed, thulium produces a continuous wave. From the patient’s side the process and expected outcomes are largely similar. The choice is made by weighing prostate volume, clotting status, equipment availability and the surgeon’s experience together.
My prostate is over 100 ml — is open surgery unavoidable?
No. This is precisely the range where HoLEP offers its clearest advantage; it can be treated without an incision. A recommendation specific to you follows the assessment of your file.
HoLEP is said to have a difficult learning curve — how does that affect me?
It means outcomes are sensitive to the experience of the operating team. In practical terms for you: with HoLEP, the choice of centre and surgeon matters as much as the choice of method. You are welcome to ask about this openly in your pre-operative consultation.
Will repeat surgery be needed in the long term?
Because enucleation removes the obstructing tissue as a whole it aims for a durable result, and HoLEP has the longest follow-up data in this respect. Even so, no method guarantees that repeat treatment will never be required; regular follow-up is advised.
How long does the catheter stay and when am I discharged?
The catheter usually stays 1–2 days and is removed once the urine is clear. After you are seen to pass urine on your own, you are generally discharged following a one-night stay.
How will my sexual function be affected?
Erectile function is usually preserved. Retrograde ejaculation — semen passing into the bladder — is a common change and affects fertility. If you plan to have children this must be discussed before surgery.
Will I have urinary leakage, and is it permanent?
Stress-type leakage can occur in the first weeks after enucleation. In most patients it improves gradually, and pelvic floor exercises speed this up. Permanent leakage is uncommon; your individual risk is discussed separately during pre-operative assessment.
I take blood thinners — is HoLEP suitable?
The bleeding control of laser enucleation makes the method worth considering in these patients. However, whether your medication is stopped is decided together with the physician who follows you; do not stop it on your own.
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This page is for general information only and is not a substitute for medical advice.
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