The HoLEP Method for Benign Prostatic Hyperplasia

HoLEP (Holmium Laser Enucleation of the Prostate) is a minimally invasive surgical procedure used to treat benign prostatic hyperplasia (BPH), a common condition that affects men as they age. In this method, the enlarged prostate tissue blocking the urinary tract is separated from its capsule using highly precise laser energy and then carefully removed from the body. By combining the definitive results of traditional open surgery with the comfort of a minimally invasive approach, this laser prostate surgery allows patients to return to their daily lives much faster.

• HoLEP is an incision-free, minimally invasive laser surgery used to treat an enlarged prostate.
• Because the risk of bleeding is exceptionally low, it is a safe choice for patients with heart conditions or high blood pressure.
• Hospital stays are typically limited to just 1 or 2 days.
• The removed prostate tissue is sent for pathological examination to screen for cancer.
• The risk of recurrence is almost non-existent, offering a permanent solution with a single surgery.

What is Benign Prostatic Hyperplasia (BPH) and the HoLEP Method?

The prostate is a gland located just below the bladder in men, wrapping around the urinary tract (urethra). As men age, the prostate gland begins to grow at a cellular level. This non-cancerous enlargement is known as Benign Prostatic Hyperplasia (BPH). As the prostate grows, it squeezes the urinary tract passing through it, making it difficult to empty urine from the bladder. Over time, this blockage can lead to bladder muscle fatigue, urinary tract infections, or even kidney problems.

The clearest answer to "what is the HoLEP method?" is that it is one of the most modern surgical techniques developed to clear this blockage. During the procedure, the enlarged prostate tissue is peeled away with a laser, much like peeling the inside of an orange away from its rind. While traditional methods only shave off a portion of the tissue, the HoLEP method clears the entire enlarged tissue right down to the capsule. As a result, the urinary tract is completely opened, and the chances of the condition returning in later years are virtually eliminated.

Causes and Risk Factors of an Enlarged Prostate

While the exact cause of benign prostatic hyperplasia is not entirely understood, aging and shifts in male hormones (specifically the balance of testosterone and estrogen) are widely accepted as the primary factors. The growth process in the prostate gland accelerates noticeably in men over 50, and a large majority of men over 60 begin to experience some difficulty urinating.

Genetic predisposition is also a significant risk factor. If you have a family history of an enlarged prostate—particularly in your father or brothers—you are more likely to experience it yourself. Furthermore, systemic health issues such as obesity, a sedentary lifestyle, diabetes, and heart disease have been observed to increase the risk of prostate enlargement. Routine health check-ups are incredibly important for managing these risk factors effectively.

Symptoms of Benign Prostatic Hyperplasia

The symptoms of an enlarged prostate range from mild to severe, depending on the degree of compression on the urinary tract. In the early stages, patients usually notice waking up frequently at night to urinate (nocturia) and a decrease in the force of their urine stream. Difficulty starting urination, a stop-and-start stream, and the feeling that the bladder hasn't completely emptied after going to the toilet are among the most common complaints.

As the condition progresses, symptoms can become far more disruptive. Serious issues may arise, such as a sudden, urgent need to urinate, leaking urine before reaching the toilet, or a complete blockage where urination becomes impossible (urinary retention). Urine constantly left behind in the bladder paves the way for urinary tract infections, bladder stones, and blood in the urine over time. If you are experiencing these kinds of symptoms, you should consult a urologist without delay to prevent your quality of life from declining further.

How Should You Prepare Before Surgery?

Before deciding on HoLEP surgery, the patient's overall health and the structure of the prostate are evaluated in detail. In the first phase, a urologist will conduct a physical examination and request a blood PSA (Prostate-Specific Antigen) test along with kidney function tests. A uroflowmetry test to measure urine flow rate and an ultrasound to determine the size of the prostate play a critical role in planning the surgery.

During the pre-operative preparation period, you must inform your doctor about all the medications you are currently taking. If you are using blood thinners, in particular, your doctor may ask you to pause them or adjust the dosage a few days before the surgery under their careful supervision. Additionally, your blood tests will be reviewed to assess conditions like anemia, which could affect the general anesthesia process. Because the procedure will be performed under general or spinal anesthesia (numbing from the waist down), you will need to completely stop eating and drinking at least 6 to 8 hours before the surgery.

How is HoLEP Surgery Performed?

HoLEP surgery is performed in a fully equipped operating room under anesthesia. To ensure you feel no pain, either general or spinal anesthesia is administered based on the anesthesiologist's evaluation. No incisions are made on your body during the procedure; the surgeon reaches the prostate by entering through the natural urinary tract using a special instrument equipped with a high-resolution camera (a resectoscope) at its tip.

Using Holmium laser energy, the enlarged prostate tissue is gently separated from the thin capsule surrounding it. Because the heat energy of the laser instantly seals blood vessels, the amount of bleeding remains at an absolute minimum. The large prostate tissue, now detached from the capsule, is pushed into the bladder. Then, a special device called a "morcellator" is used to break this tissue into small pieces inside the bladder, which are then safely vacuumed out. At the end of the procedure, a catheter is placed in the urinary tract, and the surgery is complete. The removed tissues are always sent to a pathology laboratory to check for the presence of any cancer cells.

What Are the Advantages of the HoLEP Method?

In the field of enlarged prostate treatment, the HoLEP method is considered one of the current gold standards due to the immense comfort it offers both patients and surgeons. It has many advantages compared to traditional open surgeries and other minimally invasive methods. The standout benefits of HoLEP surgery include:

• Incision-free surgery: Because it is performed through the urinary tract, there are no surgical incision scars on the body.
• Less bleeding: The laser technology instantly seals blood vessels, making the risk of bleeding very low; this provides great peace of mind for patients using blood thinners or those with heart conditions.
• Short hospital stay: Patients are usually ready to be discharged just 1 or 2 days after the surgery.
• Rapid recovery: The catheter is removed quickly, allowing patients to swiftly return to their normal daily routines.
• Permanent solution: Because the entire enlarged tissue is removed, the risk of the condition recurring and requiring a second surgery is virtually non-existent.
• Applicability to any prostate size: Unlike other minimally invasive methods, it can be applied with high success even in very large prostates without the need for open surgery.

What Are the Risks and Side Effects of HoLEP Surgery?

As with any surgical intervention, HoLEP surgery carries some risks and side effects. However, thanks to the precision of laser technology, these risks are remarkably low. The most commonly encountered side effect is "retrograde ejaculation," a condition where semen goes backward into the bladder instead of out through the penis. This is not harmful to your health, and the semen is later passed out of the body naturally with urine; however, patients planning to have children should discuss this with their doctor before the surgery.

After the surgery, experiencing mild burning, a stinging sensation while urinating, or slight bleeding that turns the urine pink is considered completely normal. These complaints usually resolve on their own within a few weeks. In very rare cases, a narrowing of the urinary tract (stricture) or temporary urinary incontinence may occur. For most patients, urinary incontinence is quickly and permanently resolved with Kegel exercises that strengthen the pelvic floor muscles. When performed by experienced surgeons, the rate of serious complications is incredibly low.

The Recovery Process After HoLEP Surgery

The recovery process after HoLEP surgery is exceptionally fast and comfortable. The urinary catheter inserted at the end of the surgery is usually removed within 1 or 2 days, depending on the color of the urine and the patient's condition. Once the catheter is removed and it is observed that the patient can urinate comfortably on their own, the discharge process is completed. For the first few days, you may experience an increase in urination frequency or a sudden feeling of urgency; this is a natural part of the bladder's process of adapting to its new situation.

To speed up the recovery process at home, it is recommended to drink at least 2 to 2.5 liters of water a day. Consuming plenty of fluids helps wash out the urinary tract naturally and clears away any small clots. For the first 3 to 4 weeks after discharge, you should avoid heavy lifting, strenuous exercises, becoming constipated, and traveling while sitting for long periods. Taking the medications prescribed by your doctor regularly and doing the recommended Kegel exercises will help you regain bladder control rapidly.

When to See a Doctor

Mild burning and minor color changes in the urine are expected after surgery. However, certain symptoms during the recovery period may require urgent medical intervention. To avoid risking your health, you should contact your doctor without delay if you experience any of the following warning signs:

• Heavy bleeding with large clots or bright red blood in your urine.
• A sudden inability to urinate at all (blockage) at home after the catheter has been removed.
• A persistent high fever of 38°C (100.4°F) or above, accompanied by chills or shivering.
• Severe, unbearable pain in the lower abdomen or groin area.
• Noticing foul-smelling, cloudy, or pus-like discharge while urinating.

In such emergencies, you can visit a hospital emergency department or call 112 (the Emergency Call Center in Türkiye) to request immediate medical support.

Urology and the Treatment Process at BHT CLINIC

At the BHT CLINIC İstanbul Tema Hastanesi Urology Department, treatments for benign prostatic hyperplasia are planned with personalized approaches and the most up-to-date technological equipment. Our team of expert physicians is by your side at every step, from the initial examination to the post-operative follow-up process. At our hospital, HoLEP surgery is performed safely in our operating rooms that meet rigorous international quality standards.

For any potential emergencies or sudden urinary blockages, our 24/7 emergency department provides uninterrupted medical support. If you are experiencing symptoms related to an enlarged prostate, you can book an appointment with the BHT CLINIC Urology Department to regain your quality of life and determine the most appropriate treatment method for you.

Frequently Asked Questions

Is HoLEP or TURP more advantageous?

The HoLEP method is generally more advantageous than TURP (Transurethral Resection of the Prostate), especially for larger prostate volumes. Because the prostate tissue is completely peeled away from its capsule in HoLEP, the risk of the disease recurring is much lower. Furthermore, the minimal bleeding and shorter hospital stay make HoLEP the preferred choice for many patients.

How are the prices for laser prostate surgery determined?

The cost of HoLEP surgery varies depending on the size of the prostate, the length of the hospital stay, the type of anesthesia used, and any additional health issues the patient may have. A detailed examination by a urologist is required to provide an accurate pricing and treatment plan.

Is sexual function affected after HoLEP surgery?

Because HoLEP surgery does not damage the nerves responsible for erections, patients' sexual functions are not negatively affected. However, retrograde ejaculation (semen flowing backward into the bladder) is a common occurrence after the procedure. This condition does not affect sexual pleasure or the ability to maintain an erection; it simply means that semen is later expelled with urine.

How long does HoLEP surgery take?

The duration of the surgery typically ranges from 1 to 2 hours, depending on the size of the prostate and the amount of tissue to be removed. The process of breaking down the removed tissue inside the bladder and vacuuming it out is one of the main factors determining the total time.

Will I experience urinary incontinence after surgery?

The risk of permanent urinary incontinence after HoLEP is exceptionally low. In the first few weeks following the surgery, temporary dribbling or sudden urges may occur as the bladder muscles adapt to the newly opened channel. With exercises that strengthen the pelvic floor muscles, this situation usually resolves completely in a short time.

This article is for informational purposes only; please consult your physician for a proper diagnosis and treatment.