Procedure guide · 8 min read

HoLEP: laser enucleation for an enlarged prostate

Last updated: 4 May 2026 · Reviewed by Mr Sanjay Rajpal, Consultant Urological Surgeon · GMC 6106646

HoLEP — Holmium Laser Enucleation of the Prostate — is widely considered the gold-standard operation for men with significant prostate obstruction, particularly when the gland is large. It removes the obstructing tissue from the inside, in one piece per lobe, with very low bleeding risk and durable, long-term symptom relief.

Key point: HoLEP is size-independent. It is well suited to large or very large prostates that would traditionally have needed open surgery, but it is also offered for moderate-sized glands when durability matters.

What HoLEP does

The prostate has an outer capsule and an inner adenoma — the part that grows with age and blocks urine flow. HoLEP uses a holmium laser, passed through a telescope in the urethra, to cleanly separate the adenoma from the capsule. The freed tissue is pushed into the bladder, then morcellated and removed. Nothing is cut from the outside; there are no skin incisions.

Who HoLEP suits

Men with bothersome obstruction not controlled by medication.
Larger prostates (often above 80 ml) where Greenlight or TURP is less efficient.
Men who need durable relief and want to avoid a second procedure later in life.
Men taking blood-thinning medication, where bleeding risk needs to be minimised.
Men in urinary retention who need a definitive solution.

Alternatives

For smaller prostates or men prioritising ejaculation, alternatives such as UroLift, Rezum, iTIND, Aquablation or Greenlight may be more appropriate. For very large prostates, the main alternative to HoLEP is open simple prostatectomy, which is now rarely needed. Mr Rajpal will explain how each option fits your anatomy, symptoms and priorities.

What happens on the day

HoLEP is performed under general or spinal anaesthetic. You will be admitted on the day of surgery. The operation usually takes between 60 and 120 minutes depending on prostate size. A catheter is placed at the end of the procedure to flush the bladder and allow it to settle. Most men stay one night in hospital and go home with the catheter removed before discharge or shortly after.

Recovery

First week: mild burning or urgency when passing urine, occasional traces of blood. Drink well and rest.
Weeks 2–4: flow improves rapidly. Avoid heavy lifting, cycling and long drives.
Weeks 4–8: the inside of the prostate channel heals fully. Symptoms continue to settle.
Three months: a flow test and review confirm the result.

Risks and side-effects

HoLEP is safe in experienced hands, but no operation is risk-free. Most men experience retrograde ejaculation, in which semen passes back into the bladder rather than out. Other possible issues include temporary urinary urgency, mild stress incontinence in the first weeks, urinary tract infection, and rarely bleeding requiring readmission. Long-term continence issues and urethral narrowing are uncommon but possible. These will be discussed in detail at consent.

When to seek help after HoLEP

Heavy fresh bleeding or clots that block the flow.
Inability to pass urine or new severe pain.
Fever, shaking chills, or worsening burning suggesting infection.
Pain or swelling in a leg that does not settle.

Questions to ask before booking

Is HoLEP the most durable option for my prostate size?
What is the chance of retrograde ejaculation, and does it matter to me?
How long will I need a catheter, and when can I drive or return to work?
What outcomes does Mr Rajpal achieve, and how many HoLEPs has he performed?