Laser Surgery for Prostate - HoLEP & ThuLEP
The Key Things to Know:
Laser enucleation of the prostate (HoLEP or ThuLEP) uses high-energy laser technology to remove obstructing prostate tissue. It achieves equivalent symptom relief to TURP but with less bleeding, faster recovery, and suitability for large prostates. Both procedures are strongly recommended by the 2025 EAU guidelines for benign prostate obstruction.
What It Is
Holmium (HoLEP) and Thulium (ThuLEP) laser enucleation remove the inner prostate tissue that causes blockage. Using a laser through a telescope, the enlarged tissue is carefully dissected away in its natural plane and then removed (morcellated) from the bladder. No cuts are made externally.
When It's Needed
Laser prostate surgery may be recommended if you have:
Significant urinary symptoms due to an enlarged prostate
Recurrent urinary retention or catheter dependence
Bladder stones or infections related to poor flow
Very large prostate where TURP may be less suitable
Surgery Diagram
Benefits
Minimally invasive with short catheter and hospital time
Works for all prostate sizes (‘size independent’)
Less bleeding and transfusion risk compared to TURP
Durable results comparable to open surgery
Low risk of recurrence or need for repeat treatment
Risks
As with any procedure, risks exist:
Temporary burning or urgency after surgery
Blood in urine for several days
Transient leakage (stress incontinence) in the first few weeks
Retrograde ejaculation in most men
Rarely, infection, bleeding, or urethral stricture
What to Expect After Surgery
Most men stay one night in hospital. The catheter is usually removed within 24 hours, and urine flow improvement is often immediate. Light activity can resume within days, but avoid strenuous exercise for 2 weeks. Mild leakage or urgency can occur but typically resolves as the pelvic floor recovers. Sexual function (erection) is usually unchanged, although ejaculation may change.
FAQs
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Both are effective. Laser surgery often has a quicker recovery and less bleeding
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Holmium or Thulium lasers; both have equivalent outcomes.
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Temporary leakage can occur in the first few weeks and is managed with pelvic floor exercises.
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Yes, laser enucleation is effective even for very large prostates (>100 g).
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