HoLEP: Holmium Laser Enucleation of the Prostate

Benign prostatic hyperplasia (BPH) causes lower urinary tract symptoms. HoLEP is a minimally invasive surgical technique to remove excess prostate tissue.

However, it is associated with an increased risk of incontinence and erectile dysfunctions.

This article will discuss the HOLEP procedure and evaluate the benefits and drawbacks of this BPH treatment option.

What is the Holmium laser enucleation of the prostate?

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure used to treat an obstruction of urine flow caused by BPH.

Men with BPH experience several urinary symptoms, such as difficulty urinating or reduced bladder control. HoLEP provides an effective solution to these urinary tract symptoms.

Unlike other minimally invasive treatment for enlarged prostate, HoLEP enables the examination of the removed tissues for different conditions.

The procedure uses a thin telescope-like instrument inserted into your urethra. This instrument guides a high-power laser to the prostate and carefully remove excess tissue.

The surgeon uses a separate instrument to slice the tissues into easily removable pieces. This second part of HoLEP surgery differs from other laser surgeries that destroy the excess tissue. This unique feature allows for the pathological examination of the tissue.

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How is HoLEP different from other types of prostate surgery?

There are several alternative BPH treatments, such as prostatectomy, TURP, and laser methods.

Prostate surgeries are divided into open surgery or minimally invasive techniques based on the size of the surgical incisions. HoLEP requires no incisions. This is beneficial compared to open prostatectomy or surgeries performed through keyhole incisions.

Comparative studies have shown that HoLEP has more significant improvements in urinary flow rate, side effects, and repeat procedures over 10-year follow up compared with TURP, traditional prostatectomy and other laser surgeries.

What are the main benefits of HoLEP surgery?

HoLEP improves the effectiveness and safety of BPH surgery compared to TURP (the gold standard for BPH treatment). Prominent benefits include:

  • Reduced blood loss. It seals the blood vessels of the prostate tissue, reducing blood loss compared to other surgical options. It can be used in men with bleeding disorders.

  • Reduced catheterization. The post-surgery catheter can be removed within 24 hours. This reduces hospital stay, recovery time, and infection.

  • Removes more tissue, making it suitable for men with varying prostate volume.

What are the main drawbacks of HoLEP surgery?

  • Increased frequent urination and urgency. You may experience this symptom within 12 weeks post-surgery, which may require further treatment.

  • Urinary tract infection. 1 in 20 patients will experience this and the associated symptoms (burning pain and blood in the urine).

  • Erectile dysfunction. About 15 in 100 patients will experience erectile problems because of nerve damage. However, some men may experience improved erectile function because of HoLEP associated improvement in their quality of life.

  • Injury to the urethra. You may have delayed scar formation and narrowing of the urethra (urethral stricture).

HoLEP surgery is similar to open surgery to remove parts or all the prostate but requires no incisions. It has internal wounds but useful for severely enlarged prostate.

Quality of life after HoLEP surgery

HoLEP surgery will cause swelling that will affect normal urine flow. You will have a catheter in place for a few hours to help with urination.

Continued urinary problems may require your doctor to reinsert the tube till you can urinate normally. Nevertheless, prolonged catheterization increases your risk of developing infections.

You might feel an urgent or frequent need to urinate. However, these symptoms will clear within 2-3 weeks. Incontinence can occur because your bladder can now push urine easier through the relaxed urethra.

Usually, incontinence post-BPH surgeries will improve over time. It will take several weeks to gain noticeable improvements in BPH symptoms.

Your doctor is likely to recommend that you wait two to three weeks after HoLEP before having sex. Ejaculating within the first few weeks can cause pain and bleeding. Further, you should avoid strenuous activities and increase your fluid intake.

What lifestyle changes do men need to make after HoLEP surgery?

The side effects of HoLEP, such as incontinence, erectile dysfunction, and infection, are unpredictable. However, you can make some lifestyle changes to help improve your recovery and health.

First, you should reduce the intensity of physical activities to lower your risk of developing complications.

Straining weak scar tissues can result in bleeding, infection, and other serious complications. Further, improved recovery will benefit your sexual function and urinary continence.

Second, you should consume a healthy diet rich in fruits and vegetables to help with your recovery. In addition to a balanced diet, adequate fluid intake also supports the wound healing process.

How successful is HoLEP surgery for BPH?

Studies investigating the efficacy of HoLEP show that it can treat prostate enlargement like the prostate TURP procedure (Transurethral resection of the prostate).

A randomized multicentre survey by Montorsi and colleagues showed that patients in the HoLEP group had shorter catheter times and hospital stay compared to TURP. HoLEP was effective in relieving BPH symptoms, with no difference in complications compared to TURP.

Similarly, clinical trials by others replicated these findings in more than 200 men treated with either HoLEP or TURP.

These results suggest that HoLEP is as effective as TURP. However, some of the associated risks require careful consideration.

Natural ways to improve prostate health

You can take action to improve your prostate health, especially before the diagnosis or progression of BPH. Lifestyle changes (regular physical activity and a healthy diet) are the best way to reduce the risk of BPH.

  • Physical activity: Sedentary lifestyle increases your risk of prostate conditions, including BPH and prostate cancer. Studies have shown that lower daily calorie intake and regular exercise can reduce your risk of BPH. Interestingly, healthy weight is beneficial in reducing urinary symptoms of BPH.

  • Healthy diet: Low-fat diet rich in fruit and vegetables can lower your risk of prostate conditions. Plant-based foods, including tomatoes, walnuts, omega-3 fatty fish, and pomegranate juice, can improve your prostate health.

What are the best supplements to improve prostate health?

  • Multivitamin and mineral supplements: Daily supplementation with multivitamins is an excellent way to ensure adequate intake of essential nutrients. Multivitamin supplementation is especially useful when you are older, with an increased risk of developing prostate conditions.

  • Beta-sitosterol: This substance has been shown to promote stronger urine flow.

  • High-fiber foods: Foods rich in fiber such as fruits, vegetables, and nuts can reduce the risk of constipation. Reducing constipation is a good way to minimize bladder pressure and the symptoms of BPH.

What are some foods that can improve prostate health?

Diet rich in specific vitamins and minerals improve prostate health and lower the rate of BPH.

Common foods rich in agents that can promote prostate health include:

  • Sesame seeds: They are rich in zinc, which is essential for prostate health. More than 75% of men with BPH have low levels of zinc compared to healthy men. This activity makes foods rich in zinc, such also almonds and pumpkin seeds beneficial to your prostate.

  • Tomatoes: They are rich in lycopene, which can lower the levels of PSA. High PSA levels connected to inflammation and BPH. Other lycopene-rich foods like watermelon, papaya, and apricots are also beneficial.

  • Avocados: They rich in beta-sitosterol, which reduces the symptoms of BPH. Supplementation with beta-sitosterol improves urinary flow and reduces residual urine volume. However, there are safety issues associated with synthetic supplements. Foods rich in beta-sitosterol, including soybeans and pumpkin, provides a natural source of this mineral.

  • Vegetables: Green leafy vegetables are rich in antioxidants, which reduces inflammation and the risk of BPH. Vitamin C found in fruit and vegetables can help fight BPH. Broccoli kale and brussels sprouts are especially rich in vitamin C.

What are common natural treatment options for BPH?

Lycopene, a natural carotenoid hydrocarbon, has been found to promote prostate health. Lycopene’s antioxidant and anti-insulin growth factor effects can inhibit the progression of BPH.

A trial investigated the effects of lycopene supplementation in 40 men diagnosed with BPH free of prostate cancer.

Schwarz et al. showed that lycopene supplementation decreased PSA levels and inhibited BPH progression compared to placebo treatment. Further, lycopene significantly improved international prostate symptom score.

Vitamin D, a group of fat-soluble steroids, slows the expansion of prostate cells. Supplementation with vitamin D decreases the rate of BPH. Studies have also shown that it reduces the prostate volume in men with BPH. Interestingly, increasing the intake of vitamin D has caused no adverse side effects.


Before choosing any treatment to treat prostate cancer, it is worth investigating all options.

All prostate treatments carry side effects, and one should choose a procedure where the side effects are less life-altering.

Boosting nutrient levels can reduce the risk of BPH and its progression. In cases of high risk of cancer progression and treatment relapse, surgical intervention may be necessary. We generally are against any invasive surgery, but we also think our readers should be informed.

Keeping your prostate healthy is the best way to reduce your risk of developing BPH. Regular physical activity and healthy diets can help reduce the risk of developing this disease or manage the symptoms.


  1. Eltabey, M.A., Sherif, H., Hussein, A.A., 2010. Holmium laser enucleation versus transurethral resection of the prostate. Can. J. Urol. 17, 5447.
  2. Espinosa, G., Esposito, R., Kazzazi, A., Djavan, B., 2013. Vitamin D and benign prostatic hyperplasia–a review. Can. J. Urol. 20, 6820–6825.
  3. Fredericks, S., Yau, T., 2013. Educational intervention reduces complications and rehospitalizations after heart surgery. West. J. Nurs. Res. 0193945913490081.
  4. Ghadian, A., Rezaei, M., 2017. Combination therapy with omega-3 fatty acids plus tamsulocin and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Inflammopharmacology 25, 451–458.
  5. Kuntz, R.M., Lehrich, K., Ahyai, S., 2004. Transurethral holmium laser enucleation of the prostate compared with transvesical open prostatectomy: 18-month follow-up of a randomized trial. J. Endourol. 18, 189–191.
  6. Michalak, J., Tzou, D., Funk, J., 2015. HoLEP: The gold standard for the surgical management of BPH in the 21st century. Am. J. Clin. Exp. Urol. 3, 36.
  7. Montorsi, F., Naspro, R., Salonia, A., Suardi, N., Briganti, A., Zanoni, M., Valenti, S.,
  8. Vavassori, I., Rigatti, P., 2008. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J. Urol. 179, S87–S90.
  9. Schwarz, S., Obermuller-Jevic, U.C., Hellmis, E., Koch, W., Jacobi, G., Biesalski, H.-K., 2008. Lycopene inhibits disease progression in patients with benign prostate hyperplasia. J. Nutr. 138, 49–53.

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