HoLEP Surgery to Treat Enlarged Prostate
At University of Utah Health, our urologists specialize in helping men achieve better health with top-notch specialty care and the latest advances in treatment and therapies. We provide care for a wide range of men’s health conditions related to infertility and sexual dysfunction.
One of our innovative treatments is holmium laser enucleation of the prostate (HoLEP)—a minimally invasive surgical option for treating the symptoms of enlarged prostate (benign prostatic hyperplasia or BPH). U of U Health Urology is currently the only medical clinic in Utah offering HoLEP surgery.
HoLEP surgery is just one of several surgical and non-surgical treatment options available to treat BPH. Our urologists will help you decide if this is the best option available based on your diagnosis, health history, and symptoms.
What Is HoLEP?
Holmium laser enucleation of the prostate (HoLEP) surgery is a procedure that targets the enlarged tissues of the prostate and removes them to relieve pressure and eliminate or reduce symptoms.
The goal of HoLEP surgery is to relieve the symptoms commonly associated with an enlarged prostate, including:
- an urgent or frequent need to urinate,
- difficulty starting to urinate,
- frequent stopping and starting during urination (weak urine stream),
- increased urination at night that disrupts sleep,
- inability to empty the bladder completely, or
- inability to urinate at all (urinary retention).
On the day of your HoLEP surgery, you will meet with your urologist to discuss the procedure.
If you have any of these symptoms or conditions, discuss them with your doctor prior to the surgery:
- inability to lie back with your legs raised for a prolonged period of time (this is necessary during the procedure),
- bleeding disorders or blood thinner medications,
- pain or difficulty urinating that came on suddenly or recently,
- an urgent need to urinate that has gotten worse over time,
- history of severe bleeding or blood clots, or
- high fever (over 101 degrees).
You will also meet with an anesthesiologist, who will explain the process of anesthesia and answer any questions you have. The anesthesiologist will administer general anesthesia (put you to sleep).
The entire procedure usually takes about three to four hours, but it may be shorter or longer depending on the size of your prostate.
During the Procedure
After you are under anesthesia in the operating room, your surgeon will look at your prostate through a small camera (cystoscope) inserted into your urethra (the small tube that connects your bladder to your penis) through the tip of your penis. The surgeon will insert a small laser and scope, which are used to cut extra tissues in the prostate causing BPH symptoms. The prostate tissue will be removed leaving only the prostate capsule. The tissue is typically removed in two to three large pieces, which are put into the bladder. Your surgeon will use a laser to seal up any blood vessels. A second device called a morcellator will break up the prostate tissue in the bladder and suction it out. There may be a small amount of tissue left behind that will be safely urinated out of your system.
Before the procedure is finished, your surgeon will insert a catheter to flush out any blood. A catheter is a small tube that runs from the bladder through the urethra and drains urine into a bag outside your body.
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Risks Of HoLEP
As with any surgical procedure, HoLEP surgery has some risks such as:
- incontinence (the inability to hold your urine in) which is common for a few months after surgery, but it's rarely permanent (about one percent of cases)
- bleeding after surgery,
- the need for transfusion or another operation due to bleeding,
- urinary tract infection (UTI),
- damage to the bladder,
- damage to the ureteral orifice (a small tube where the kidneys drain into the bladder),
- prolonged need for a catheter after surgery, or
- scar tissue in the area of the surgery.
These risks are very low, but your urologist will discuss them with you and answer your questions prior to the surgery.
What to Expect After HoLEP Surgery
Most people can leave the day of surgery after a few hours of monitoring. If you are at higher risk for complications, you may need to stay for one night or more so our doctors and nurses can monitor you for complicationst.
Your doctor will look at the catheter (a small tube that runs from the bladder through the urethra and drains urine into a bag outside your body) to make sure everything looks good. You will go home with the catheter in place. You will not need to urinate into the toilet while the catheter is in place. The catheter can usually be removed after just one or two days, but some people may need to keep it in longer.
You will need to arrange to have someone drive you home from the hospital. Your doctor will prescribe pain medication or instructions for over-the-counter pain medications for any pain you may experience.
For the first few nights after you leave the hospital, you will need to watch for the following issues:
- A catheter that is not draining — This could be a sign of a blood clot in the bladder.
- Blood in the urine — Some bleeding after HoLEP surgery is normal, but the volume of blood should generally go down over time. If there is enough blood to cause a clot in your catheter, call your doctor right away.
- Signs of infection — Monitor yourself for signs of infection such as fever or chills.
Recovering from HoLEP Surgery
You will likely have a follow-up appointment within one or two days after you are released from the hospital. During this appointment, a nurse or medical assistant will check the catheter and remove it, or provide a timeline for when it can be removed.
For a smoother recovery, make sure you:
- drink plenty of fluids.
- rest for one to two weeks.
- avoid heavy lifting or strenuous physical activity for two to three weeks, or longer if instructed by your doctor.
Once you are cleared to increase your activity, start slowly and work your way up to more vigorous exercise or daily activities.
You may be able to return to work within one or two weeks, especially if you work from home or at a “desk job” that doesn’t require a lot of physical exertion. If your work involves strenuous physical activity, you may need to wait three to four weeks before returning to work. Urinary incontinence is common in the first few months after surgery and can make it more difficult to return to normal activities for some patients.
HoLEP surgery has a low rate of complications. Some people require re-treatment (another follow-up surgery) after HoLEP, but the re-treatment rate is lower for HoLEP than it is for other common BPH surgeries. Long-term incontinence (the inability to hold in urine or urine leakage) is also possible, but your chances are extremely low.
HoLEP Side Effects
There are some potential side effects following a HoLEP surgery procedure:
- Retrograde ejaculation — A condition where semen goes into the bladder during sexual climax (orgasm) instead of through the penis. This is sometimes called a dry orgasm.
- Anejaculation — A condition where no semen comes out during sexual climax.
- Fertility issues — HoLEP surgery is generally not harmful to your reproductive organs, but will often cause retrograde ejaculation. You can discuss any specific concerns you have with your urologist.
- Incontinence — Most people will experience short-term incontinence for a few weeks or months following HoLEP surgery, but this usually does not last.
- Temporary burning or bleeding during urination – You may see blood in your urine and feel a burning sensation for up to a few weeks or months after surgery. This is normal and is an indication that your body is still healing.
Cost of HoLEP Procedure
The total out-of-pocket cost for a HoLEP procedure depends on your insurance coverage. Most insurance policies cover it as a routine part of in-network care. If you do not have insurance, our financial counselors can help you understand the costs. If you have insurance but U of U Health is out of your network, contact our financial counselors and we may be able to request authorization as the only place currently offering this procedure in the state of Utah.
These past three months have been an incredible learning process for me. My doctor in Mexico [told] me about the HoLEP procedure…I want to thank [Dr. Gross] for taking me as a new patient…Thank you for the knowledge and skills you have developed to learn this technique. You are rather unique in your field.
Schedule an Appointment to See a Urologist
To schedule an appointment with a urologist at University of Utah Health, call 801-213-2700. You do not need a referral from your primary care provider (PCP) or another care provider to schedule an appointment with our urologists. However, some insurance plans do require a referral in order for HoLEP to be covered. Talk to your insurance carrier about your specific plan requirements.