Holmium laser Enucleation of the Prostate (HoLEP)

Last updated: May 18, 2026

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HoLEP (Holmium laser Enucleation of the Prostate) is one of the most advanced endoscopic BPH operations available today. To understand its advantages, we first need to understand the conventional operation it replaced — TUR-P (Transurethral Resection of the Prostate).

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Conventional TUR-P uses an electrical surgical knife passed through the urethra to scoop prostatic tissue piece by piece — sometimes hundreds of scoops per operation, each carrying a risk of bleeding. TUR-P also struggles with large prostates over 80 grams. HoLEP was developed to overcome these limitations using Holmium YAG laser technology.

HoLEP enucleates the entire prostatic adenoma in one intact specimen — analogous to peeling the core of an apple away from its shell in a single maneuver, without breaching the prostatic capsule. This results in a superior surgical outcome compared to piecemeal TUR-P resection.

HoLEP’s Pros

1. Less bleeding – Holmium laser resects and coagulates simultaneously, reducing intraoperative blood loss
2. No prostate size limit – HoLEP handles prostates of any size; TUR-P cannot effectively treat glands over 80 grams, which would otherwise require open surgery
3. Lower retreatment rate – only 1.4% of patients need retreatment at 7 years after HoLEP, compared to 17.7% after conventional TUR-P
4. Better sexual function outcomes – 60.6% of patients report improved sexual functioning after HoLEP, better than other laser methods (PVP and laser ablation). Conventional TUR-P carries a 13% erectile dysfunction rate
5. Incidental prostate cancer detection – HoLEP is the only laser approach that yields prostatic tissue for pathological examination. Up to 13% incidental prostate cancer has been discovered in HoLEP specimens
6. Lower urethral stricture rate – 2.6% after HoLEP vs. 4.4% after conventional TUR-P
7. Shorter hospitalization – 2 days for HoLEP vs. 3 days for conventional TUR-P

HoLEP’s Cons

1. Steep learning curve – at least 25 cases required for proficiency
2. Specialized equipment required – Holmium laser systems add to procedure cost compared to conventional TUR-P
3. Longer operative time – the morcellator required for tissue removal adds to operating room time

In conclusion, HoLEP is considered one of the best BPH surgical options available and requires a well-trained urologist with dedicated laser equipment.

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Frequently Asked Questions About HoLEP (Holmium Laser Enucleation of the Prostate)

What is HoLEP and how is it different from conventional TUR-P?

HoLEP (Holmium laser Enucleation of the Prostate) uses Holmium YAG laser energy to enucleate the entire prostatic adenoma as a single intact specimen through the urethra, without any incision. Conventional TUR-P uses an electrical knife to scoop prostatic tissue in multiple fragments. The key difference is that HoLEP removes tissue in one piece (like peeling an apple core), while TUR-P removes it piecemeal. This gives HoLEP superior bleeding control, lower retreatment rates, and the unique ability to provide tissue for pathological analysis.

What are the clinical advantages of HoLEP over TUR-P?

HoLEP offers multiple clinically proven advantages: it handles any prostate size (including glands over 80 grams where TUR-P fails), has a retreatment rate of only 1.4% vs. 17.7% at 7 years, causes less bleeding, has a lower urethral stricture rate (2.6% vs. 4.4%), produces better sexual function outcomes (60.6% improvement vs. 13% erectile dysfunction risk with TUR-P), allows incidental prostate cancer detection in up to 13% of specimens, and results in shorter hospitalization (2 vs. 3 days).

Is HoLEP available at Bangkok Hospital?

Yes. HoLEP is performed at Bangkok Hospital Headquarters by Dr. Soarawee Weerasopone, a urologist with specialized training in Holmium laser and minimally invasive urological surgery. The procedure requires dedicated Holmium laser equipment and a surgeon with a sufficient learning curve of at least 25 cases — both of which are established at the center. For men with symptomatic BPH, especially those with large prostates or who have failed medical therapy, HoLEP offers a durable surgical solution.

If you are experiencing urinary symptoms from BPH and would like to discuss surgical options including HoLEP, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.