Holmium laser Enucleation of the Prostate (HoLEP)

Last updated: August 15, 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 was designed to improve on — TUR-P (Transurethral Resection of the Prostate).

Please note: this article is written as patient education about the procedure itself. HoLEP is not among the procedures performed at Bangkok Hospital Headquarters. If assessment shows that HoLEP is the most appropriate option for you, a referral to a centre that offers it can be arranged. BPH treatments available at BHQ include medical therapy, Rezum water-vapour therapy and TUR-P, and the right choice is decided after assessment of prostate size, symptoms and your own priorities.

• Urology center Bangkok hospital Thailand Booking online 02-310-3009 bhquro@bdms.co.th
• Samitivej Sriracha hospital Chonburi 088-022-1445

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 more complete removal of obstructing tissue than piecemeal TUR-P resection.

HoLEP’s Pros

1. Less bleeding – the 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 – reported at around 1.4% at 7 years after HoLEP, against 17.7% after conventional TUR-P
4. Better sexual function outcomes – around 60.6% of patients report improved sexual functioning after HoLEP, better than other laser methods (PVP and laser ablation). Conventional TUR-P carries a reported 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 against 4.4% after conventional TUR-P
7. Shorter hospitalization – around 2 days for HoLEP against 3 days for conventional TUR-P

HoLEP’s Cons

1. Steep learning curve – at least 25 cases are generally required for proficiency
2. Specialized equipment required – holmium laser systems and a tissue morcellator add to procedure cost compared with conventional TUR-P, and are not available in every hospital
3. Longer operative time – the morcellation step needed to remove the enucleated tissue adds to operating room time

What the operation costs the patient, not the hospital

The list above is about the surgeon and the equipment. There are also things a man undergoing any enucleation procedure should expect, and they are the questions patients actually ask afterwards:

• Retrograde ejaculation is the usual outcome, not a rare complication. Because the operation opens the bladder neck, semen passes backwards into the bladder at orgasm in the large majority of men. Erections and orgasm itself are generally preserved — which is what the sexual-function figures above refer to — but fertility is affected, and this is the single point most worth understanding before consenting.
• Temporary urgency and leakage are common in the first weeks. After a large adenoma is removed, the bladder needs time to adapt. Most men settle within weeks to a few months, and pelvic floor exercises help; long-lasting incontinence is uncommon but is not zero.
• A catheter, and burning on passing urine, for a short period afterwards, with some blood in the urine that can reappear intermittently for several weeks as the raw surface heals.

After any of these operations, inability to pass urine, fever with chills, or heavy bleeding with clots needs same-day medical assessment rather than waiting for the follow-up appointment.

In conclusion, HoLEP is considered one of the best BPH surgical options available, and it depends on two things being present together: a well-trained urologist and dedicated laser equipment. That combination is the reason it is offered at some centres and not at others.

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 better bleeding control, lower retreatment rates, and the ability to provide an intact specimen for pathological analysis.

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

HoLEP offers several reported advantages: it handles any prostate size (including glands over 80 grams where TUR-P is limited), a retreatment rate of around 1.4% against 17.7% at 7 years, less bleeding, a lower urethral stricture rate (2.6% against 4.4%), better sexual function outcomes (around 60.6% reporting improvement, against a 13% erectile dysfunction risk with TUR-P), incidental prostate cancer detection in up to 13% of specimens, and shorter hospitalization (around 2 days against 3).

Will HoLEP affect ejaculation or fertility?

Usually, yes. Retrograde ejaculation — semen passing backwards into the bladder at orgasm — is the expected outcome after enucleation rather than an uncommon complication, because the operation opens the bladder neck. Erections and the sensation of orgasm are generally preserved, which is what the reported sexual-function figures describe, but natural fertility is affected. Any man for whom future fertility matters should raise it before deciding on the operation.

Will I be incontinent after the operation?

Urgency and some leakage are common in the first weeks after a large adenoma is removed, because the bladder needs time to adapt to the change. Most men settle within weeks to a few months, and pelvic floor exercises help the recovery. Persistent long-term incontinence is uncommon but not impossible, and it is worth asking your surgeon for their own figures.

Is HoLEP available at Bangkok Hospital Headquarters?

No. HoLEP is not among the procedures performed at Bangkok Hospital Headquarters, because it requires a dedicated holmium laser platform and morcellator that are not part of the unit’s current equipment. This article is provided as patient education so that men weighing up BPH surgery understand what the procedure involves. BPH treatments available at BHQ include medical therapy, Rezum water-vapour therapy and TUR-P, and if assessment shows HoLEP is genuinely the best option for your prostate, a referral to a centre that performs it can be arranged.

If you are experiencing urinary symptoms from BPH and would like to discuss the treatment options, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation. Appointments at Samitivej Sriracha Hospital can be arranged by calling the Urology department on 088-022-1445.

Bangkok Hospital also runs a Telemedicine service, which suits a first discussion of the BPH options, including whether a referral for HoLEP is the sensible route in your case — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. The prostate measurement, flow study and other assessments that decide the choice are done in person. Samitivej Sriracha is in-person only.

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. HoLEP is not performed at Bangkok Hospital Headquarters; this article is educational and a referral can be arranged where it is the appropriate option. After any prostate operation, inability to pass urine, fever with chills, or heavy bleeding with clots needs same-day medical assessment. No medical advice, diagnosis or prescription is provided through personal messaging channels. Always consult a qualified healthcare professional before starting any medical treatment.