前列腺钬激光去核术（HoLEP）

最后更新： 8 月 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.

• 曼谷医院泌尿外科中心 泰国 在线预订 02-310-3009 bhquro@bdms.co.th
• 春武里府斯里拉查（Samitivej Sriracha）医院 088-022-1445

传统经尿道前列腺切除术 (TUR-P) 使用通过尿道插入的电外科刀，一块一块地刮取前列腺组织——有时一次手术需要数百次刮取，每次都伴有出血的风险。TUR-P 在处理大于 80 克的巨大前列腺时也存在困难。. 高能环境计划 为了克服这些限制，我们采用了钬激光技术。.

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. 无前列腺大小限制——HoLEP 可处理任何大小的前列腺；TUR-P 无法有效治疗80克以上的前列腺，否则将需要开放手术。
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. 偶然发现的前列腺癌——HoLEP是唯一能获取前列腺组织供病理检查的激光治疗方法。在HoLEP标本中，已发现多达131例偶然发现的前列腺癌
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.

关于钬激光前列腺剜除术（HoLEP）的常见问题

什么是钬激光前列腺剜除术（HoLEP），它与传统的经尿道前列腺切除术（TURP）有什么区别？

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.

与经尿道前列腺切除术（TURP）相比，钬激光前列腺剜除术（HoLEP）的临床优势包括： * **出血量少：** HoLEP 通常比 TURP 引起的出血量更少，这使得它对接受抗凝治疗的患者尤其有益。 * **住院时间缩短：** 由于出血量少和并发症发生率低，HoLEP 患者的住院时间通常比 TURP 患者短。 * **更好地控制前列腺肥大：** HoLEP 可以有效地治疗各种大小的前列腺肥大，包括非常大的前列腺。 * **较低的并发症发生率：** HoLEP 相关的并发症，如尿失禁和勃起功能障碍的发生率通常低于 TURP。 * **组织样本可供病理学检查：** HoLEP 可以在手术过程中获得完整的组织样本，这对于进行病理学检查非常重要。 * **复发率较低：** 一些研究表明 HoLEP 的远期疗效更好，复发率较低。 然而，HoLEP 的学习曲线可能比 TURP 更陡峭，需要经过专门培训的泌尿科医生来操作。

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. 预约咨询. 如需预约三美泰是拉差医院，请致电泌尿科： 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.

免责声明 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.