What Is Holmium Laser Prostate Surgery?

Medically Reviewed by Jabeen Begum, MD on November 04, 2022
Written by Julian Selemin
5 min read

The holmium laser prostate (HoLEP) surgery is a minimally-invasive procedure that treats a condition known as benign prostatic hyperplasia. Although it’s usually considered safe for most people, it can cause minor side effects like bleeding, pain, and increased urination frequency. Here’s what you need to know.

Holmium laser enucleation of the prostate (HoLEP) is a surgical procedure that removes obstructions that block urine flow. Developed in the 90s, HoLEP presents a less invasive and costly alternative to other surgeries that treat the same problem. 

A holmium laser is a surgical laser that has proven effective and safe in treating cases of excess soft tissue. A HoLEP surgery consists of removing bulky prostate tissue that may prevent urine from flowing easily.

The most common cause for obstruction of the urine flow is a condition called benign prostatic hyperplasia (BPH). As its name suggests, it affects the prostate — a small gland that surrounds the urethra, which carries pee and sperm out of your body. BPH causes the prostate to grow, preventing pee and sperm from leaving your body.

BPH has symptoms similar to prostate cancer and is the most common prostate problem in men of all ages. These are the most common signs that you may have BPH:

Usually, doctors can treat BPH with specific medications and therapies, and some cases may not need any treatment. However, if your symptoms are causing too many complications, like bleeding, experts may recommend a surgical procedure such as HoLEP.

Before going through a HoLEP surgery, you’ll need to take a few steps to ensure the safety and effectiveness of the procedure. While doctors will walk you through all the necessary preparations, it’s always a good idea to know a rough guideline of what you’ll need to do.

First, you’ll have to take a few tests to check if HoLEP is the right surgery for you. Blood and urine tests are the two most important tests — but doctors may also require some X-rays. Similarly, they may also ask for an electrocardiogram to check your heart.

If you’re taking blood thinners, some doctors will require you to stop taking them about a week before the surgery. Yet, recent research shows that blood-thinning therapies may not affect HoLEP, so ask your doctor if you need to do it.

You’ll also need to take antibiotics for about a week before the procedure to eliminate any possible bacterial infections. If you’re in pain, doctors may also prescribe painkillers to get through the preparation stage comfortably.

Finally, doctors will ask you to stop eating solid foods for at least four hours before the surgery. Likewise, you’ll be required to avoid any other liquid that’s not water. You’ll also need to bring an adult companion to the hospital — even if you aren’t placed under general anesthesia.

While surgeries are scary for most people, one of the most significant advantages of HoLEP is that it’s a minimally-invasive, mostly risk-free procedure. Experts have deeply studied most side effects, and research shows that most patients don’t have any complications after this surgery.

Holmium laser prostate surgery side effects can be divided into three categories: common, occasional, and rare. These vary in severity, but most can be treated by the team of doctors that will take care of you after the HoLEP procedure.

The most common post-HoLEP side effects include temporary burning and bleeding during urination. Similarly, you may notice an increased urination frequency and a slight loss of urinary control. Other common side effects include:

  • Impotence and a lack of semen during orgasms
  • Bladder, testicle, or kidney infection
  • Re-obstruction of the urine flow
  • Injuries in the urethra

Occasional side effects occur in less than 1 in 10 people who go through HoLEP. Usually, they involve partial urination problems requiring a catheter — a small tube carrying urine out of the bladder. Occasional side effects may include:

  • Failure to pass urine
  • Severe enough bleeding to warrant a blood transfusion

Finally, the least common side effects of HoLEP usually require medical intervention. The most severe one is finding unsuspected cancer in the removed tissue. Rare side effects may also include:

  • Perforation of the bladder
  • Complete loss of urinary control
  • Tissue fragments floating in the bladder

Unlike most surgical interventions, the HoLEP procedure is relatively straightforward. Doctors will usually explain it before the day of the surgery. You won’t be able to tell what’s happening during the process. But if you’re curious, here’s how a usual HoLEP surgery goes:

Anesthesia and preparation. The first step that doctors take is to place you under general anesthesia. Then, they’ll inject you with antibiotics to reduce the chance of infection. Doctors may also put you on your back with your legs raised for the duration of the procedure.

Insertion of the surgical tools. Once doctors ensure you’re under the effects of the anesthesia, they’ll insert a small tube with a camera called the resectoscope. This tool goes through the urethra — the channel that carries urine from the bladder. After examining the prostate with the camera, they’ll insert the laser into the resectoscope.

Removal and sealing of the tissue. After the laser is in place, the surgeon carefully cuts the excess tissue blocking the urine flow. This removal process is called enucleation. Then, doctors will seal up the blood vessels in the zone with the laser. Once that’s done, they’ll remove the cut tissue with a device called morcellator.

Waking up. Finally, doctors will withdraw the tools from your body and insert a urinary catheter. After some time has passed, you’ll wake up either in the operating room or in the recovery room.

Once the procedure is done, you’ll have to spend the night in the hospital for overnight observation. You can expect some bleeding and pain during this stage, although this usually goes away after about 12 hours. Then you can go home, where you’ll probably notice an increase in urination frequency during the first months after the procedure.

If you have any doubts, clear them with the doctors in charge of your operation. They’ll be able to tell you the HoLEP pros and cons, which side effects to expect, and how to treat them during the first post-surgery months.