Questions most commonly asked in the rooms about HoLEP and the other laser treatments for an enlarged prostate.
Yes. HoLEP is well documented for prostates over 70 g, over 100 g and beyond 200 cc, and is the preferred endoscopic option when the gland is too large for a standard TURP.1, 4, 5 See HoLEP for large and giant prostates.
In most cases, yes. The laser seals small vessels as it cuts, and HoLEP is cited in international guidance as an appropriate option for men at higher bleeding risk. Whether any medication is paused around the operation is decided case by case with the treating cardiologist or haematologist.1, 11, 12, 18 See HoLEP on blood thinners.
Erectile function is not generally affected; long-term data show no meaningful change in validated erectile function scores at 12 months and beyond.15 However, most men (around 70 to 80%) will have reduced or absent ejaculate afterwards, because opening the bladder neck allows semen to pass into the bladder rather than out through the urethra.15
Most men feel well enough to resume light daily activity and to drive within 1-2 weeks, and return to office work in a similar timeframe. Heavy lifting, cycling and strenuous exercise are typically deferred for approximately four weeks while the prostatic fossa heals. The what to expect guide covers the full week-by-week pattern.
It is very unlikely. In a single-centre series of more than 1,000 HoLEP procedures, 95% of men had not required any further prostate operation at ten years.8 In a national registry of more than 33,000 patients, 97% of HoLEP patients had not needed a repeat procedure at three years.17
Yes. Because HoLEP removes tissue (rather than vaporising it), the fragments are routinely sent to pathology. This occasionally identifies incidental prostate cancer that was not apparent on pre-operative investigations.10
HoLEP is performed under general or spinal anaesthesia. The specific choice is made with the anaesthetist on the day and depends on medical history and personal preference.
A catheter is in place overnight to flush the bladder clear while the prostate bed seals. It is usually removed the following morning once the urine is clear.4, 9 In a small number of cases the catheter is kept in for a second night.
A small minority of men have some urinary leakage on coughing or exertion for the first few weeks. This typically improves quickly with pelvic-floor exercises.13, 14 Persistent incontinence is uncommon, particularly at high-volume centres.7
A pink tinge and occasional small clots are common in the first two weeks. Blood-tinged urine can also recur briefly around 10-14 days after surgery when a small healing scab separates. Rest and drinking more fluid usually settles it within 24 hours.
Usually not. Alpha-blockers and 5-alpha-reductase inhibitors taken pre-operatively for BPH are typically stopped once the procedure has taken effect.
HoLEP enucleates the obstructing adenoma as whole lobes, removes the tissue (which is sent to pathology) and scales to any gland size. GreenLight vaporises the tissue with a 532 nm laser, is day-surgery in most cases and is best suited to small-to-medium glands. See the laser options hub for a fuller comparison.
HoLEP is an MBS-listed procedure. Private hospital costs are covered by private health insurance where there is an appropriate level of cover. Out-of-pocket costs depend on the hospital and the level of cover. The rooms will provide a written informed-financial-consent quote before surgery.
Yes. Please see the second opinion page for how to arrange one.
Dr Raji Kooner performs the procedure personally, assisted by a surgical trainee and the theatre team. He has been performing HoLEP for more than 20 years and has completed over 3,000 holmium laser procedures at St Vincent's Private and Mater Hospital North Sydney.
You can ask for a second opinion on your symptoms, flow studies and prostate size before deciding between medication, HoLEP, GreenLight, TURP, UroLift, Rezum or iTind.