HoLEP in special situations

HoLEP is the preferred laser option across the full range of gland sizes, but its anatomical, haemostatic and size-independent properties matter most in three clinical scenarios where other prostate surgery options are limited.

Large and giant prostates

HoLEP has largely replaced open simple prostatectomy for glands over 100 g, with equivalent outcomes and less bleeding.4, 5

Men on blood thinners

AUA guidance identifies HoLEP as appropriate at higher bleeding risk, including men on anticoagulant or antiplatelet therapy.1, 11, 12

Urinary retention

HoLEP for men who are catheter-dependent after acute retention or who have failed trial of void.16

Why HoLEP behaves differently in these settings

HoLEP enucleates the adenoma along its natural plane with the capsule, rather than shaving it from the lumen. This produces three properties that matter in the special-situations scenarios:

  • Size independence. The technique scales from small to giant prostates without the upper limits that affect TURP and most minimally-invasive alternatives.
  • Haemostasis. The laser seals small vessels as it cuts, independent of the patient's own clotting status.
  • Saline irrigation. TUR syndrome is not a meaningful risk, which matters for long operations and for medically complex patients.

Considering laser surgery for an enlarged prostate?

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.

Request a second opinion Call 02 8382 6980