Your doctor will first confirm your prostate obstruction is due to benign prostatic hyperplasia (BPH) rather than some other condition such as prostate cancer or prostatitis (inflammation of the prostate). Once BPH is confirmed, your doctor will advise you about treatment options, including holmium laser prostate surgery (HoLEP).
Surgeons perform HoLEP surgery using a laser system operated through a endoscope inserted through the urethra. The procedure offers quicker recovery and excellent long-term outcomes.
In the procedure, the surgeon operates through a thin tube (endoscope) inserted through the urethra. The holmium:YAG laser system is used to separate the central portion of the prostate gland from its surrounding fibrous capsule — like peeling an orange from the inside out, leaving the outside rind intact. The separated tissue is then guided into the bladder, where it is reduced to smaller pieces using a machine called a morcellator. The tissue fragments are then removed from the bladder and sent to the pathology lab for analysis.
HoLEP is generally an outpatient procedure, although you may be asked to remain in the hospital for 23 hours for observation. You can generally return to work and normal activities within seven to 10 days. Catheterization is temporarily required and the catheter can usually be removed within one day of the procedure. Most patients are able to urinate immediately with an improved stream. In extremely rare cases, a blood transfusion may be necessary.
HoLEP is sometimes used as a palliative treatment (reduce discomfort) for urinary obstructions caused by prostate cancer and prostatitis.
Mayo Clinic doctors use several diagnostic procedures — including digital rectal exam, ultrasound and cystoscopy — to determine whether HoLEP is an appropriate treatment option for you.