HoLEP
Holmium Laser Enucleation of the Prostate — a size-independent, highly durable treatment for BPH with the lowest retreatment rate of any surgical option.
HoLEP (Holmium Laser Enucleation of the Prostate) is an advanced endoscopic procedure for benign prostatic hyperplasia (BPH) that uses a holmium laser to precisely separate the obstructing prostate tissue from the surrounding capsule — similar to scooping the flesh out of an orange. The enucleated tissue is pushed into the bladder, where a morcellator breaks it into small pieces for removal.
Because the procedure works from the inside through the urethra, there are no external incisions. HoLEP can treat prostates of virtually any size, making it one of the most versatile BPH surgeries available. It is considered the gold standard for large prostates and offers outcomes equivalent to open simple prostatectomy with significantly less morbidity.
Advantages of HoLEP
HoLEP stands out among BPH procedures for its durability, versatility, and recovery profile.
Lowest Retreatment Rate
HoLEP removes the obstructing tissue completely, resulting in a retreatment rate of less than 2% over 10 years — significantly lower than TURP (10–15%) and most other BPH procedures. For most men, HoLEP is a one-time solution.
Size Independent
Unlike TURP, which is limited to prostates under about 80 grams, HoLEP can effectively treat prostates of any size — from 40 grams to well over 200 grams. This makes it an excellent option for men with very large prostates who would otherwise need open surgery.
Minimal Blood Loss
The holmium laser simultaneously cuts and coagulates tissue, resulting in significantly less bleeding than TURP or open prostatectomy. HoLEP can often be safely performed on patients taking blood thinners.
Shorter Hospital Stay
Most patients go home the same day or the following morning — even for very large prostates. This is a significant improvement over open simple prostatectomy, which typically requires two to three days in the hospital.
Tissue Available for Pathology
Because HoLEP removes intact tissue, it is sent to pathology for analysis. This can occasionally identify incidental prostate cancer that was not previously detected, providing valuable diagnostic information.
Faster Catheter Removal
The catheter is typically removed the morning after surgery, and most patients are voiding well and ready for discharge the same day. Patients generally return to normal activities within one to two weeks.
HoLEP vs. TURP
TURP has been the traditional gold standard for BPH surgery for decades. Both procedures are performed through the urethra with no incisions. However, HoLEP offers several advantages: it can treat larger prostates, has less blood loss, achieves a lower retreatment rate, and provides tissue for pathology. TURP remains a good option for medium-sized prostates, but for larger glands, HoLEP provides superior long-term outcomes.
HoLEP vs. Robotic Simple Prostatectomy
For very large prostates (over 80–100 grams), both HoLEP and robotic simple prostatectomy are excellent options. HoLEP has the advantage of no external incisions and a slightly shorter recovery, while robotic simple prostatectomy may be preferred when there are associated conditions like large bladder stones or bladder diverticula that benefit from simultaneous treatment. Dr. Radtke performs both procedures and will recommend the approach best suited to your anatomy and situation.
HoLEP vs. Rezūm
Rezūm is an office-based option that works well for smaller prostates and offers the advantage of preserving ejaculatory function. HoLEP provides more complete tissue removal and is better suited for men with moderate to large prostates or those who want the most durable long-term result. Retrograde ejaculation (dry orgasm) is common after HoLEP but is not harmful.
What to Expect
From your initial evaluation through full recovery, here is the typical HoLEP timeline.
Evaluation & Planning
Dr. Radtke will assess your symptoms, review your prostate size (via PSA, imaging, and/or cystoscopy), and discuss whether HoLEP is the best option. Pre-operative instructions and expectations are reviewed in detail.
Surgery Under General Anesthesia
HoLEP typically takes one to two hours depending on prostate size. The procedure is performed entirely through the urethra. A catheter is placed at the end of the procedure.
Catheter Removal & Discharge
The catheter is removed the morning after surgery. Once you are voiding comfortably, you are discharged home. Many patients go home the same day as the procedure.
Early Recovery
Urinary urgency and frequency are common in the first one to two weeks as the urethra heals. These symptoms improve steadily. Most patients return to desk work and light activity within a few days of discharge.
Full Recovery
Urine flow and symptoms continue to improve over the first one to three months. By three months, most men have reached their full benefit. Follow-up confirms excellent voiding function.
Durable, long-term reliefSchedule a HoLEP Consultation
Dr. Radtke will evaluate your prostate and determine the best BPH treatment for you.
Schedule an Appointment
Dr. Radtke sees patients through Prevea Health. You can book an appointment online or call our office directly.
Clinic Information
(920) 458-6664
Monday – Friday: 8:00 AM – 5:00 PM
Saturday – Sunday: Closed