Holmium Laser Enucleation of the Prostate (HoLEP): Procedure, Recovery, Risks and Results
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is HoLEP?
Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive laser surgery for benign prostatic hyperplasia (BPH) that removes the prostate tissue blocking urine flow, working through the urethra with no skin incisions. It suits any prostate size, especially large glands; most people go home within hours and have the catheter removed the next day. [1]
What the research says
HoLEP cuts transfusion risk and shortens the hospital stay compared with TURP. A meta-analysis of 15 studies (including 8 randomized trials, 855 patients) found an 83% lower relative risk of blood transfusion with HoLEP (risk ratio 0.17), a catheter time about 20 hours shorter and a hospital stay about 25 hours shorter. Surgery took about 14 minutes longer. (Li et al., PLoS One, 2014) [2]
HoLEP works well for large prostates. A review of 11 randomized trials with 1,258 patients with prostates larger than 80 mL found HoLEP shortened the hospital stay, reduced postoperative bleeding and improved urine flow over the medium and long term compared with other surgeries. (Sun et al., American Journal of Men's Health, 2022) [3]
Symptom relief is durable at five years. In 567 men followed for 60 months after HoLEP, 4.4% needed repeat surgery, and 22% had some urinary symptoms by strict criteria. Men with severe symptoms or a lot of leftover urine before surgery were more likely to have symptoms return. (Droghetti et al., The Prostate, 2022) [4]
Key takeaways
HoLEP treats urinary blockage from an enlarged prostate (benign prostatic hyperplasia) using a laser passed through the urethra. [1]
The surgeon usually removes about 50% to 60% of the total prostate volume. [1]
Surgery takes one to three hours, and most people go home the same day with a catheter. [1]
Light bleeding, burning and frequent urination are normal for weeks; full bladder adjustment can take months. [1]
About 75% of people have dry (retrograde) ejaculation afterward, but erections are usually unaffected. [1]
Few people need a second surgery for blockage; in one five-year study, about 4% did. [1]
HoLEP at a glance
Feature | What to expect |
Treats | Benign prostatic hyperplasia (BPH) causing blocked urine flow [1] |
Approach | Through the urethra; no skin incisions [1] |
Anesthesia | General (asleep) or spinal (numb from the waist down) [1] |
Operating time | 1 to 3 hours [1] |
Prostate tissue removed | About 50% to 60% of total volume [1] |
Hospital stay | A few hours in recovery for most people [1] |
Catheter | Usually removed the day after surgery [1] |
Back to work | 1 to 2 weeks for most people [1] |
Repeat surgery | About 4% within 5 years [1] |
What is holmium laser enucleation of the prostate (HoLEP)?
Holmium laser enucleation of the prostate (HoLEP) is a laser surgery that removes the overgrown prostate tissue pressing on the urethra so urine can flow freely again. [1] The prostate wraps around the urethra, the tube that carries urine out of the bladder. When the gland enlarges, it squeezes that tube.
HoLEP was developed in the 1990s as a more effective and potentially less costly surgery for urinary blockage caused by BPH. [1] It requires no cuts in the skin and offers a faster recovery than older open operations. [1]
What does HoLEP treat?
HoLEP treats urinary obstruction caused by benign prostatic hyperplasia (BPH), the most common reason urine flow becomes blocked in men. [1] BPH affects more than 60% of men over 60, and the chance of developing it rises with age. [1]
Common signs of BPH include: [1]
Difficulty starting to urinate
A weak urine stream
A stream that starts and stops
Burning during urination
Needing to urinate very often
Sudden urgency or leaking urine before reaching the bathroom
Who is a good candidate for HoLEP?
A good candidate for HoLEP is someone whose BPH symptoms are bothersome or who is at risk of complications such as urinary tract infections or bladder stones. [1] Not everyone with BPH needs surgery, and many people do well with medication and other treatments. [1]
HoLEP is especially effective for large prostates, but it can work for a prostate of any size. [1] Other procedures for BPH include transurethral incision of the prostate (TUIP), prostatic urethral lift and Aquablation. Your urologist can explain which option fits your prostate size and symptoms.
How do you prepare for HoLEP surgery?
Preparing for HoLEP starts with a medical history, a physical exam and tests that measure how severe the blockage is. [1]
Test | Why it is done |
Prostate exam | Checks the size and feel of the prostate [1] |
Post-void residual (bladder scan) | Measures how much urine stays in the bladder after urinating [1] |
PSA blood test and urinalysis | Screens blood and urine before surgery [1] |
Urine flow and volume tests | Show how strong and complete urination is [1] |
Transrectal ultrasound or CT scan | Measures the size of the prostate [1] |
Cystoscopy | A camera looks inside the urethra, prostate and bladder for cancer, infection or blockage [1] |
Urodynamic testing | Checks how well the bladder works and whether removing tissue is likely to help [1] |
Tell your doctor about every medication you take. You may need to stop some of them up to 10 days before surgery, and you cannot eat or drink after midnight the night before. [1]
How is HoLEP performed?
HoLEP is performed through the urethra under general anesthesia, or spinal anesthesia if general anesthesia is not suitable. [1] An antibiotic injection may be given to lower the risk of infection. [1]
The five main steps of HoLEP surgery.
The surgery follows these steps: [1]
Positioning. Once you are asleep, the team places you on your back with your legs raised.
Resectoscope insertion. The surgeon passes a resectoscope, a thin instrument with a camera, through the urethra to view the prostate.
Laser enucleation. A holmium laser fired through the resectoscope separates the blocking tissue from the prostate, and the same laser seals the blood vessels.
Tissue removal. A morcellator replaces the laser, breaks up the freed tissue in the bladder and suctions it out. The tissue goes to a lab to check for abnormalities such as prostate cancer.
Catheter placement. The surgeon removes the resectoscope and places a urinary catheter.
How long does HoLEP take, and how much of the prostate is removed?
HoLEP usually takes one to three hours, depending on your condition. [1] The surgeon typically removes about 50% to 60% of the total prostate volume, with the exact amount depending on how large the blockage is and how much the prostate presses on the urethra. [1]
What happens right after HoLEP surgery?
Right after HoLEP, most people spend a few hours in a recovery room and then go home with a catheter in place. [1] A few people stay in the hospital if there is concern about bleeding or other problems. [1]
Bladder flushing. Fluid is flushed through the catheter to clear blood from the urine. You can go home once the urine is clear pink or clear red. [1]
Catheter removal. The catheter usually comes out the day after surgery. If you can urinate two to three times afterward, you can carry on as normal. If you cannot, the catheter goes back in and is removed a few days later. [1]
Pain relief. Urination may be painful and more frequent at first; medications and over-the-counter pain relievers ease the discomfort. [1]
Fluids. Drinking plenty of fluids after the catheter comes out helps clear blood from the urine faster. [1]
What does the HoLEP recovery timeline look like?
The HoLEP recovery timeline runs from walking and driving the next day to most bladder symptoms settling over several months. [1]
Typical recovery milestones after HoLEP.
Time after surgery | What to expect |
Same day | Home after a few hours in recovery, with a catheter [1] |
Day 1 | Catheter usually removed; walking and driving allowed [1] |
Day 1 onward | Pelvic floor (Kegel) exercises may start to improve leakage [1] |
1 to 2 weeks | Most people return to work; physically demanding jobs may need longer [1] |
At least 2 weeks | No strenuous activity (running, heavy lifting) and nothing heavier than 10 pounds (about 4.5 kg) [1] |
6 weeks | No straddle activities such as cycling or riding a motorcycle or lawnmower [1] |
Several weeks to 3 months | Burning, light bleeding and blood in the urine gradually fade [1] |
Several months | Urgency, frequency and waking at night to urinate improve as the bladder adjusts [1] |
Your doctor will see you after surgery to repeat tests such as urine flow rate and a bladder scan, which show how well the surgery worked. [1] Pelvic floor exercises can reduce leakage when coughing, sneezing or lifting. [1]
What are the side effects of HoLEP?
The most common side effects of HoLEP are temporary burning and bleeding during urination, short-term leakage and dry ejaculation. [1]
Side effect | How long or how common |
Burning when urinating | Several weeks; normal [1] |
Up to three months while the prostate heals [1] | |
Urine leakage | Pads may be needed for a few days; usually improves within weeks. Long-term leakage is uncommon [1] |
About 75% of cases; little or no semen at orgasm [1] | |
Erections | Usually not affected [1] |
The risk of long-term leakage depends on age, prostate size, symptoms and other medical conditions. [1]
What are the risks and complications of HoLEP?
The main risks of HoLEP are injury to nearby urinary organs, infection, prolonged leakage and the general risks of anesthesia. [1]
Injury to the prostate, urethra, bladder or ureters
Urinary incontinence lasting longer than three months
Infection of the bladder, testicles or kidneys
Anesthesia risks, including blood clots, heart attack or aspiration
Bleeding heavy enough to need a blood transfusion
Needing a catheter for longer than 24 hours
About 5% to 15% of people learn they have prostate cancer when the removed tissue is examined. [1] Having HoLEP does not limit future prostate cancer treatment. [1] Few people develop blockage again and need a second surgery (about 4% at five years in one large study). [1]
What are the benefits of HoLEP?
The main benefits of HoLEP are the removal of a large amount of tissue without incisions, a short hospital stay and a low chance of repeat surgery. [1]
Large amounts of prostate tissue can be removed with no skin incisions
Excellent for large prostates and effective for any size
Minimal or no hospital stay
Lower risk of bleeding and blood transfusion
Lower risk of needing a repeat procedure
How does HoLEP compare with TURP?
HoLEP and transurethral resection of the prostate (TURP) both remove prostate tissue to treat BPH, but they differ in how the tissue is removed, which changes recovery, risks and cost. [1] HoLEP is less likely to need a blood transfusion or a repeat operation for regrowth. [1]
How HoLEP compares with TURP in pooled trial data.
Outcome | HoLEP compared with TURP |
Blood transfusion | 83% lower relative risk (risk ratio 0.17) [2] |
Catheter time | About 20 hours shorter [2] |
Hospital stay | About 25 hours shorter [2] |
Operating time | About 14 minutes longer [2] |
Urine flow and symptom scores at 12 months | Better with HoLEP [2] |
Repeat surgery for regrowth | Less likely with HoLEP [1] |
Only you and your healthcare team can decide which surgery suits you best, based on your condition. [1]
When should you call a doctor after HoLEP?
Call your doctor after HoLEP if you have any of these warning signs: [1]
Passing blood clots, or bright red urine that looks like tomato soup
Fever higher than 101°F (38.3°C)
Pain that does not ease with medication
Being unable to urinate (see urinary retention)
Conclusion
HoLEP is an effective, incision-free laser surgery for an enlarged prostate that suits glands of every size, including very large ones. Most people go home the same day, lose the catheter the next day and return to work within two weeks. Expect some burning, bleeding and urgency for weeks to months, and plan for dry ejaculation. Research supports its lower transfusion risk and shorter hospital stay compared with TURP, and symptom relief that lasts at five years.
Living with BPH symptoms? Start with our complete guide to benign prostatic hyperplasia (BPH): symptoms, causes and treatment, then take your questions to a urologist to find out whether HoLEP fits your prostate size and health.
FAQ
Is HoLEP a major surgery?
HoLEP is a minimally invasive surgery with no skin incisions and a low risk of complications compared with other operations for BPH. Like any surgery, it still carries risks, so discuss them with your urologist.
How long does HoLEP surgery take?
HoLEP surgery usually takes one to three hours, depending on your condition and the size of the blockage.
Do you stay in the hospital after HoLEP?
Most people go home after a few hours in a recovery room, with a catheter in place. A short hospital stay may be needed if there is concern about bleeding or other problems.
How long does the catheter stay in after HoLEP?
The catheter is usually removed the day after HoLEP. If you cannot urinate after removal, it is put back in and removed a few days later.
Is blood in the urine normal after HoLEP?
Blood in the urine is normal for several weeks after HoLEP and can last up to three months while the prostate heals. Call your doctor if you pass clots or your urine is bright red like tomato soup.
Does HoLEP affect erections or ejaculation?
Getting an erection is usually not a problem after HoLEP. In about 75% of cases, little or no semen comes out during orgasm, which is called retrograde ejaculation.
Can the prostate grow back after HoLEP?
Only a small share of people (about 4% at five years in one large study) develop urinary blockage again after HoLEP and need a second surgery. HoLEP is less likely than TURP to need a repeat operation.
When can you return to work after HoLEP?
Most people return to work one to two weeks after HoLEP, while people with physically demanding jobs may need longer. Avoid lifting more than 10 pounds for at least two weeks.
Who is a good candidate for HoLEP?
HoLEP may suit people with bothersome BPH symptoms or complications such as urinary infections or bladder stones. It works for a prostate of any size and is especially useful for large glands.
Will I leak urine after HoLEP?
Some short-term leakage is common after HoLEP and usually improves as you heal. Pelvic floor exercises can help, and you should tell your urologist if leakage does not get better.
Related Reading
Prostatectomy: Types, Surgery, Risks and Recovery explains prostate removal surgery and recovery.
References
Cleveland Clinic. Holmium Laser Enucleation of the Prostate (HoLEP). Cleveland Clinic. Last updated August 17, 2023. https://my.clevelandclinic.org/health/treatments/17917-holmium-laser-enucleation-of-the-prostate-holep
Li S, Zeng XT, Ruan XL, et al. Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis. PLoS One. 2014;9(7):e101615. PMID 25003963. https://doi.org/10.1371/journal.pone.0101615
Sun F, Yao H, Bao X, et al. The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis. American Journal of Men's Health. 2022;16(4):15579883221113203. PMID 35864746. https://doi.org/10.1177/15579883221113203
Droghetti M, Porreca A, Bianchi L, et al. Long-term outcomes of Holmium laser enucleation of prostate and predictive model for symptom recurrence. The Prostate. 2022;82(2):203-209. PMID 34694647. https://doi.org/10.1002/pros.24259
Medical disclaimer
This article is for general educational purposes and does not replace professional medical advice, diagnosis or treatment. Always talk with your doctor or a qualified urologist about your symptoms and treatment options before making any health decision.
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