Holmium Laser Enucleation of the Prostate (HoLEP)

This guide explains what to expect before, during, and after holmium laser enucleation of the prostate (HoLEP) — a minimally invasive treatment for an enlarged prostate. Reading it ahead of your surgery can help you feel prepared and know what to ask your urologist.

About Your Prostate and BPH

The prostate is a walnut-sized gland that sits just below the bladder and wraps around the urethra — the tube that carries urine out of the body. With age, the prostate commonly enlarges. This condition is called benign prostatic hyperplasia, or BPH. It is not cancer, but the extra tissue squeezes the urethra and obstructs urine flow.

Common Symptoms

• • A weak or interrupted urine stream
  • Difficulty starting urination
  • Frequent trips to the bathroom, especially at night
  • A sense of incomplete bladder emptying
  • Sudden, hard-to-control urges to urinate

Over time, the bladder muscle has to push harder against the obstruction. It can become either irritable (giving you sudden urges) or weakened (failing to empty). For many men, these symptoms significantly affect daily life, sleep, and confidence.

The prostate is a walnut-sized gland that sits just below the bladder and wraps around the urethra — the tube that carries urine out of the body. With age, the prostate commonly enlarges. This condition is called benign prostatic hyperplasia, or BPH. It is not cancer, but the extra tissue squeezes the urethra and obstructs urine flow.

Common Symptoms

• • A weak or interrupted urine stream
  • Difficulty starting urination
  • Frequent trips to the bathroom, especially at night
  • A sense of incomplete bladder emptying
  • Sudden, hard-to-control urges to urinate

Over time, the bladder muscle has to push harder against the obstruction. It can become either irritable (giving you sudden urges) or weakened (failing to empty). For many men, these symptoms significantly affect daily life, sleep, and confidence.

What Is HoLEP?

HoLEP uses a high-powered holmium laser to remove the obstructing inner portion of the prostate from inside the body. No skin incisions are made. A slender scope is passed through the urethra to reach the prostate, where the laser carefully separates the inner tissue from the outer capsule — much like scooping the fruit out of an orange and leaving the peel intact.

A device called a morcellator then breaks up and removes the freed tissue through the scope. The outer prostate capsule heals into a wide, open channel that allows urine to flow freely. The removed tissue is sent to a pathologist to check for cancer or other findings.

Who Is HoLEP For?

HoLEP can treat a prostate of nearly any size. It may be a good option for you if you have:

• • Bothersome urinary symptoms from BPH
  • A weak bladder along with BPH
  • BPH that has returned or did not improve with prior treatment
  • Bladder stones or other urinary problems that can be treated at the same time
  • Urinary blockage due to prostate cancer (note: HoLEP relieves the obstruction but does not treat the cancer itself)

Benefits of HoLEP

• • Durable results — most patients do not need further BPH treatment
  • Effective for very large prostates that might otherwise require open surgery
  • Short catheter time, often less than 24 hours
  • Lower bleeding risk; generally safe even for many patients on blood thinners
  • Faster recovery than traditional BPH surgery; many return to normal activity within 1–2 weeks

During the Procedure

You will be under general or spinal anesthesia. The urologist passes a thin scope through your urethra and uses the laser to enucleate (free) the inner prostate tissue from the surgical capsule. The freed pieces fall into the bladder, where the morcellator collects and removes them.

At the end of the procedure, a urinary catheter is placed to drain the bladder while the area heals. HoLEP typically takes between 45 minutes and 3 hours, depending on prostate size.

After the Procedure

Most patients go home the same day. Some stay overnight depending on the case. The catheter is usually removed before discharge or the following morning in the urology clinic.

What to Expect at Home

• • Blood in urine: Some pink or red coloration is normal for 1–2 weeks. It may last longer if you take blood thinners. Drinking plenty of water helps clear it.
  • Burning with urination: Common in the first days to weeks; improves on its own.
  • Mild pelvic discomfort: Usually manageable with over-the-counter pain relievers.
  • Urinary leakage (incontinence): Often temporary. Most men improve substantially over the course of weeks, with continued gains for several months.
  • Frequent urination and urgency: Your bladder needs time to readjust to flowing freely again.

Activity Restrictions

Gradually easing back into activity is one of the best ways to support healing.

• • Week 1-2: Rest. Do not lift more than 15 pounds (about 6.8 kg).
  • Week 3: Light activity — about half of your usual exercise level.
  • Week 4: Return to your usual activities as tolerated.
  • For 1 month: Avoid biking, horseback riding, motorcycle riding, and other activities that put prolonged pressure on the perineum.

Retrograde Ejaculation

Almost all men have retrograde (or “dry”) ejaculation after HoLEP. This means semen flows backward into the bladder during orgasm and is passed out later with urine, rather than coming out through the penis.

Your erections and the sensation of orgasm typically feel the same. Most men report no change in pleasure; a small number say it feels slightly different. This change is permanent because the enucleated prostate no longer generates the pressure needed to direct ejaculation forward. It does not affect your health.

Caring for Your Bladder

Incontinence after HoLEP is usually temporary. Your pelvic floor muscles — which help control urine flow — may have weakened over the years due to BPH. Now that the obstruction is gone, they need to do more of the work again. Pelvic floor (Kegel) exercises help strengthen them.

Tips for the First Few Weeks

• • Wear an absorbent pad or brief if it helps your confidence — most men find they stop needing one as the weeks go on.
  • Stay well-hydrated. Cutting back on fluids can irritate the bladder and worsen leakage. Aim for about 2 liters (eight 8-oz glasses) of water daily unless your urologist tells you otherwise.
  • Limit caffeine, alcohol, and carbonated drinks while healing, since these can irritate the bladder.
  • Empty your bladder on a regular schedule rather than waiting until you feel urgency.

Pelvic Floor (Kegel) Exercises

The pelvic floor is a hammock of muscles between the pubic bone and the tailbone. It supports the bladder and rectum and helps control urination, bowel function, and erections.

Finding the Right Muscles

• • While urinating, briefly try to stop the stream. The muscles you feel tightening are the ones to target. (Do this only once to identify the muscles — do not make stopping mid-stream a habit.)
  • Sitting in a chair, imagine drawing your scrotum slightly upward, toward your belly button.
  • Squeeze as if you were holding back gas.

The “Rule of 5s”

• • 5 sets of Kegel exercises per day
  • 5 contractions per set
  • 5 seconds each (squeeze for 5 seconds, then relax for 5 seconds)

Tips for Good Form

• • Breathe normally — do not hold your breath.
  • Keep your buttocks, thighs, and abdomen relaxed.
  • Fully relax between contractions. The release phase matters as much as the squeeze.
  • Quality over quantity. A few focused, well-targeted reps are more useful than many rushed ones.

Start gentle Kegels as soon as you feel comfortable after surgery — usually after the catheter is out. Improvement typically appears over several weeks of consistent practice.

When to Call Tulane Urology

Follow-Up

A follow-up visit is typically scheduled around 3 months after surgery. You will have a prostate-specific antigen (PSA) blood test at that visit to establish a new baseline. If you have no new or worsening symptoms after that, no additional routine visits are needed.