Benign prostatic hyperplasia (BPH) — non-cancerous enlargement of the prostate — is among the most prevalent conditions in men over 50. By age 60, over 50% of men have histological evidence of BPH; by 85, that figure approaches 90%. The prostate surrounds the urethra, and as it enlarges, it compresses the urinary channel, causing lower urinary tract symptoms: slow stream, hesitancy, frequency, nocturia, and a sense of incomplete emptying.
HoLEP — Holmium Laser Enucleation of the Prostate — is widely regarded as the surgical gold standard for BPH, irrespective of prostate size. Using a holmium laser delivered through a resectoscope, the surgeon enucleates the entire obstructing adenoma in distinct anatomical planes. The enucleated tissue is then morcellated and retrieved for histological analysis. The key advantage over TURP is completeness: HoLEP removes more obstructing tissue, resulting in superior urinary flow rates, lower retreatment rates, and durable outcomes.
Clinical data supports HoLEP's durability: retreatment rates at 10 years remain under 2%, compared to 10-15% for TURP. Blood loss is minimal — HoLEP is safely performed in patients on anticoagulants. The procedure is transurethral (no external incisions), catheterisation time is typically 24 hours, and most patients are discharged the following morning. Urinary function improves progressively over 4-8 weeks as post-operative irritative symptoms resolve.
The principal objection to HoLEP historically has been the learning curve — it requires approximately 50-70 cases to achieve proficiency. However, in experienced hands, it represents the most complete and durable surgical treatment for BPH available. All resected tissue is also sent for histology, providing the added benefit of incidental detection of prostate cancer in a proportion of patients.