Holmium laser enucleation of the prostate (HoLEP) at Nuffield Health at St Bartholomew's Hospital

The prostate gland is part of the male reproductive system. It surrounds the tube that carries urine from the bladder. The gland is the size of a walnut and also produces some of the fluid that makes up semen. If something goes wrong with the prostate gland it can affect your sex life, or cause difficulties with passing urine.

It is normal for the prostate to grow larger as you age. However, if the gland tightens around the urethra it can interrupt the flow of urine from your bladder.

If conservative treatment for your enlarged prostate is not successful, your consultant may recommend Holmium Laser Enucleation of the prostate (HoLEP).

What happens during HoLEP?

The surgery may be done under general or spinal anaesthetic and usually takes from 45-120 minutes depending on the size of your prostate. You may be required to stay one night in hospital.

Your surgeon will insert a resectoscope (a small operating telescope with a light) into your urethra (the tube that carries urine from you bladder to your penis). A laser is inserted through this instrument. High pulse laser energy will be directed on your prostate, freeing it and removing any tissue that is obstructing your urethra. The prostate tissue will be removed from your bladder using another instrument called a morcellator. Some of the removed tissue will be sent to a lab for analysis.  A catheter will be placed in your bladder to drain your urine. This will be removed before you are discharged from hospital. In some cases you may be discharged with the catheter in place. This will be removed at a later date.

Going home after HoLEP

You will not be able to drive so please arrange for someone to take you home on the day of discharge.

It is normal to have blood in your urine following this procedure. Be sure and drink plenty of water.

You may still experience difficulty in passing urine or a burning sensation when passing urine. You may also see an increase in urgency and frequency of passing urine. These symptoms will ease over the next few weeks. If your symptoms increase or you experience heavy bleeding contact your GP.

You may be given pelvic floor exercises to do to help you control your bladder. Continue these as directed.

Most men can return to normal activities about a week after having HoLEP. Be sure and discuss this with your surgeon.

As with any surgical procedure there could be complications including:

• Bleeding
• Blood clots (deep vein thrombosis – DVT)
• Pain
• Difficulty passing urine

Specific complications of HoLEP may include:

• Increase in urinary frequency and urgency
• Erectile dysfunction
• Urinary infection
• Infertility
• Prostate regrows.