Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in BPH Management?



Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer


In summary, HoLEP is an independent gland size technique for managing BPH, which has some advantages including shorter catheterization time and hospital stay, fewer bleeding, a lower complication and reoperation rate. While operation time in HoLEP is often longer than TURP and OP, when analyzed by the grams of tissue removed per unit time, HoLEP is equivalent to OP and better than TURP. Despite some drawbacks including a steep learning curve, high cost and longer operation time, HoLEP can be used as a suitable alternative for any methods in different situations.