HoLEP / ThuLEP: a durable BPH surgery—when the goal is definitive obstruction relief
HoLEP (Holmium Laser Enucleation of the Prostate) and ThuLEP (Thulium Laser Enucleation of the Prostate) are modern endoscopic surgeries for BPH. They aim to remove the obstructing prostate tissue effectively through the urinary passage, without an external incision. Patients usually consider HoLEP/ThuLEP when: symptoms are significant, or complications of obstruction are emerging, or prostate anatomy/size suggests that a more definitive approach is appropriate.
Quick navigation
What HoLEP/ThuLEP are
Both HoLEP and ThuLEP are laser enucleation procedures. In plain language: a scope is passed through the urethra (no skin cut), laser energy is used to separate ('enucleate') obstructing prostate tissue from its capsule, the tissue is removed from the bladder, the urinary channel is opened more definitively. Conceptually, this is closer to 'removing the obstructing core' than simply 'trimming the channel.'
Who is a good candidate
HoLEP/ThuLEP are often considered when: BPH symptoms are moderate to severe, medicines are no longer adequate or tolerated, there is high residual urine, recurrent retention, or catheter dependence, recurrent infections are occurring due to incomplete emptying, the goal is a more definitive, durable relief. These procedures are also highly operator-dependent. Outcomes are best when performed by experienced teams—at MyDocsy, we have India's best urologists who are mostly Heads of departments at top hospitals.
When HoLEP/ThuLEP are often preferred
HoLEP/ThuLEP may be favoured when: prostate enlargement is more substantial and a durable clearance approach is desired, the patient has had long-standing obstruction with high residual urine, there is a history of retention or catheterization, there is need to minimize the chance of incomplete relief.
Pre-procedure evaluation (tests that matter)
1) Symptom assessment + objective markers
Symptom score and impact on sleep/life, retention episodes, catheter history, infection history.
2) Urine tests
Microscopy, culture if indicated.
3) Ultrasound with post-void residual
Helps assess: degree of incomplete emptying, bladder changes, kidney impact, prostate size approximation.
4) PSA in context
PSA is interpreted carefully with clinical context.
5) Additional evaluation (selected cases)
Uroflowmetry, cystoscopy in selected cases, anesthesia fitness assessment, blood thinner management planning if relevant.
What happens during the procedure
In general: Anesthesia is given as per clinical plan. A scope is passed through the urethra into the prostate channel. Laser is used to enucleate obstructing tissue. Tissue is removed from the bladder. A catheter is placed afterward to allow drainage and manage postoperative bleeding risk. You are monitored for urine clarity, comfort, and voiding stability.
Catheter and hospital stay
Most men should expect: catheter use after surgery, a short hospital stay (often at least overnight), depending on bleeding, comfort, and comorbidities. Catheter duration varies by: intraoperative findings, urine clarity and bleeding tendency, baseline bladder function, center protocols.
Expected benefits and timelines
Early phase (days to weeks)
Burning and urinary frequency can occur during healing. Mild blood in urine can occur initially. Stream often improves relatively early. Nocturia and urgency may take longer if bladder has been irritated by long-standing obstruction.
Stabilization (weeks to months)
Many men notice: stronger stream, less straining, improved emptying, reduced sleep disruption. Durability is one of the common reasons these procedures are selected.
Risks and side effects
Possible risks include: bleeding (usually monitored and controlled), infection, temporary urinary irritation symptoms, temporary urinary leakage during early healing in some cases, sexual side effects (varies by individual), need for re-intervention is generally low, anesthesia-related risks. A good program includes proactive counseling on pelvic floor recovery if temporary leakage occurs.
HoLEP/ThuLEP vs TURP vs PAE vs Rezum
HoLEP/ThuLEP
Endoscopic laser enucleation. Definitive obstruction relief in appropriate settings. Strong durability profile when done well.
TURP
Established endoscopic resection. Predictable relief in suitable size/anatomy. Often used widely and effectively.
PAE
Minimally invasive vascular approach. Gradual improvement; anatomy-dependent. Useful for selected candidates.
Rezum
Minimally invasive steam therapy. Gradual improvement; healing-phase symptoms. Anatomy-dependent candidacy.
FAQs
Talk to a doctor / plan your HoLEP or ThuLEP
For an enucleation candidacy review, share: ultrasound report (prostate size + post-void residual), urine report, PSA history, symptom pattern and retention history, medications (especially blood thinners). We will guide you: whether HoLEP/ThuLEP is a good fit, whether TURP, PAE, or Rezum would be better aligned, what recovery timeline is realistic, and how to plan a smooth post-procedure course.
