Benign prostatic hyperplasia (BPH) is a common condition that occurs in men after middle age. As the prostate enlarges, it compresses the urethra and causes various urinary symptoms. In the early stage, symptoms can often be managed with medication, but when the prostate becomes significantly enlarged or when patients do not respond to medication, surgical treatment may be required. Among the available options, holmium laser enucleation of the prostate (HoLEP) is widely preferred by patients because it removes the enlarged prostate tissue completely using a holmium laser, while offering minimal bleeding, faster recovery, and strong treatment effectiveness.
According to a study published in the *World Journal of Urology* in 2024, the effectiveness of HoLEP surgery varies significantly depending on the surgeon’s experience. In an analysis involving 500 patients performed by a single surgeon, the average operation time for the first 100 cases was 67 minutes, while the last 100 cases were completed in 43 minutes. This difference represents more than just an improvement in surgical speed. It also reflects factors that directly influence patient safety and outcomes, including reduced bleeding, faster recovery, and a lower risk of complications.
As the time required to remove the prostate tissue decreases, the overall physical burden on the patient is reduced and postoperative recovery tends to proceed more quickly. The total amount of laser energy used during surgery also tends to decrease as surgical experience accumulates, allowing surgeons to achieve the same therapeutic effect more efficiently with less energy. This highlights why the surgeon’s technique and experience are just as important as the performance of the equipment itself.
Although various laser surgical techniques and different energy sources have been introduced, the study concluded that the surgeon’s level of experience has a greater impact on the outcome than the specific surgical technique used.
BPH cannot be evaluated based solely on prostate size. In addition to the size of the enlarged tissue, factors such as its anatomical location and growth pattern, the severity of lower urinary tract symptoms, changes in bladder or kidney function, the presence of complications, disease duration, and previous treatment history must all be considered. When surgery is deemed necessary, the most appropriate procedure should be selected based on these comprehensive clinical factors.
Achieving this requires a treatment system capable of performing all available surgical options along with extensive clinical experience. Major surgical treatments for BPH include HoLEP, prostatic urethral lift (UroLift), Aquablation (robotic waterjet surgery), iTIND, and the Rezum system.
BPH surgery is therefore more than simply removing prostate tissue with a laser. Because the size and shape of the prostate and the severity of symptoms vary from patient to patient, a personalized treatment approach based on extensive clinical experience is essential.
Dr. Ryu Kyung-ho of Goldman Urology Clinic Gangnam Branch explained that for procedures such as HoLEP, which involve a long learning curve, the surgeon’s experience directly influences the patient’s recovery speed and overall satisfaction with the surgery. He emphasized that such experience is the result of time and accumulated effort rather than coincidence, and advised that patients considering surgery for BPH should carefully evaluate not only the surgical technique but also the physician’s experience and cumulative case volume.