Benign prostatic hyperplasia (BPH) is a common condition in middle-aged and older men, where the enlarged prostate compresses the urethra, causing various urinary problems. While medication can manage symptoms initially, surgical treatment is necessary when the prostate is large or medication is ineffective. Among surgical options, HoLEP (Holmium Laser Enucleation of the Prostate) is a preferred treatment, using a holmium laser to completely remove hyperplastic prostate tissue with minimal bleeding, quick recovery, and excellent therapeutic effects.
According to a 2024 study published in World Journal of Urology, the effectiveness of HoLEP surgery varies significantly with the physician's experience. When one physician analyzed 500 patients, the average surgery time for the first 100 patients was 67 minutes, while it decreased to 43 minutes for the last 100 patients. This doesn't simply mean faster surgery speed. It also positively affects patient safety and prognosis, including reduced bleeding, faster recovery, and lower complication risks.
Particularly, as the time to remove the prostate decreases, the patient's systemic burden reduces and post-operative recovery proceeds faster. The total laser energy used also decreases with experience, efficiently achieving the same effect with less energy. This shows why the physician's technique and proficiency are as important as equipment performance.
Additionally, while various laser surgery techniques and energy sources are being introduced, the research shows that the surgeon's proficiency has a greater impact on results than which technique is used.
BPH cannot be judged simply by prostate size alone. The size of hyperplastic tissue, its location and pattern, the degree of lower urinary tract symptoms, changes in bladder or kidney function, presence of complications, disease duration, and previous treatment history must all be comprehensively considered. When surgery is deemed necessary, the optimal surgical method should be selected for each individual patient based on these various factors.
This is achievable when supported by a system capable of all surgical treatments and diverse clinical experience. Major BPH surgical methods include HoLEP, UroLift, Aquablation (waterjet robotic surgery), iTIND, and Rezum.
BPH surgery is a complex medical procedure beyond simply "removing with laser." Since each patient has different prostate size, shape, and symptom severity, a customized approach based on sufficient experience is important.
Dr. Kyung-ho Ryu, Director of Goldman Urology Clinic Gangnam, stated: "For surgeries with long learning curves like HoLEP, the physician's experience directly affects patient recovery speed and surgical satisfaction. Since experienced proficiency is not coincidental but a result of accumulated time and effort, when considering BPH surgery, it's wise to carefully examine not only the surgical technique but also the physician's experience and cumulative case numbers."