Benign prostatic hyperplasia (BPH) is a common condition that develops in men as they age. It occurs when the prostate enlarges abnormally and compresses the urethra, leading to urinary difficulties. A normal prostate weighs about 20 grams, but as enlargement progresses it can exceed 100 grams, and in severe cases develop into a very large prostate reaching up to 200 grams. At this stage, symptoms such as a feeling of incomplete bladder emptying, frequent urination, nocturia, and decreased urinary flow may occur, significantly affecting daily life. If left untreated, it may also lead to complications such as reduced bladder function, urinary retention, or even impaired kidney function.
One of the treatments gaining increasing attention for BPH is HoLEP (Holmium Laser Enucleation of the Prostate). HoLEP is a modern endoscopic surgical technique that uses a holmium laser to remove enlarged prostate tissue. Unlike the traditional transurethral resection of the prostate (TURP), HoLEP can be applied to very large prostates, including those exceeding 100 grams, which has contributed to its growing clinical importance.
The holmium laser has a high absorption rate in water and a shallow depth of energy penetration, which minimizes damage to surrounding tissues. This allows surgeons to precisely separate and remove the enlarged prostate tissue along the natural boundary between the prostate capsule and the hyperplastic tissue. Because the laser simultaneously cuts and coagulates blood vessels, bleeding during surgery is minimal and the surgical field remains clear.
HoLEP is a minimally invasive procedure performed using an endoscope without the need for open surgery. As a result, recovery is relatively fast and the length of hospital stay is typically short. In many cases, the urinary catheter can be removed the day after surgery, and most patients are discharged within a few days. One of the most significant advantages of HoLEP is that it can safely remove even extremely large prostates of up to 200 grams, whereas the traditional TURP procedure is limited by prostate size.
Because bleeding is minimal, HoLEP is also suitable for elderly patients or those with chronic conditions such as hypertension or diabetes, and blood transfusion is rarely required. The procedure has a low recurrence rate, and the removed tissue can be examined through pathological testing to detect possible conditions such as prostate cancer. In addition, complications such as urinary incontinence or erectile dysfunction have been reported in less than 1% of cases, demonstrating its high level of safety.
The procedure is also covered by national health insurance, which helps reduce the financial burden on patients. In many cases, it may be more efficient in the long term than continuing medication indefinitely. Surgical treatment may be considered if symptoms do not improve with medication, if significant residual urine remains after urination, or if urinary retention occurs repeatedly.
Dr. Kim Byung-hoon of Goldman Urology Clinic’s Incheon branch explained that HoLEP has become a representative treatment for BPH because it can safely and effectively restore urinary function regardless of prostate size or patient age. He added that if urinary discomfort persists or nocturia disrupts sleep, patients should visit a urology specialist to receive an accurate diagnosis and appropriate treatment.