Benign prostatic hyperplasia (BPH) is a common urological condition among middle-aged and older men, characterized by urinary symptoms such as urgency, a sensation of incomplete bladder emptying, and frequent nighttime urination. If treatment is delayed, the condition may lead to complications including urinary tract infections, decreased bladder function, and even kidney damage. In the past, when symptoms became severe, open surgery was often considered the only definitive treatment. However, due to concerns about bleeding risk, long hospital stays, and surgical scars, many patients hesitated to undergo the procedure.
In recent years, holmium laser enucleation of the prostate (HoLEP) has emerged as a widely recognized standard treatment in the field of urology. HoLEP uses a high-powered holmium laser to precisely remove enlarged prostate tissue while simultaneously controlling bleeding. As a result, the procedure is associated with minimal blood loss, faster recovery, and a lower rate of complications such as urinary incontinence. From the patient’s perspective, HoLEP offers results comparable to open surgery without the need for a large surgical incision.
HoLEP is particularly notable for its effectiveness in treating large prostate enlargement. When the prostate size exceeds approximately 70 cc, conventional endoscopic procedures can become technically difficult. In cases of extremely large prostates weighing more than 150 grams, patients were often advised to undergo more invasive treatments such as robotic surgery or open surgery at tertiary hospitals. However, HoLEP has demonstrated excellent outcomes even in these cases. In fact, it is often considered one of the few minimally invasive techniques capable of safely removing very large prostate tissue.
Another advantage of HoLEP is that it is covered by national health insurance, allowing patients to receive an effective and definitive treatment at a reasonable cost. In addition to reducing prostate size, the procedure can also lower prostate-specific antigen (PSA) levels, which may contribute to better long-term prostate health management.
Nevertheless, certain considerations remain. One potential side effect of HoLEP is retrograde ejaculation, a condition in which semen flows backward into the bladder rather than exiting through the urethra. While this does not affect erectile function, it may influence sexual satisfaction for some patients. Therefore, when deciding on surgery, it is important to develop a personalized treatment strategy that takes into account the patient’s age, lifestyle, and priorities regarding the preservation of sexual function.
Dr. Kim Jae-woong of Goldman Urology Clinic’s Gangnam branch emphasized that patients experiencing urinary symptoms that interfere with daily life should seek medical evaluation without delay. He noted that for patients with large prostates measuring over 70 cc, HoLEP surgery has proven to be a safe and effective solution capable of delivering stable clinical outcomes.