Benign prostatic hyperplasia (BPH) refers to a condition in which the prostate gland enlarges abnormally. It commonly develops as men age, and when the enlarged prostate compresses the urethra, it can obstruct urine flow and cause a variety of urinary problems.
Holmium laser enucleation of the prostate (HoLEP) is one of the surgical treatments used to manage BPH. The procedure uses a holmium laser to remove the enlarged prostate tissue and relieve pressure on the urethra, thereby improving urine flow. Because HoLEP is performed through a minimally invasive approach, it places less physical burden on the patient. In addition, the laser allows both tissue removal and bleeding control at the same time, resulting in shorter recovery periods and a lower risk of complications.
HoLEP surgery may be particularly considered in certain clinical situations. One example is when BPH has already caused damage to bladder function, when there is a large amount of residual urine, or when the median lobe of the prostate is significantly enlarged.
If the bladder develops trabeculation—thickened folds inside the bladder caused by long-term obstruction—urination can become increasingly difficult. In such cases, performing HoLEP before bladder function deteriorates further is often recommended. After the procedure, patients typically experience improved peak urinary flow rates.
Another situation is when a patient has a large amount of residual urine after urination. When more than 100 mL of urine remains in the bladder, complications such as cystitis or decreased kidney function may develop. HoLEP surgery can improve peak urinary flow and significantly reduce residual urine volume in these cases.
A third example involves enlargement of the prostate’s median lobe. When the median lobe becomes significantly enlarged, it can severely compress the urethra and cause urinary obstruction. Procedures such as the prostatic urethral lift (UroLift) may not be effective in such cases, whereas HoLEP can remove the obstructing tissue and improve urinary flow.
Because HoLEP removes the enlarged portion of the prostate completely, it is highly effective in relieving urinary symptoms. The ability to cut and cauterize tissue simultaneously reduces bleeding during surgery and shortens the overall procedure time compared with traditional surgical techniques. Since the enlarged prostate tissue is removed entirely, the recurrence rate is also very low. In addition, the procedure is covered by national health insurance in Korea, making it relatively affordable for many patients.
Dr. Jo Jung-ho of Goldman Urology Clinic’s Gangnam branch explained that selecting the appropriate treatment for BPH depends on the patient’s health condition and specific needs. He advised that men who experience difficulty urinating should not dismiss it as a normal part of aging, but instead visit a urology clinic to receive proper evaluation and treatment.