Cases of HoLEP (Holmium Laser Enucleation of the Prostate), a surgical treatment for benign prostatic hyperplasia (BPH), are rapidly increasing in clinic-level medical institutions. According to health authority statistics, the number of HoLEP procedures performed in clinics rose from 676 cases in 2020 to 1,517 cases in 2023, representing an increase of nearly 2.2 times.
BPH is a common urologic condition among middle-aged and older men. It occurs when the prostate enlarges and compresses the urethra, leading to urinary difficulties. If symptoms worsen, the condition can significantly reduce quality of life and may also lead to secondary health problems such as decreased bladder function, urinary tract infections, and kidney damage. HoLEP surgery is a minimally invasive procedure that uses a holmium laser to remove enlarged prostate tissue entirely. Because the laser allows both tissue removal and bleeding control at the same time, the procedure typically results in less bleeding, faster recovery, and a relatively low risk of urinary incontinence, reducing the overall burden on patients.
Dr. Kim Tae-heon of Goldman Urology Clinic’s Seoul Station branch explained that in 2023 alone, Goldman Urology Clinic performed 619 HoLEP procedures, accounting for 40.8 percent of all HoLEP surgeries performed in clinic-level institutions. This figure also represents approximately 4.87 percent of all BPH surgeries performed nationwide. He noted that the increase in HoLEP procedures at clinics is driven by the presence of experienced surgeons, advanced surgical infrastructure, and a growing number of patients seeking precise diagnosis and treatment for BPH.
One of the most important points is that patients should not simply endure symptoms. Instead of assuming urinary symptoms are a normal part of aging, individuals should visit a urology clinic for proper evaluation. If necessary, personalized treatment options—including HoLEP surgery—should be considered to improve quality of life.
Certain patients may benefit particularly from HoLEP surgery. One example is when bladder function has already begun to deteriorate. In some BPH patients, cystoscopy reveals trabeculation, or ridges, inside the bladder wall, which can indicate declining bladder function. In such cases, surgery should ideally be considered before significant bladder dysfunction develops.
Another indication is a large amount of residual urine remaining in the bladder. Excess residual urine can increase the risk of cystitis and reduced kidney function. HoLEP surgery can help resolve residual urine problems while also improving maximum urinary flow rate.
A third case involves enlargement of the prostate’s middle lobe. Even when the overall prostate size is relatively small, the middle lobe may protrude into the bladder and compress the urethra. In such situations, procedures like prostatic urethral lift may be less effective, making HoLEP a more suitable option.
HoLEP surgery may also be effective for patients with elevated PSA (prostate-specific antigen) levels, narrowing of the bladder neck, or significant protrusion of the prostate into the bladder or urethra.
Dr. Kim added that BPH is often mistakenly regarded as a normal aging process, but when urinary symptoms interfere with daily life, active treatment should be considered. He also noted that HoLEP surgery has recently shown successful outcomes regardless of prostate size and can even be applied to patients with extremely enlarged prostates approaching 200 grams, demonstrating stable and reliable results.