HoLEP (Holmium Laser Enucleation of the Prostate) surgery has become widely used as an effective treatment option for benign prostatic hyperplasia (BPH) in middle-aged and older men. One of its key advantages is that it can be applied even in cases of significantly enlarged prostates, including those measuring over 70cc and sometimes reaching 150–200cc.
BPH is a urologic condition in which the prostate enlarges and compresses the urethra, leading to urinary difficulties. If not treated in time, it can lead to complications such as urinary tract infections, decreased bladder function, and kidney damage. HoLEP surgery uses a laser to remove the enlarged prostate tissue entirely while simultaneously providing effective hemostasis. As a result, bleeding is minimal, recovery is relatively fast, and the risk of urinary incontinence is low.
Another advantage is that HoLEP can provide results comparable to open prostate surgery. Traditional open surgery removes a large portion of the enlarged prostate, which is effective in reducing recurrence risk. However, it often involves significant bleeding, longer hospitalization, and visible surgical scars on the lower abdomen. HoLEP reduces these burdens by removing the enlarged prostate tissue without open surgery while still achieving a similar level of effectiveness, even in patients with very large prostates.
In addition to patients with large prostate glands, HoLEP may be particularly beneficial for individuals who are beginning to show signs of bladder dysfunction, those with significant post-void residual urine, or those with a prominent median lobe that compresses the urethra. It may also be recommended in cases where prostate-specific antigen (PSA) levels are elevated or when bladder neck narrowing is present. When bladder trabeculation—wrinkling of the bladder wall—is observed, performing HoLEP earlier can help prevent further deterioration of bladder function. Since residual urine can lead to bladder infections and kidney dysfunction, improving urinary flow through surgery can be an important therapeutic goal.
There are also factors patients should be aware of. Although HoLEP is not associated with erectile dysfunction, it may lead to retrograde ejaculation, a condition in which semen flows backward into the bladder during ejaculation. While this does not pose a physiological health risk, it may affect the sensation of ejaculation and overall sexual satisfaction.
For this reason, treatment planning should consider how important the preservation of ejaculatory function is for each patient. A personalized surgical strategy should be developed by carefully evaluating the patient’s age, lifestyle, and treatment goals.
Dr. Lee Chang-gi of Goldman Urology Clinic’s Incheon branch explained that when urinary symptoms begin to interfere with daily life, patients should seek professional evaluation and consider surgical treatment if necessary. He added that in cases where the prostate volume exceeds 70cc, HoLEP surgery can provide stable and reliable outcomes.