Benign prostatic hyperplasia (BPH) is one of the most common urologic conditions affecting middle-aged and older men. As men age, the prostate naturally increases in size. When the enlarged prostate compresses the urethra, it can lead to urinary symptoms such as a weak urinary stream, a feeling of incomplete bladder emptying, frequent urination, nighttime urination, and urinary urgency. Many people consider these symptoms a natural part of aging and tend to tolerate them. However, if left untreated, BPH can progress to complications such as urinary tract infections, decreased bladder function, and kidney problems.
A normal prostate typically weighs around 20 grams. In patients with BPH, however, the prostate can enlarge beyond 100 grams, and in some cases it may grow to 150 or even 200 grams. According to statistics from the Health Insurance Review and Assessment Service, the number of patients diagnosed with BPH exceeded 1.58 million in 2024, with a sharp increase observed among men over the age of 50. During seasonal transitions, when sudden temperature changes stimulate the sympathetic nervous system, urinary symptoms may worsen, leading more patients to seek medical care.
Treatment depends on the severity of symptoms and the size of the prostate. In the early stages, medications such as alpha-blockers and 5-alpha reductase inhibitors are commonly used to relieve urinary symptoms and slow prostate enlargement. However, surgical treatment may be considered when medication fails to control symptoms, when post-void residual urine remains above 300 mL, when urinary difficulty becomes severe, or when acute urinary retention repeatedly occurs and catheterization becomes necessary. In such cases, surgery can be an important step to preserve bladder function.
In the past, open prostate surgery was considered the primary definitive treatment for severe cases. Later, transurethral resection of the prostate (TURP) became widely used, but it showed limitations in patients with large prostates exceeding 80cc due to concerns about bleeding and the extent of tissue removal. To overcome these limitations, holmium laser enucleation of the prostate, known as HoLEP, has become widely recognized as a standard surgical option in modern urology.
HoLEP uses a high-powered holmium laser to precisely separate and remove enlarged prostate tissue. Because the laser simultaneously cuts and coagulates tissue, bleeding is minimal. The procedure is performed endoscopically as a minimally invasive surgery, allowing faster recovery compared to traditional open surgery. Despite being minimally invasive, it can achieve a level of tissue removal comparable to open prostatectomy while placing less physical burden on the patient.
The advantages of HoLEP become particularly evident in patients with large prostates. It can be applied even in cases where the prostate exceeds 100 grams and, in some instances, reaches 150 or 200 grams. In situations where patients might previously have been advised to undergo robotic or open surgery at large tertiary hospitals, HoLEP now provides a minimally invasive alternative with reliable outcomes.
Clinical outcomes have also demonstrated meaningful improvements. In some cases, patients who did not respond well to long-term medication experienced a significant improvement in urinary flow after surgery, with maximum flow rates recovering to around 23.8 mL/sec and a noticeable reduction in urinary discomfort. Even in patients with acute urinary retention, precise removal of prostate tissue protruding into the bladder can help restore urination relatively quickly. Temporary urinary incontinence may occur in a small number of cases, but most patients recover, and the rate of persistent incontinence is reported to be less than 1 percent. In addition, the procedure is covered by national health insurance in Korea, which helps reduce financial burden. Because a substantial portion of prostate tissue is removed, prostate-specific antigen (PSA) levels often decrease, and long-term recurrence rates are considered relatively low.
Like any surgical procedure, HoLEP also has aspects that require consideration. One of the most common postoperative effects is retrograde ejaculation, in which semen flows backward into the bladder instead of exiting through the urethra during ejaculation. Although it does not pose a serious health risk, it can affect sexual satisfaction for some patients. For this reason, treatment decisions should involve careful consultation that considers the patient’s age, expectations regarding sexual function, and lifestyle.
Dr. Ryu Je-man of Goldman Urology Clinic’s Seoul Station branch explained that when BPH causes patients to wake multiple times during the night to urinate, feel incomplete bladder emptying, or experience anxiety about leaving home due to urinary symptoms, it may already indicate that their quality of life is being significantly affected. He emphasized that for patients with large prostates exceeding 70cc, the choice of surgical method can influence long-term outcomes. Rather than dismissing urinary symptoms as a normal part of aging, patients are encouraged to seek professional evaluation and develop an appropriate treatment strategy with a specialist to protect both daily stability and overall quality of life.