A man in his early 60s had been experiencing urinary frequency, nocturia, and a persistent sensation of incomplete emptying for several years. Initially, he considered these symptoms a normal part of aging. However, as his urinary stream weakened and voiding time became prolonged, his daily life began to be affected. He eventually sought medical attention and was diagnosed with benign prostatic hyperplasia (BPH). When medication provided only limited relief, he was advised to consider surgery. He chose holmium laser enucleation of the prostate (HoLEP), a procedure known for its quick recovery and low recurrence rate.
BPH is a common condition in middle-aged and older men, in which the enlarged prostate compresses the urethra and causes various lower urinary tract symptoms. While medications can help manage symptoms in the early stages, surgical treatment becomes necessary when the prostate is significantly enlarged or when medical therapy is ineffective. Among surgical options, HoLEP is widely preferred because it removes the enlarged prostate tissue completely using a holmium laser, resulting in minimal bleeding, faster recovery, and excellent long-term outcomes.
According to a study published in the World Journal of Urology in 2024, the effectiveness of HoLEP varies significantly depending on the surgeon’s experience. In an analysis of 500 patients performed by a single surgeon, the average operative time decreased from 67 minutes in the first 100 cases to 43 minutes in the last 100 cases. This improvement reflects more than just increased speed. It is associated with reduced bleeding, faster recovery, and a lower risk of complications—factors that directly impact patient safety and outcomes.
As surgical experience increases, the time required to remove prostate tissue decreases, reducing the overall physical burden on the patient and promoting faster recovery. Additionally, the total laser energy used during the procedure tends to decrease with experience, allowing the same therapeutic effect to be achieved more efficiently. This highlights that surgical skill and expertise are just as important as the technology itself. While various laser techniques and energy sources continue to be introduced, the study emphasizes that outcomes are more strongly influenced by the surgeon’s proficiency than by the specific technique used.
At the author’s institution, more than 5,300 BPH surgeries have been performed to date, reflecting extensive clinical experience in managing urinary symptoms. BPH is not a condition that can be evaluated based solely on prostate size. Factors such as the location and pattern of prostate enlargement, severity of symptoms, bladder and kidney function, presence of complications, disease duration, and prior treatment history must all be considered. When surgery is indicated, these variables should guide the selection of the most appropriate, individualized treatment approach. This level of personalized care is best achieved in centers that offer a full range of surgical options and have substantial clinical experience. In addition to HoLEP, procedures such as UroLift, Aquablation, and Rezūm are also available in such settings.
BPH surgery is not simply a matter of removing tissue with a laser. It is a complex medical intervention that requires careful planning and individualized decision-making. Because prostate size, anatomy, and symptom severity vary from patient to patient, a tailored approach based on extensive experience is essential. In procedures like HoLEP, which have a significant learning curve, the surgeon’s experience directly influences recovery time and patient satisfaction. Clinical expertise is not accidental—it is the result of accumulated experience and continuous refinement. Therefore, when considering BPH surgery, it is wise to evaluate not only the surgical method but also the experience and track record of the treating physician.