Grandparent gardening with grandchildLiving with bothersome urinary symptoms due to benign prostatic hyperplasia (BPH), also known as “enlarged prostate,” is a common frustration for many men. Almost all men experience some degree of BPH at some point during their lives. And while it is usually not a harmful condition, it can interfere with your quality of life.

Urologists affiliated with Memorial Hermann are experienced in the latest treatment options for BPH, including the Holmium Laser Enucleation of the Prostate (HoLEP) procedure. Known as the “gold standard” for treating BPH, the HoLEP procedure is a minimally invasive option to remove the enlarged portion of the prostate to relieve urinary symptoms with no incisions and minimal downtime.

What is the HoLEP Procedure?

The HoLEP procedure is a minimally invasive treatment for enlarged prostate. The procedure involves inserting a small, state-of-the-art camera through the urethra and using laser technology to vaporize the excess prostate tissue that blocks the flow of urine. When the excess tissue is removed, urine can flow freely through the prostate, which relieves symptoms. HoLEP is an alternative to traditional prostate surgery that involves an incision and carries the risk of additional side effects and a longer recovery period.

The minimally invasive process has been performed for more than 20 years with consistently positive results. Memorial Hermann-affiliated surgeons are on the forefront of HoLEP technology, utilizing the latest laser and instrument options to more effectively remove the excess tissue.

How Does it Work?

The surgeon uses a small camera device to guide the laser instrument through the urethra until it reaches the enlarged portion of the prostate. The light-beam technology peels back and destroys the excess tissue that may be obstructing the bladder.

The HoLEP procedure typically takes about three hours to complete. Most patients go home the same day, but some may stay in the hospital overnight depending on how much tissue needs to be removed.

What is BPH?

Benign prostatic hyperplasia (BPH) is a noncancerous condition where the prostate gland increases in size. BPH is very common, and it affects the vast majority of men as they age. One typical sign of BPH is the need to get up during the night to urinate. The prostate gland is located beneath the bladder. The urethra, which carries urine from the bladder to be emptied through the end of the penis, runs through the prostate. If the prostate is enlarged, it can put pressure on the bladder and slow or block the flow of urine.

As men get older, their prostate grows larger. Around age 50, approximately half of men have experienced BPH. Among men in their mid-80s and older, about 90% have symptoms.

Experts do not believe having an enlarged prostate increases the risk of prostate cancer. Although, untreated BPH may lead to urinary problems that require treatment.

Symptoms of BPH

The symptoms of BPH can vary between individuals and may become more severe as men age, including:

  • Urgent or frequent need to urinate
  • Need to urinate during the night
  • Difficulty starting to urinate
  • Weak urine stream
  • Urine that stops and starts, or dribbles when urination ends
  • Difficulty emptying the bladder completely

Who is a Candidate for the HoLEP Procedure?

Approximately 98% of men who experience bothersome BPH symptoms are candidates for the HoLEP procedure. Men with extremely large prostates may need to consider an open surgical process, known as simple prostatectomy, instead.

Benefits of the HoLEP Procedure

The HoLEP procedure is minimally invasive and does not require an incision. Most men who undergo the procedure experience significant symptom relief and recover more quickly than those who undergo traditional prostate surgery. Advanced laser technology allows surgeons to remove more prostate tissue than other minimally invasive treatment options, and has results similar to the traditional, more invasive surgical option. Very few men require a follow-up procedure to achieve and maintain urinary-symptom relief.

What Other Treatment Options Exist?

BPH is not a dangerous condition, and treatment is only needed when symptoms are problematic. It is important to speak with your physician about enlarged-prostate treatment options that are appropriate for your individual condition. Together with your physician, you may consider:

Watchful Waiting

If your symptoms are mild, your urologist may recommend delaying treatment and continuing with regular examinations to monitor your symptoms. You may be advised to limit your fluid intake before bed to reduce the need to urinate during the night.


Medications are usually the starting point for treating an enlarged prostate. Your physician may recommend medications that reduce the size of your prostate by treating hormonal imbalances that may be causing symptoms. Another type of medication aims to relax the muscles surrounding the prostate so that it is easier to urinate.

Other Procedures

Transurethral resection of the prostate (TURP): The prostate is accessed through the urethra, and tissue is cut and removed to reduce the blockage.

Transurethral incision of the prostate (TUIP): Small incisions are made to widen the urethra to improve the flow of urine.

Water vapor treatment: Thermal (heat) energy creates water vapor used to reduce the amount of prostate tissue.

Prostatic urethral lift (UroLift): Implants are placed on both sides of the prostate to widen the urethra.

Simple Prostatectomy: Prostate tissue is remove through an incision in the abdomen.

What to Expect During the Procedure

The HoLEP procedure is performed while the patient is under general anesthesia (asleep). First, the surgeon places a resectoscope (small device with a camera) through the urethra to view the prostate. Next, the surgeon places the laser device in the resectoscope and transmits laser energy into the prostate to destroy the enlarged tissue. After the tissue is destroyed, the surgeon removes any excess tissue that remains. Last, a catheter is inserted until the patient is ready to go home.

Risks and Side Effects

The HoLEP procedure is considered a safe procedure but, like any medical procedure, there are some risks involved. Some patients may experience:

  • Infection
  • Blood in urine
  • Burning with urination
  • Unresolved urinary symptoms

After the Procedure

Patients can expect to wait about a week before resuming work, exercise or other normal activities. Some residual bladder symptoms like urgency, frequency and blood in urine are common for a few weeks as the body heals. Most patients report an 80% to 90% improvement in urinary symptoms.

Scheduling an Appointment

If urinary symptoms like awakening for frequent bathroom trips during the night are interfering with your quality of life, it may be time to consider BPH treatment. Schedule an appointment online with a urologist affiliated with Memorial Hermann to diagnose your condition and recommend options to address your needs and overall health.