HoLEP — What to Expect

What is this procedure?

HoLEP (Holmium Laser Enucleation of the Prostate) is a minimally invasive endoscopic operation to treat an enlarged prostate (benign prostatic hyperplasia, BPH). Using a fine telescope passed along the urethra — no skin cuts are made — a holmium laser separates the obstructing prostate tissue from its surrounding capsule. The freed tissue is then drawn into the bladder and finely morcellated (minced) before being washed away. HoLEP removes the obstructing tissue in its entirety, giving it an extremely low retreatment rate compared with other procedures.

Before your procedure

• Fasting: Do not eat or drink anything (including water) for at least six hours before your admission time.
• Medications: Continue most regular medications as normal. If you take blood thinners (warfarin, rivaroxaban, apixaban, clopidogrel, aspirin), Dr Hadjipavlou’s team will give you specific bridging or stopping instructions — do not stop these on your own. Bring all your current medications to hospital.
• Bowel preparation: Not required for HoLEP.
• What to bring: Photo ID, insurance documents, a list of all medications, and comfortable loose clothing for discharge.
• You will be seen by the anaesthetic team on the day; most patients have a spinal or general anaesthetic.

What happens during the procedure

You will be positioned lying on your back with your legs supported. The telescope is passed through the urethra into the bladder under anaesthesia — there are no incisions in the skin. The holmium laser precisely enucleates (separates) the obstructing prostate lobes, and a morcellator removes the tissue fragments. The entire process usually takes approximately 60 minutes. The tissue is sent to the laboratory for pathological examination.

After the procedure and recovery

• Catheter: A urinary catheter is placed at the end of the operation. In most cases it is removed the following morning after a bladder washout.
• Hospital stay: Typically one to two nights.
• Haematuria: Some pink or blood-stained urine is normal for 2–4 weeks. Drink 2–3 litres of fluid daily to keep the urine flushing through.
• Driving: Do not drive for at least 24 hours after a general anaesthetic, and not until you can perform an emergency stop comfortably — usually 1–2 weeks.
• Return to work: Most patients with desk jobs return within 1–2 weeks. Avoid heavy lifting and strenuous exercise for four weeks.
• Sexual activity: Wait at least four weeks. Note that retrograde ejaculation (semen passing into the bladder) is a common and expected outcome; it does not affect orgasm or urinary continence.
• Clinic follow-up: You will be seen in outpatients at approximately six weeks. Further urine flow and symptom checks will be arranged as needed.

When to seek medical help

Contact Dr Hadjipavlou’s secretary on 22 444 444 or call El Greco Medical Centre (+357 22 782 000) out of hours for surgical matters if you experience:

• Fever above 38 °C or shivering / rigors
• Heavy, bright-red bleeding or clots blocking urinary flow
• Inability to pass urine after catheter removal
• Severe pain not controlled by prescribed analgesia

Attend the nearest Accident & Emergency department if you cannot reach us or feel acutely unwell.