HoLEP and ThuLEP: your questions, answered
When an enlarged prostate blocks the flow of urine, two laser procedures can clear the blockage from the inside. Dr. Moshe Shapiro of Advanced Urology answers the questions men ask most.
Questions in this guide
- Why does an enlarged prostate cause trouble?
- What do HoLEP and ThuLEP actually do?
- Are there any cuts on the skin?
- Is this the same as removing the prostate, or treating cancer?
- Who might be a candidate?
- What is the day of the procedure like?
- What does healing feel like?
- Will it change sex?
- What are the other risks?
Why does an enlarged prostate cause trouble?
The prostate wraps around the urethra, the tube urine passes through. As the inner part of the prostate grows, it can squeeze that tube. Men notice a weak stream, straining, getting up at night, or a sense of not having emptied. Some men need a catheter because they cannot urinate at all.
What do HoLEP and ThuLEP actually do?
Both are forms of enucleation: the enlarged inner tissue is separated from the outer capsule of the prostate. Picture scooping out the inside of an orange and leaving the peel. HoLEP uses a holmium laser; ThuLEP uses a thulium laser.
Are there any cuts on the skin?
No. A scope passes through the penis into the urethra. The laser frees the blocking tissue, which is moved into the bladder, broken into smaller pieces by a device (a step called morcellation) and removed through the scope. That tissue is sent to the lab to be examined.
Is this the same as removing the prostate, or treating cancer?
No to both. The outer prostate stays in place, so this is not removal of the whole prostate and it is not a prostate cancer treatment. If you need ongoing prostate cancer checks, you’ll still need an individualized plan for those.
Who might be a candidate?
These procedures can treat a range of prostate sizes, including larger glands. They may be an option for men whose symptoms stay troublesome despite medicines, or who have retention or other problems from the blockage. A large prostate doesn’t automatically mean surgery. Our urologists look at your symptoms, prostate size, bladder function, medicines and overall health. A weak bladder can still affect emptying after the blockage is gone.
What is the day of the procedure like?
It’s done under anesthesia, and a temporary catheter drains the bladder afterward. How long surgery takes, when the catheter comes out, and whether you go home the same day or stay overnight depend on your procedure and recovery. Don’t stop blood thinners or other medicines unless your care team gives you specific instructions.
What does healing feel like?
Burning, blood in the urine, urgency and frequent trips to the bathroom can happen while you heal. Temporary leakage can occur, and some men need pelvic floor exercises. Follow your discharge instructions on activity and follow-up. Improvement takes time, and results vary.
Will it change sex?
Ejaculation often changes: little or no semen may come out at orgasm, which can affect fertility, so talk about any future pregnancy plans before surgery. Erection problems can also occur.
What are the other risks?
Infection, bleeding, scar tissue, leakage that persists, injury to nearby structures, and needing another procedure. Anesthesia has risks too. We go over the benefits, risks and alternatives for you specifically.
This guide is educational, not medical advice. Every treatment and procedure has risks and benefits; your care team will review yours. More on this topic: Advanced Urology condition page.