HoLEP (Holmium Laser Enucleation of the Prostate) at KIMS Secunderabad — The Gold Standard for BPH Surgery
At a glance — HoLEP at KIMS
- Full procedure name: Holmium Laser Enucleation of the Prostate — complete anatomical removal of the obstructing adenoma through the urethra
- Laser power at KIMS: 100W Holmium YAG laser — the power level that enables efficient enucleation of large glands
- Size limitation: None — HoLEP works on any prostate size. Prostates of 300cc and above are routinely treated.
- Retreatment rate: Less than 2% at 5 years — the lowest of any BPH surgical technique
- Blood loss: Virtually bloodless — Holmium laser seals blood vessels as it cuts. Safe for patients on blood thinners.
- Catheter removal: Typically within 24 hours of the procedure
- Hospital stay: 1–2 nights
- Tissue for histology: The entire enucleated adenoma is sent for histological analysis
- TULSA-PRO alternative: For patients who want an incision-free option without general anaesthesia
What is HoLEP and why is it the gold standard?
Benign Prostatic Hyperplasia (BPH) — the enlargement of the prostate gland that obstructs urine flow in middle-aged and older men — has multiple surgical treatment options. Of all these options, Holmium Laser Enucleation of the Prostate (HoLEP) has the strongest long-term evidence base, the lowest retreatment rate, the most complete adenoma removal, and no practical size limitation. It is endorsed as the definitive surgical treatment for BPH by the EAU (European Association of Urology), AUA (American Urological Association), and every major international urology guideline.
The reason HoLEP achieves these results lies in its anatomical principle. The obstructing prostate adenoma — the inner zone of the prostate that enlarges with age and compresses the urethra — sits within a surgical capsule formed by the compressed outer prostate tissue. HoLEP enucleates the adenoma from inside this capsule using the Holmium laser to incise along the natural surgical plane between the adenoma and the capsule — the same plane a urologist's finger uses in open prostatectomy, but performed endoscopically without any skin incision. The result: the entire adenoma is removed in one procedure, leaving the surgical capsule intact.
KIMS Secunderabad also offers TULSA-PRO — India's only MRI-guided, incision-free prostate treatment — for patients with BPH who want effective treatment without any surgical procedure. For patients suitable for either HoLEP or TULSA-PRO, the KIMS urology team discusses both options honestly and helps each patient choose the approach that best fits their clinical situation and personal priorities.
How HoLEP is performed — the enucleation technique
HoLEP is an endoscopic procedure — performed entirely through the urethra with no skin incision. The patient is placed under spinal or general anaesthesia and a resectoscope is passed through the urethra into the bladder, then withdrawn to the level of the prostate.
| Stage | What happens |
|---|---|
| 1 — Incision of the bladder neck | The Holmium laser makes precise incisions at the bladder neck at the 5 and 7 o'clock positions, creating entry points into the surgical plane between adenoma and capsule. |
| 2 — Enucleation of the adenoma lobes | The laser dissects along the surgical plane, separating the adenoma from the surrounding capsule. Each lobe is enucleated completely. The laser simultaneously seals blood vessels. |
| 3 — Morcellation | The enucleated lobes are pushed into the bladder. A morcellator (a bladed suction device) is inserted and grinds the adenoma tissue into small pieces that are aspirated out of the bladder. |
| 4 — Haemostasis and inspection | The surgical capsule is inspected for any bleeding points, which are coagulated with the Holmium laser. The resectoscope is removed and a urethral catheter is placed. |
| 5 — Catheter removal | The catheter is removed 24 hours post-operatively in most cases — considerably earlier than after TURP (typically 48–72 hours). |
| 6 — Histology | All morcellated tissue is sent for histological examination. In approximately 5% of HoLEP specimens, incidental prostate cancer is detected in the resected adenoma. |
Why HoLEP is superior to TURP for most BPH patients
TURP (Transurethral Resection of the Prostate) has been the standard endoscopic BPH surgery for 40 years — but its fundamental limitation is that it chips away at the adenoma rather than removing it completely.
| Feature | HoLEP | TURP |
|---|---|---|
| Adenoma removal | Complete enucleation of entire adenoma — anatomically complete | Partial resection — removes central core, leaves peripheral adenoma |
| Size limitation | None — any prostate size including 300cc+ | Practical limit ~80–100cc — above this, blood loss risk becomes unsafe |
| Blood loss | Virtually bloodless — Holmium laser seals vessels as it cuts | Variable — increases with prostate size, may require transfusion for large glands |
| Retreatment rate at 5 years | <2% — adenoma fully removed | ~15% — residual adenoma tissue can regrow and re-obstruct |
| Safety on blood thinners | Excellent — laser haemostasis negligible regardless of anticoagulation | Higher risk — bleeding from resection surface |
| Catheter removal | 24 hours | 48–72 hours typically |
| Hospital stay | 1–2 nights | 2–3 nights |
| TUR syndrome risk | None — saline irrigation | Present — hypotonic glycine irrigation can cause TUR syndrome in large resections |
| Tissue for histology | Yes — entire enucleated specimen sent for analysis | Yes — resected chips analysed |
| Long-term durability | Excellent — NICE guideline-preferred for all prostate sizes | Good for smaller glands, diminishes with larger glands |
Choosing between HoLEP, TURP, and TULSA-PRO at KIMS
KIMS is uniquely positioned to offer all three major BPH surgical options — HoLEP, TURP, and TULSA-PRO (as India's only TULSA-PRO centre). Each has distinct indications:
| BPH Treatment Option | Best suited for · Key considerations |
|---|---|
| HoLEP (100W Holmium) | Best for: any prostate size especially >80cc · patients wanting definitive single-procedure solution · patients on anticoagulation · priority on complete adenoma removal and lowest retreatment rate. Key note: spinal or general anaesthesia · 1–2 night stay · retrograde ejaculation in ~75% (same as TURP) |
| TURP | Best for: smaller prostates under 80cc · selected cases as alternative to HoLEP. Key note: higher retreatment rate than HoLEP at 5 years · practical size limit · blood loss risk with anticoagulation |
| TULSA-PRO (India's only centre at KIMS) | Best for: patients wanting incision-free treatment · ejaculation preservation is priority · lower to intermediate prostate volumes. Key note: MRI-guided · same-day discharge · no general anaesthesia · better ejaculation preservation than HoLEP · PSA and symptom follow-up required |
Retrograde ejaculation — where semen travels back into the bladder instead of forward during orgasm — occurs in approximately 75% of men after HoLEP or TURP. It is not harmful, does not affect the sensation of orgasm, and is not the same as erectile dysfunction. However, men who wish to father children should discuss sperm banking before HoLEP or TURP. For patients where ejaculation preservation is a high priority and prostate size is appropriate, TULSA-PRO has significantly better ejaculation preservation rates.
Who is eligible for HoLEP?
- Symptomatic BPH with IPSS score ≥ 8 who have failed medical treatment or who prefer surgical treatment
- Any prostate size — HoLEP is the preferred surgical option for very large glands (>80cc, up to 300cc+)
- Patients on anticoagulation (warfarin, apixaban, rivaroxaban, clopidogrel) — Holmium laser's inherent haemostasis makes HoLEP safe
- Urinary retention — HoLEP achieves definitive relief in a single procedure
- Patients who have had previous TURP or prostate procedures and have symptomatic regrowth
- Patients requiring histological exclusion of prostate cancer (the complete enucleated specimen provides a comprehensive tissue sample)
HoLEP is NOT for prostate cancer treatment — it is specifically for BPH. Patients with known or suspected prostate cancer should be assessed for their cancer treatment pathway before any BPH surgery is considered.
Recovery after HoLEP at KIMS
- Catheter removal: 24 hours post-operatively — this is one of HoLEP's most appreciated advantages.
- Hospital stay: 1–2 nights
- Urinary symptoms: Temporary urgency and frequency for 2–6 weeks as the bladder adjusts. Occasional blood in urine for the first few days.
- Return to desk work: 1–2 weeks
- Return to strenuous activity: 4–6 weeks
- Follow-up: KIMS reviews IPSS symptom score and uroflowmetry at 6 weeks and 3 months.
- PSA: Will fall significantly after HoLEP as the adenoma has been removed. A new PSA baseline is established at 3 months.
Why choose KIMS Secunderabad for HoLEP?
100W Holmium laser
The power level for efficient large gland enucleation. The 100W+ Holmium laser at KIMS enucleates efficiently even in prostates of 150, 200, and 300cc — the cases where the power advantage matters most.
No prostate size limitation
The case most other centres decline. Prostates larger than 150cc are often referred for open surgery elsewhere. KIMS HoLEP treats these patients endoscopically with 1 to 2 nights in hospital.
Complete adenoma removal
The lowest retreatment rate. The anatomical enucleation principle of HoLEP removes virtually all adenoma tissue — leaving a retreatment rate under 2% at 5 years. This choice is statistically very unlikely to need repeating.
TULSA-PRO as an honest alternative
KIMS's unique position as India's only TULSA-PRO centre means the pre-operative conversation for BPH is genuinely comprehensive. We discuss all clinical advantages and limitations honestly.
Our HoLEP specialists at KIMS Secunderabad
Frequently Asked Questions
HoLEP and TURP are both endoscopic BPH procedures performed through the urethra with no skin incision — but their technique and outcomes differ significantly. TURP uses an electrical loop to chip away at the obstructing prostate tissue in pieces — removing the central core but leaving peripheral adenoma tissue. HoLEP uses the Holmium laser to dissect the entire adenoma from inside its surgical capsule — like shelling a walnut — and remove it completely.
Yes — HoLEP is one of the safest BPH surgical options for men on anticoagulation. The Holmium laser seals blood vessels as it enucleates the adenoma — creating inherent haemostasis regardless of anticoagulation status. Men on warfarin, apixaban, rivaroxaban, or clopidogrel who require BPH surgery are best served by HoLEP rather than TURP.
Retrograde ejaculation — where semen travels into the bladder rather than forward during orgasm — occurs in approximately 75% of men after HoLEP. This is similar to TURP and is a consequence of the bladder neck changes from prostate surgery. The sensation of orgasm is not affected. Retrograde ejaculation is not the same as erectile dysfunction — erectile function is preserved in the vast majority of HoLEP patients.
HoLEP has no practical prostate size limit. KIMS routinely performs HoLEP on prostates of 100cc, 150cc, 200cc, and above — cases that would historically have required open simple prostatectomy (a major abdominal operation with 5 to 7 days in hospital).
Yes — a urinary catheter is placed at the end of HoLEP to drain the bladder while the surgical capsule heals and swelling resolves. At KIMS, the catheter is removed 24 hours post-operatively in most cases — this is one of HoLEP's most significant quality-of-life advantages over alternatives.
HoLEP significantly reduces PSA — because the adenoma tissue that produces PSA has been removed. A new, lower PSA baseline is established at 3 months after HoLEP. Future PSA monitoring for prostate cancer continues from this new baseline. Additionally, all enucleated adenoma tissue is sent for histological analysis.
HoLEP's benefits are highly durable because the procedure removes the entire obstructing adenoma. Long-term data from multiple international studies show retreatment rates under 2% at 5 years and under 5% at 10 years — compared to approximately 15% at 5 years for TURP.
KIMS Secunderabad — 100W Holmium laser enabling efficient enucleation of any prostate size (including 300cc+ glands that other centres decline), complete adenoma removal with <2% retreatment rate at 5 years, safe on blood thinners. KIMS also offers TULSA-PRO (India's only centre) for patients where an incision-free option with ejaculation preservation is preferred.