When patients say they have had laser prostate surgery, they usually mean they were operated on endoscopically (without an incision, through the urethra – TURP). But is a laser actually used? No. TURP uses electric current to resect small “chips” of prostate tissue, which widens the urethra (cavitation surgery).
HoLEP (Holmium Laser Enucleation of the Prostate) is a relatively new procedure (fairly widespread in Western Europe) in which the prostate tissue is enucleated (detached from the prostatic capsule) using a high-power laser, then morcellated (broken into fragments) and aspirated.
Unlike the standard operation, TURP (which is also minimally invasive), HoLEP does not just widen the central part of the urethra – it detaches the tissue from the capsule. The difference? More tissue is removed, with a minimal long-term risk of recurrence and a better safety profile. It can also be performed regardless of prostate size (including very large adenomas).
Following numerous specialist studies on outcomes and perioperative safety, HoLEP has a STRONG recommendation in the European Association of Urology guidelines.
| Recommendation | Strength rating |
| Offer laser enucleation of the prostate using Ho:YAG laser (HoLEP) to men with moderate- to-severe LUTS as an alternative to transurethral resection of the prostate or open prostatectomy. | Strong |
