HoLEP (Holmium Laser Enucleation of the Prostate)
HoLEP changed the BPH landscape by doing endoscopically what used to require open surgery: enucleating the entire adenoma off the surgical capsule, then morcellating it for removal.
The big picture
HoLEP changed the BPH landscape by doing endoscopically what used to require open surgery: enucleating the entire adenoma off the surgical capsule, then morcellating it for removal. Its two defining advantages flow from that: it works regardless of prostate size (so it competes with simple prostatectomy for huge glands), and because the holmium laser coagulates as it cuts, it has low bleeding risk (so it suits anticoagulated patients). The guiding principle is captured in the field's mantra: "enucleation is enucleation" — the anatomical plane is the same whatever the gland size.
The framework: the enucleation principle, its size-independence and low bleeding, and where it fits in the chooser.
Mechanism pathway
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Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
HoLEP enucleates the whole adenoma off the surgical capsule, then morcellates it — "enucleation is enucleation."
Size-independent — works for any prostate size, including very large glands (rivals simple prostatectomy, no incision).
Low bleeding (laser coagulates) → preferred when anticoagulation can't be stopped (with ThuLEP/PVP).
Steeper learning curve than TURP (enucleation + morcellation).
Durable, complete removal → low retreatment; like all BPH surgery, exclude an underactive detrusor first.