Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 27 February 2026
If you've been told your prostate is enlarged and medications are no longer controlling your urinary symptoms, your urologist may have recommended HoLEP — Holmium Laser Enucleation of the Prostate. It's one of the most effective surgical treatments for benign prostatic hyperplasia (BPH), yet many men find it difficult to get clear, practical information about what the procedure actually involves and what recovery looks like.
This guide explains everything you need to know about having HoLEP surgery in Melbourne with Dr Brendan Dias — from pre-operative preparation through to full recovery — including how HoLEP compares to the older TURP procedure.
What Is HoLEP and Why Is It Considered the Gold Standard?
HoLEP is a minimally invasive laser surgery performed entirely through the urethra — no abdominal incisions are required. Using a holmium laser, the surgeon enucleates (shells out) the enlarged prostate tissue from its capsule, similar to scooping the segments from an orange. The removed tissue is then morcellated (cut into small pieces) inside the bladder and extracted for pathological examination.
HoLEP is considered the gold standard for surgical BPH treatment because it:
- Can treat any size prostate — there is no upper limit on gland volume
- Has the lowest retreatment rate of any BPH procedure (under 2% at 10 years)
- Produces minimal blood loss — safe for patients on blood thinners
- Allows same-day discharge (Day Case HoLEP) for many patients
- Provides tissue for pathology — incidental prostate cancer can be detected
Who Is a Good Candidate for HoLEP?
HoLEP is appropriate for men with moderate to severe lower urinary tract symptoms (LUTS) caused by BPH who meet one or more of the following criteria:
- Medications (tamsulosin, finasteride, dutasteride) are no longer providing adequate symptom relief
- The prostate is significantly enlarged — particularly over 80 grams, where TURP becomes less effective
- Recurrent urinary retention requiring catheterisation
- Recurrent urinary tract infections caused by incomplete bladder emptying
- Bladder stones secondary to chronic obstruction
- Currently taking blood-thinning medications (warfarin, apixaban, rivaroxaban) that cannot be safely stopped
Men with smaller prostates (under 40g) may be better suited to less invasive options such as UroLift, Rezum, or iTIND. Dr Dias will recommend the most appropriate procedure based on your prostate size, symptom severity, and personal goals.
What to Do Before HoLEP Surgery
Good preparation helps the procedure go smoothly and reduces the risk of complications:
- Pre-admission clinic — you'll attend a pre-operative assessment 1–2 weeks before surgery, including blood tests, urine tests, and an anaesthetic review
- Medication review — one of HoLEP's advantages is that most blood thinners can be continued. Dr Dias will advise which medications to continue or pause
- Start pelvic floor exercises — strengthening the pelvic floor muscles before surgery helps with continence recovery afterwards. Aim for 3 sets of 10 contractions daily for at least 2 weeks before surgery
- Fasting — no food for 6 hours and no clear fluids for 2 hours before your scheduled surgery time
- Arrange transport and support — you cannot drive yourself home after a general anaesthetic. Arrange for someone to collect you and stay with you for the first night
- Plan time off — most men need 3–5 days off desk work and 2–3 weeks off physically demanding work
What Happens During HoLEP Surgery
Understanding each step of the procedure can help reduce anxiety about what to expect on the day.
1. Anaesthesia
HoLEP is performed under general anaesthesia (you are fully asleep) or spinal anaesthesia (numb from the waist down). Your anaesthetist will discuss the best option for you at the pre-admission appointment.
2. Enucleation — Removing the Prostate Tissue
A resectoscope (a thin telescope with a camera) is passed through the urethra to the prostate. Using the holmium laser, Dr Dias carefully separates the enlarged prostate adenoma from its outer capsule. The laser provides precise cutting with simultaneous sealing of blood vessels, which is why blood loss is minimal. The adenoma lobes are pushed into the bladder intact.
3. Morcellation — Extracting the Tissue
Once all the prostate tissue has been enucleated into the bladder, a morcellator device is used to cut the tissue into small fragments and suction them out. These fragments are sent for histopathological analysis — this is important because incidental prostate cancer is found in approximately 5–10% of HoLEP specimens.
4. Catheter Insertion
A urinary catheter is placed at the end of the procedure to drain the bladder and irrigate (wash out) any remaining blood or tissue debris. The catheter is typically connected to a drainage bag and an irrigation fluid bag for the first few hours.
Recovery Timeline
| Timeframe | What to Expect | Key Actions |
|---|---|---|
| Day 0 (Surgery Day) | Catheter in place with irrigation; mild blood-stained urine; rest in hospital or at home (Day Case) | Drink plenty of water; mobilise gently |
| Day 1–2 | Catheter trial of void (removal); urine may still be pink-tinged; mild urgency and frequency | Continue high fluid intake; begin pelvic floor exercises |
| Week 1 | Urinary urgency and frequency; mild burning; possible small stress leaks; fatigue | Rest; avoid heavy lifting (>5kg); no strenuous exercise |
| Week 2–4 | Symptoms gradually improving; stream noticeably stronger; continence improving | Gradual return to normal activities; continue pelvic floor exercises |
| Week 4–8 | Most men back to full function; occasional urgency may persist; continence usually fully restored | Resume exercise, sexual activity; follow-up with Dr Dias |
| 3–6 Months | Final improvement in flow rate and symptom scores; pathology results reviewed | Repeat flow study to confirm improvement |
Managing Temporary Incontinence
Temporary stress urinary incontinence is the most common concern after HoLEP. Small leaks with coughing, sneezing, or sudden movement are normal in the first 2–6 weeks as the urinary sphincter readjusts. Key strategies to manage this include:
- Pelvic floor exercises — 3 sets of 10 contractions daily, starting the day after catheter removal
- Incontinence pads — light pads (1–2 per day) are usually sufficient; most men are pad-free by 4–8 weeks
- Avoid heavy lifting — straining increases abdominal pressure and worsens leakage
- Caffeine and alcohol reduction — both irritate the bladder and worsen urgency
HoLEP vs TURP — How Do They Compare?
Transurethral Resection of the Prostate (TURP) has been the standard surgical treatment for BPH for decades. While it remains a reliable procedure, HoLEP offers several important advantages:
| Factor | HoLEP | TURP |
|---|---|---|
| Technique | Laser enucleation — adenoma shelled out whole | Electrosurgical resection — tissue shaved in chips |
| Prostate Size Limit | No upper limit — any size | Best for prostates under 80g |
| Blood Loss | Minimal — laser seals vessels | Moderate — higher transfusion risk |
| Hospital Stay | Same day or 1 night | 1–3 nights |
| Catheter Duration | 1–2 days | 2–3 days |
| Blood Thinners | Can usually continue | Must stop — higher bleeding risk |
| Retreatment Rate | <2% at 10 years | 10–15% at 10 years |
| Tissue for Pathology | Yes — complete specimen | Yes — but smaller chips |
| Availability | Specialist centres — requires specific expertise | Widely available |
The most significant difference is the retreatment rate. Because HoLEP removes the entire adenoma (similar to the completeness achieved by open surgery), prostate tissue regrowth causing recurrent obstruction is exceptionally rare. TURP, by contrast, only removes the inner portion of the adenoma by shaving, leaving tissue behind that can regrow over time — which is why 10–15% of men need a repeat procedure within 10 years.
When Is TURP Still a Reasonable Option?
Despite HoLEP's advantages, TURP remains a valid choice in certain situations:
- Smaller prostates (under 60–80g) — the difference in outcomes is less pronounced for smaller glands
- Availability — HoLEP requires specialised equipment and training; not all hospitals or surgeons offer it
- Surgeon expertise — outcomes for both procedures are strongly operator-dependent; a highly experienced TURP surgeon may achieve comparable results
Risks and Potential Complications of HoLEP
HoLEP is a safe procedure with a low overall complication rate. As with any surgery, some risks exist:
- Temporary stress incontinence (10–20%) — small leaks with coughing or straining; resolves within 4–8 weeks in the vast majority
- Retrograde ejaculation (75–80%) — semen passes into the bladder during orgasm; orgasm sensation is preserved
- Urinary tract infection (3–5%) — treated with antibiotics if it occurs
- Bleeding requiring return to theatre (<2%) — very uncommon with laser haemostasis
- Urethral stricture (1–3%) — narrowing of the urethra that may require minor treatment
- Permanent incontinence (<1%) — extremely rare
- Erectile dysfunction (<1%) — HoLEP does not affect the nerve bundles responsible for erections
Day Case HoLEP — Going Home the Same Day
Dr Dias pioneered Day Case HoLEP at Western Health, enabling carefully selected patients to undergo HoLEP surgery and return home the same day. This is possible because of HoLEP's minimal blood loss and rapid post-operative recovery.
Day Case HoLEP is suitable for men who:
- Have adequate home support (someone to stay with them overnight)
- Live within reasonable distance of the hospital
- Have no significant medical comorbidities that require extended observation
- Are comfortable with having a catheter at home overnight (if needed)
Not all patients are suitable for same-day discharge — men with very large prostates, those on anticoagulants, or those with significant medical conditions may benefit from an overnight stay. Dr Dias will discuss the best plan for your circumstances.
About Dr Dias and the HoLEP Service
Dr Brendan Dias is a fellowship-trained urologist with specialist expertise in HoLEP surgery and robotic urological surgery. He pioneered Day Case HoLEP at Western Health and performs the procedure at multiple hospitals across Melbourne's western and northern suburbs.
Dr Dias offers the full spectrum of BPH treatments — from minimally invasive office procedures like UroLift and Rezum through to HoLEP and Robotic Simple Prostatectomy for the largest prostates — ensuring you receive a tailored recommendation rather than a one-size-fits-all approach.
Frequently Asked Questions
How long does HoLEP surgery take?
HoLEP surgery typically takes between 60 and 120 minutes depending on the size of the prostate. Larger glands take longer because there is more tissue to enucleate and morcellate. You will be under general or spinal anaesthesia for the duration and will not feel any discomfort during the procedure.
Is HoLEP painful?
The procedure itself is performed under anaesthesia so you will not feel pain. After the surgery, most men experience mild bladder discomfort, urinary urgency, and occasional stinging when passing urine. These symptoms are well managed with simple oral pain relief and typically settle within 1–2 weeks.
How long is the catheter in after HoLEP?
A urinary catheter is usually inserted during surgery and remains in place for 1–2 days. Many patients who undergo Day Case HoLEP have their catheter removed the same evening or the following morning. Some men with very large prostates or those on blood thinners may need the catheter for slightly longer.
Will I be incontinent after HoLEP?
Temporary stress urinary incontinence (small leaks with coughing, sneezing, or physical activity) is common in the first few weeks after HoLEP. This occurs because the sphincter muscles need time to readjust after the obstruction is removed. In the vast majority of men, continence recovers fully within 4–8 weeks. Pelvic floor exercises before and after surgery help speed recovery. Permanent incontinence is very rare (less than 1%).
Does HoLEP cause erectile dysfunction?
HoLEP does not damage the nerves responsible for erections. Erectile function is preserved in the vast majority of patients. However, retrograde ejaculation (where semen passes backward into the bladder during orgasm) occurs in approximately 75–80% of men. This does not affect the sensation of orgasm but does affect fertility. Men considering future fatherhood should discuss this before proceeding.
Is HoLEP better than TURP?
HoLEP is considered superior to TURP for most patients. It offers lower blood loss, shorter catheter time, shorter hospital stay (often same-day discharge), the ability to treat any size prostate, and a much lower retreatment rate (under 2% at 10 years versus 10–15% for TURP). The main advantage of TURP is that it is a simpler procedure with a shorter learning curve, meaning it is more widely available.
Is HoLEP covered by Medicare?
Yes. HoLEP is a Medicare-listed urological procedure and attracts a Medicare rebate. If you have private health insurance with hospital cover, the hospital and anaesthetic fees are also substantially covered. Out-of-pocket costs vary depending on your level of cover and the hospital used. Dr Dias' rooms can provide a detailed cost estimate at the time of your consultation.
The Bottom Line
HoLEP is the most durable and effective minimally invasive surgery for enlarged prostate (BPH). It offers significant advantages over TURP — including lower blood loss, shorter hospital stays, the ability to treat any prostate size, and a retreatment rate under 2% at 10 years. For men in Melbourne with bothersome urinary symptoms from BPH, a consultation with Dr Dias can help determine whether HoLEP, or one of the other BPH treatment options, is the right choice for you.