Holmium Laser Enucleation of the Prostate (HoLEP): Before Your Procedure

Holmium laser enucleation of the prostate (HoLEP) is surgery to reduce or remove prostate tissue. It is done when an overgrown prostate gland is pressing on the urethra and causing problems with the urine stream.

The prostate gland is a small organ just below the bladder. It makes most of the fluid in semen. The urethra is the tube that carries urine from the bladder out of the body through the penis. The urethra passes through the prostate. When the prostate gets too large, it can press on the urethra.

Your doctor will give you medicine to make you sleep or feel relaxed. You will be kept comfortable. If you are awake during the surgery, you will get medicine to numb you from the chest down.

The doctor puts a thin, lighted tube into your urethra. This is called a scope. It goes in through the opening in your penis. Then the doctor puts a small surgical laser through the scope. The laser cuts and removes extra tissue from around the urethra. The tissue is moved into the bladder. Then another tool replaces the laser and is used to cut the tissue into small pieces. This makes the tissue easier to remove. When the doctor is finished, the tool and the scope are taken out. A catheter will be placed in your bladder.

This surgery may make it easier for you to urinate. You may have better control when you start and stop your urine stream. And you may feel like you get more relief when you urinate.

You may go home from the hospital on the day of surgery. Or you may stay a night in the hospital for observation. Most people can resume their daily activities in 1 to 2 weeks. But you may need to avoid heavy lifting and activities that might put extra pressure on your bladder for a few weeks.

Your doctor will give you detailed instructions on how to prepare for the surgery. Be sure to follow them.

• If you plan to have biological children, talk to your doctor about saving your sperm before the surgery. After HoLEP, there is a chance that your semen may go into your bladder when you ejaculate instead of out through your penis.
• You may need to empty your bowels with an enema or laxative. Your doctor will tell you how to do this.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
• Don’t smoke, vape, or use other tobacco and nicotine products. These things increase surgery risks. Your doctor may require that you quit for a period of time before and after surgery. You have the best chance for a healthy recovery if you quit completely. If you need help quitting, talk to your doctor about quit programs and medicines.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no surgical site errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take a few hours.

• You have questions or concerns.
• You don't understand how to prepare for your surgery.
• You become ill before the surgery (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the surgery.