Laser Prostate Surgery (HoLEP): ThuLEP, GreenLight and Recovery

🔵What laser prostate surgery is

Laser prostate surgery treats benign prostatic hyperplasia (BPH), a non-cancerous enlargement that can squeeze the urethra. It is done through the urethra with a thin telescope, with no skin cut. There are two main approaches:

• Laser enucleation (HoLEP and ThuLEP): a holmium (HoLEP) or thulium (ThuLEP) laser peels the enlarged inner prostate away from its outer shell. According to the University Hospitals Sussex NHS leaflet, the tissue is then broken up in the bladder and removed.
• Photoselective vaporisation (PVP, often called GreenLight): a laser vaporises the blocking tissue. The BAUS leaflet notes that no tissue sample is left for laboratory examination.

See also our guides to enlarged prostate and prostate surgery types.

2Who may be suitable

The NIDDK notes that surgery is usually considered when symptoms are severe, enlarged prostate medicines do not help, or complications develop. The guidelines describe the laser options this way:

• NICE (2003 guidance) finds the evidence on holmium laser prostatectomy adequate to support its use by specially trained clinicians.
• NICE recommends GreenLight as an option for BPH. Experts cited by NICE consider it safe for prostates up to 100 ml (150 ml in experienced hands); prostates bigger than 150 ml are more likely to be considered for HoLEP. NICE states that GreenLight is not used in men with prostate cancer.
• The EAU says laser enucleation is usually recommended for moderate to very large prostates.
• The AUA describes HoLEP and ThuLEP as options for any prostate size, and PVP as another option.
• NICE and the AUA note laser methods can be considered for men at higher bleeding risk, including those on blood thinners.

The choice depends on prostate size, general health and the surgeon’s expertise. Some men may instead be offered Rezum water vapour therapy.

3How suitability is assessed

The urologist first confirms the symptoms come from the prostate. According to the NIDDK, this relies on history and examination, including a digital rectal examination, and tests such as:

• urine test and PSA blood test, with a biopsy if needed
• urodynamic tests of bladder storage and emptying
• cystoscopy and transrectal ultrasound

Because vaporisation leaves no tissue, BAUS advises discussing any cancer concern beforehand.

4Laser surgery compared with TURP

Transurethral resection of the prostate (TURP) cuts tissue away with an electric loop. The table summarises the cited sources; it is general, not a prediction for any individual.

5Preparing for the operation

• The team reviews your health and all medicines, including blood thinners; only the doctors decide whether these are paused. You sign a consent form.
• The UH Sussex leaflet describes compression stockings and antibiotics; a general or spinal anaesthetic is used.
• For same-day discharge, arrange a responsible adult at home.

6Catheter, hospital stay and recovery

A urinary catheter is placed at the end of the operation. According to the BAUS leaflet, after GreenLight vaporisation most men go home the same day and the catheter is usually removed within 72 hours. The UH Sussex leaflet says HoLEP is usually a day case or needs one night in hospital, and the catheter is often removed the next morning or around the third day, occasionally later.

During recovery:

• the UH Sussex leaflet says most men return to work after about two weeks
• it advises avoiding heavy lifting for about four weeks after HoLEP
• BAUS notes flow usually improves quickly, but urgency can take up to three months to settle

⚠️Side effects and risks

• Temporary urinary symptoms: burning, frequency, urgency and some blood in the urine are common at first. BAUS states that about 1 in 5 men have some bleeding two to three weeks after going home, as healing scabs come away.
• Retrograde ejaculation: semen flows back into the bladder rather than out, so ejaculation is dry. It is not harmful to health but can affect fertility, and the UH Sussex leaflet notes it is not a form of contraception. The UH Sussex leaflet says it occurs in nearly all men after HoLEP; BAUS gives 3 to 5 in 10 after GreenLight.
• Urine leakage: according to the UH Sussex leaflet, up to 1 in 10 men have temporary leakage after HoLEP, with a long-term risk of 1 to 2%. Pelvic floor exercises often help.
• Infection: BAUS gives a urinary infection risk of about 1 in 20 after GreenLight.
• Other risks: scar narrowing, incomplete symptom relief, needing a catheter again, and anaesthetic risks.

See also: is an enlarged prostate dangerous.

⏰When to seek urgent care

Contact your urology team or go to the emergency department straight away if you:

• cannot pass urine at all, or the catheter stops draining
• have heavy bleeding or pass blood clots
• have bleeding that does not settle within 24 to 48 hours, as the UH Sussex leaflet advises
• develop fever, chills or painful frequent urination, which the NIDDK lists as reasons to seek care right away
• have severe pain in the lower abdomen, or feel generally unwell

❓Frequently asked questions

10Sources

1. Holmium laser prostatectomy (NICE HealthTech guidance HTG5)
2. GreenLight XPS for treating benign prostatic hyperplasia (NICE HealthTech guidance HTG650)
3. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline
4. Laser enucleation of the prostate for BPE – EAU Patient Information
5. Green light laser prostatectomy (GLLP) – BAUS patient information leaflet
6. Holmium Laser Enucleation of the Prostate (HoLEP) – University Hospitals Sussex NHS Foundation Trust
7. Enlarged Prostate (Benign Prostatic Hyperplasia) – NIDDK