Difficulty urinating, a weak stream, and the constant feeling that the bladder hasn’t fully emptied are daily struggles for countless men. When benign prostatic hyperplasia (BPH) leads to severe bladder outlet obstruction, the impact on quality of life can become overwhelming.

Today, thanks to advanced minimally invasive surgery, it is possible to permanently resolve this issue safely, rapidly, and virtually painlessly.

Surgical procedures for bladder outlet obstruction have evolved dramatically since the 1950s. But what exactly is HoLEP, and is it painful?

We discussed this topic with Dr. Alessandro Pittari, Urologist at our clinic.

“HoLEP refers to Holmium Laser Enucleation of the Prostate—the precise removal of obstructing prostatic tissue using a high-powered holmium laser. While its obstructive relief matches that of traditional surgeries, it is significantly less invasive, requires much shorter hospitalization, and drastically minimizes intra- and postoperative bleeding risks.”

Clinical Evidence: Key Data on Holmium Laser Efficiency

• 60 to 90 Minutes: The average duration of the procedure, regardless of prostate size.

• Near 0% Bleeding: The exceptional precision of the holmium laser cauterizes blood vessels instantaneously.

• Unlimited Prostate Volume: Unlike legacy endoscopic techniques, HoLEP successfully treats both small and exceptionally large prostates.

When Medication Is No Longer Enough: Addressing Patient Needs

The ideal candidate for HoLEP decompressive therapy is a man experiencing significant obstructive symptoms that no longer respond to medication.

When pharmacological treatments stop delivering a smooth, healthy urinary flow, surgical intervention becomes essential. Many men delay treatment out of fear—worrying about postoperative pain or historic complications like catheter-clogging blood clots. HoLEP eliminates these concerns.

Performed under spinal anesthesia, the procedure involves no external incisions, keeping postoperative discomfort to a minimum. Using a specialized instrument known as a morcellator, the enucleated prostatic tissue is broken down into small fragments directly inside the bladder, then safely aspirated and removed.

How Long Does the Surgery Take?

In the past, the choice between endoscopic surgery and open abdominal surgery was dictated entirely by prostate volume.

HoLEP has completely eliminated this barrier. Specialists can now operate on prostate glands ranging from small to exceptionally large volumes. During HoLEP, the obstructing tissue is enucleated in whole blocks and pushed into the bladder. A dedicated tissue morcellator then finely shreds and vacuums the tissue away.

Because of this streamlined process, the entire procedure typically takes between 60 and 90 minutes, regardless of how large the prostate is.