Home › Treatments › HoLEP
Signature treatment
HoLEP: Holmium Laser Enucleation of the Prostate
A laser treatment that removes the part of an enlarged prostate blocking the flow of urine — suited to prostates of any size, and usually carried out as a day case.
Written and clinically reviewed by Mr Daniel Swallow, Consultant Urologist (MA MB BChir, FRCS Urol) — Cambridge-trained and a faculty member on the University of Cambridge HoLEP training course. Last reviewed: August 2026.
What is HoLEP?
HoLEP (Holmium Laser Enucleation of the Prostate) is a keyhole laser operation that removes the part of an enlarged prostate that is blocking the flow of urine. It treats benign (non-cancerous) prostate enlargement, works for prostates of any size, and is usually carried out as a day case or a single overnight stay. Mr Daniel Swallow offers HoLEP privately in London — at The Princess Grace Hospital and The Harley Street Clinic — and in Chelmsford.
The prostate sits just below the bladder, wrapped around the urethra (the tube that carries urine out of the body). As the prostate enlarges with age, it can squeeze this tube and block the flow of urine — a condition called benign prostate hyperplasia, or BPH.
HoLEP uses a laser, passed up through the urethra on a telescope, to carefully separate the enlarged inner portion of the prostate from its outer shell — a process called enucleation (freeing the tissue whole, rather than trimming it away) — and push it into the bladder, where it is then broken up and removed. This creates a wide, open channel for urine to pass through, similar in principle to coring an apple. The tissue that is removed is then sent to the laboratory for microscopic analysis, which also has the benefit of checking for any unexpected findings.
Why HoLEP is different
Compared with older techniques, HoLEP removes a greater amount of the obstructing tissue in one sitting. Because so little is left behind, results tend to be durable, and the chance of needing a repeat procedure later is low.
Suited to prostates of any size
Some minimally invasive treatments work best only on smaller glands. HoLEP is effective across the full range of prostate sizes, including very large prostates that can be difficult to treat with older methods without open surgery.
Less bleeding than older techniques
The laser seals small blood vessels as it works, which means bleeding during and after the procedure is usually low. That generally means a shorter time with a catheter afterwards, and a quicker return to normal activity.
Short hospital stay with a lasting result
Many men are able to go home the same day or on the first morning after surgery, once their catheter has been removed. Because the whole obstructing portion of the prostate is removed rather than trimmed, the improvement in flow tends to be long-lasting.
HoLEP treats benign (non-cancerous) enlargement of the prostate. It is not a cancer treatment, though the tissue removed is always checked in the laboratory as routine good practice.
What to expect
- 1Assessment
A review of your symptoms, a flow test, an assessment of your prostate size, and a review of your current medicines.
- 2The procedure
Carried out under general or spinal anaesthetic. The laser separates and removes the obstructing tissue, and a catheter is placed at the end of the operation.
- 3Recovery in hospital
Most men stay one night. The catheter is usually removed on the first morning after surgery, once your urine has cleared.
- 4Follow-up
A review appointment to check your recovery and flow, and to discuss the result of the tissue analysis.
Possible after-effects
As with any surgery to widen the prostate channel, temporary burning, urgency or blood in the urine are common in the days afterwards, and usually settle on their own. Retrograde ejaculation (sometimes called a “dry orgasm”) — where semen passes back into the bladder rather than out during sex — is common after this type of surgery and is not harmful, though it does affect fertility. There may be a period of initial difficulty with continence; this may be rarely more prolonged. Less commonly, further bleeding, infection, or difficulty passing urine after the catheter is removed can occur and may need further treatment. Mr Swallow will talk through the specific risks that are relevant to you.
HoLEP compared with other options
| HoLEP | TURP | |
|---|---|---|
| How it works | Laser enucleation — the blocking tissue is freed whole and removed | Telescopic resection — tissue is trimmed away using an electric current |
| Prostate size | Suitable across all sizes, including very large glands | Best suited to small- to moderate-sized glands |
| Typical stay | Short hospital stay with a lasting result | Usually one to two nights |
Both are legitimate, well-established options. Which is more suitable depends on your prostate size, your general health, and your current medicines — Mr Swallow will discuss the right choice for you individually. You're welcome to ask any surgeon about their personal experience and results with a procedure; this is a right recommended by the Royal College of Surgeons.
Information on this page follows patient guidance published by the British Association of Urological Surgeons (BAUS).
Common questions about HoLEP
Is HoLEP suitable for a large prostate?
Yes. HoLEP is effective across the full range of prostate sizes, including very large glands that were traditionally difficult to treat without open surgery. Prostate size is one of the main reasons HoLEP is chosen over some other minimally invasive treatments.
How long does it take to recover from HoLEP?
Most men go home on the first morning after surgery, once the catheter has been removed. Mild burning, urgency or blood in the urine are common in the first days and usually settle on their own. Many men return to light activity within a week or two, with Mr Swallow advising on anything more strenuous.
How does HoLEP compare with TURP?
Both are well-established operations for an enlarged prostate. HoLEP removes the whole obstructing portion of the prostate rather than trimming it, which suits prostates of any size and tends to give a durable result with a low chance of needing a repeat procedure. TURP is suited to small- to moderate-sized glands. The right choice depends on your prostate size, general health and current medicines — see the comparison above.
Will HoLEP affect sex or fertility?
HoLEP does not usually affect the ability to get an erection. However, retrograde ejaculation (a “dry orgasm”, where semen passes back into the bladder rather than out during sex) is common after this type of surgery. It is not harmful, but it does affect fertility, so it is an important consideration for men who may wish to father children.
Is HoLEP available privately in London?
Yes. Mr Daniel Swallow offers private HoLEP assessment and surgery at The Princess Grace Hospital (Marylebone) and The Harley Street Clinic — Devonshire Diagnostic Centre, 16 Devonshire Street — as well as at Springfield Hospital in Chelmsford. Consultations are open to both self-paying and insured patients.
How do I arrange a HoLEP consultation?
Contact the private secretary team on 01245 234414 or through the contact page. Your first appointment covers your symptoms, a flow test and an assessment of your prostate, so Mr Swallow can advise whether HoLEP is a suitable option for you.