What Happens During a HoLEP

Positioning and preparation

Once you are asleep or your spinal is working, the team positions you on your back with your legs raised in supports. This position gives the surgeon access through the urethra.

The skin around your groin is cleaned with antiseptic. A drape covers everything else. The surgeon and scrub nurse change into sterile gowns and gloves.

A soft flexible scope is passed through the urethra to look at the inside. This first look confirms the size and shape of the prostate and the condition of the bladder.

Starting the enucleation

The laser fibre is introduced through a working channel in the scope. Saline flows through the scope continuously to keep the view clear.

The surgeon finds the capsule plane — the layer between the growing inside and the outer shell. This is the natural plane that HoLEP follows.

A small cut is made at the bladder neck to establish the plane, and then the laser follows the layer around each lobe in turn.

Peeling the lobes

The middle lobe, when present, comes free first. The two side lobes follow.

Each lobe is peeled away like lifting the pith away from the inside of an orange peel. As each plane opens, the laser seals small vessels at the edge.

When a lobe is fully free, it is pushed into the bladder to wait for the next stage.

Morcellation

A separate tool, called a morcellator, replaces the laser fibre at this stage. It fits through the same scope.

The morcellator has a rotating blade at its tip. It breaks the freed lobes into small pieces and suctions them out through the scope.

Final inspection

Once the last fragments are out, the scope is used to inspect the prostate fossa and the bladder. The surgeon checks for any small bleeder that needs sealing.

A urinary catheter with a bladder-washout connection is inserted. The catheter stays in for a day or two.

The team counts instruments, confirms the count, and transfers you to recovery.

How long each stage takes

Positioning and preparation take about fifteen minutes. Enucleation takes thirty to ninety minutes depending on prostate size.

Morcellation takes five to thirty minutes. It also depends on the volume of tissue.

Final inspection and catheter placement add another fifteen minutes.

What tissue sampling looks like

The fragments collected after morcellation are weighed, labelled, and sent to pathology. A pathologist examines a sample from the lobes.

Because whole fragments are recovered, the tissue can be examined microscopically; vaporisation techniques leave no tissue to sample, since the tissue is destroyed in place. Any unsuspected early cancer can be flagged at this stage.

Your team tells you the histology result at your first follow-up.

Plain bottom line

A HoLEP is a three-act operation through the urethra[¹]. Positioning, enucleation, and morcellation each have a clear job.

The plane, the laser, and the morcellator do the work. Your clinical team makes sure every step happens in the right order.