Choosing the Right Surgeon for Your HoLEP

What makes HoLEP different for surgeon selection

HoLEP has a steeper learning curve than classic TURP. Outcomes depend on technique, not just the tool.

A trained HoLEP surgeon handles the capsule plane, the morcellator, and the anatomy of each gland confidently. A surgeon early in their HoLEP career takes longer in theatre and may have more variable outcomes.

This is why HoLEP tends to cluster in higher-volume centres worldwide.

Training backgrounds to look for

Formal HoLEP fellowship or structured mentorship carries significant weight. Ask whether the surgeon has completed a dedicated HoLEP fellowship or received one-to-one mentoring from an experienced HoLEP mentor.

Participation in regular HoLEP workshops and cadaveric courses counts. International society memberships (urology, endourology, laser surgery) add credibility.

A publication record in HoLEP outcomes is not required, but it signals that a surgeon actively follows the field.

Case volume as a useful signal

Annual HoLEP case volume matters. Surgeons with fewer than about 20 cases per year are generally still on their learning curve. Surgeons with 50 or more per year are at a stable experience level.

Case volume does not tell you everything. A new but well-mentored surgeon can have good outcomes, while a high-volume surgeon can have variable outcomes if technique has drifted.

A 2026 multi-generational survey study of en-bloc HoLEP training and learning curves confirms that structured training, peer feedback, and sustained case volume are the three pillars of consistent outcomes[¹].

Complication rates — ask in plain terms

Ask your surgeon for their own complication rates. The key numbers are transfusion rate, re-operation rate for bleeding, bladder-neck contracture rate, and persistent incontinence beyond six months.

Good answers are specific (for example, "my bladder-neck contracture rate is under 2%"), not vague ("very rare"). A surgeon who tracks these numbers is a surgeon who takes them seriously.

It is reasonable to ask how they record and audit outcomes. Registry participation is a positive sign.

Questions that help you decide

Ask how many HoLEPs the surgeon does each year. Ask how long they have been doing HoLEP specifically.

Ask what the hospital pathway looks like — catheter time, expected stay, follow-up schedule. Ask what happens if a complication occurs at night.

Ask whether the surgeon will be present for the operation, or a trainee. In teaching hospitals, both can be appropriate with proper supervision.

Red flags to take seriously

A surgeon who refuses to give numbers. A clinic that promises specific results or uses guarantee-style language.

Pressure to decide quickly or book same-week surgery for an elective BPH operation. Lack of written pre-op or discharge instructions.

No clear pathway for out-of-hours concerns. If any of these show up, seek another opinion.

Second opinions are normal

Getting a second urology opinion is a sensible step for any elective surgery. A second opinion is not a criticism of the first surgeon.

Bring your notes, your IPSS, and any imaging to the second visit. A consistent plan across two surgeons is reassuring.

If the two opinions differ materially, a third visit or a multidisciplinary review is reasonable.

Verifying credentials

National medical councils publish registration status for every practising clinician. Check that the surgeon is currently registered and in good standing.

Hospital websites usually list consultant credentials. Society membership lists (national urology society, endourology society) are often public.

Never rely on social-media testimonials alone. They are not verifiable.

Plain bottom line

A trained, regularly-operating HoLEP surgeon who tracks their own outcomes and answers your questions honestly is what you are looking for. Training and numbers matter. Pressure and guarantees are red flags.

Take the time, ask the questions, and write the answers down.