Frequently Asked Questions about HoLEP
The questions below are the ones men (and their spouses, children, primary care doctors) actually ask before HoLEP — drawn from years of clinic conversations, documented patient experiences, and the questions that recur in patient forums. They’re organized by topic; jump to whichever section is most relevant.
About the procedure
What does HoLEP stand for?
Holmium Laser Enucleation of the Prostate. A holmium:YAG laser is used to remove the obstructing inner portion of the prostate through the urethra, with no skin incisions. The removed tissue is morcellated (the freed tissue is broken into tiny fragments and suctioned out through the scope) and extracted, and goes to a pathologist.
Is HoLEP open surgery?
No. HoLEP is a transurethral procedure — performed through the urethra. There are no external incisions, no abdominal cuts, no scars. The closest non-surgical analogy is the way a colonoscopy is endoscopic rather than open.
How long does the surgery take?
Usually one to two hours, depending on prostate size. A 60-gram prostate is faster than a 200-gram prostate; the procedure scales linearly.
Will I be asleep?
Either general anesthesia (asleep) or spinal anesthesia (numb from the waist down, awake or lightly sedated). Both are common. The choice depends on patient-specific factors that the anesthesia team and surgeon will discuss with you.
How is HoLEP different from TURP?
Transurethral resection of the prostate (TURP) cuts pieces of the prostate from the inside out using an electric wire loop. HoLEP enucleates (the prostate's inner core is removed whole, leaving the outer shell intact) the entire inner prostate as intact lobes along the natural surgical plane, then morcellates and extracts them. The mechanical difference produces less bleeding, more durable symptom relief, and the ability to handle prostates of any size — including glands much larger than TURP can safely manage.
Is HoLEP the same as ThuLEP?
Similar but not identical. ThuLEP (Thulium Laser Enucleation of the Prostate) uses a different laser (thulium fiber laser, often pulsed) instead of holmium:YAG. The principle — enucleating the adenoma (the inner part of the prostate that enlarges with age and squeezes the urethra) — is the same. Outcomes are comparable. Long-term data are stronger for HoLEP simply because it has been in clinical use longer.
Will the prostate grow back?
The obstructing inner adenoma that is removed during HoLEP does not regenerate. The outer surgical capsule that is left in place can theoretically continue growing, but in published long-term cohorts, surgical retreatment rates are near zero at 5 and 7 years.
Who is HoLEP for
Is my prostate too small for HoLEP?
There’s no strict lower limit. Very small prostates (under ~30 grams) with obstructive symptoms are usually treated differently — sometimes with medication, sometimes with smaller-footprint procedures. The right answer depends on the specific symptoms and anatomy. A consultation establishes whether HoLEP fits.
Is my prostate too large for HoLEP?
No. HoLEP has the highest published upper-size limit of any benign prostatic hyperplasia (BPH) procedure — routine use extends from 30 grams to 300+ grams. For prostates above 80 grams, HoLEP is the procedure with the strongest randomized-trial evidence supporting use.
I’m 85. Am I too old?
No. Published outcomes are excellent in men over 80, and a recent series specifically studied men over 85 with excellent safety and effectiveness. Age alone is not a contraindication to HoLEP. The relevant questions are about cardiac, pulmonary, and functional status — discussed at consultation and pre-operative evaluation.
I’m on blood thinners. Can I still have HoLEP?
In most cases, yes. HoLEP is the safest enucleation procedure for patients on anticoagulation (blood-thinning medication), including direct oral anticoagulants and antiplatelet (a type of blood thinner, such as aspirin or clopidogrel) agents. For warfarin and dual antiplatelet therapy, the medication plan is individualized. Often HoLEP can be performed without stopping the blood thinner at all.
I had UroLift / Rezum / GreenLight years ago and it didn’t last. Can I still have HoLEP?
Yes. HoLEP is an appropriate option after failed minimally invasive procedures, and a meaningful fraction of HoLEP patients arrive after one or more prior procedures. Prior surgery does not preclude HoLEP.
I have a urinary catheter and can’t urinate on my own. Am I a HoLEP candidate?
Yes — and you are exactly the patient HoLEP serves well. Men in urinary retention (being unable to empty the bladder on your own) often have very large prostates that other procedures can’t address. HoLEP routinely restores spontaneous urination in men who have been catheter-dependent (a thin, flexible tube that drains urine from the bladder) for months or years.
What if I have prostate cancer?
If active prostate cancer requires treatment first, HoLEP can be discussed afterward. If prostate cancer is identified on the HoLEP specimen (about 10% of cases — sometimes called “incidental T1a or T1b cancer”), the management plan is discussed at follow-up. Often no further treatment beyond monitoring is needed.
Recovery and side effects
How long is the hospital stay?
Most patients go home the same day as surgery. A small minority stay overnight, typically for specific medical indications.
How long is the catheter in?
Usually 24 to 48 hours. The catheter is removed at home — following written and hands-on instructions given before discharge — or, if you’d prefer, with a brief office visit and voiding trial.
When can I drive?
Once you’re off any narcotic pain medication and feeling fully alert. For most patients, within a few days.
When can I go back to work?
Desk work: typically within 1–2 weeks. Physical jobs: typically 4–6 weeks. Your specific timeline is discussed at consultation.
When can I have sex again?
Most surgeons clear sexual activity at 4–6 weeks.
Will I lose my erections?
Very unlikely. HoLEP does not directly affect the nerves that control erection. In published long-term head-to-head data, HoLEP performs as well as or better than alternative procedures on long-term erectile function.
What is retrograde ejaculation?
First, the reassuring part: sexual function has two components — erections and orgasm — and HoLEP leaves both intact. Retrograde ejaculation refers only to where the fluid goes. At orgasm, the semen travels backward into the bladder instead of out through the penis, so the climax is “dry” — little or nothing comes out, and it leaves harmlessly with the next urination. This happens in roughly 75% of men after HoLEP and is usually permanent. Erections are unaffected and orgasm sensation is essentially unchanged — most men report it the same or even more intense. The main practical consequence is reduced fertility, so men hoping to father children should discuss that before surgery.
Will I be incontinent?
Most men have temporary stress-related leakage in the first few weeks. By 12 weeks, most have full control. Persistent incontinence past 3 months is uncommon (1% or less in long-term published data) and is almost always treatable when it does occur.
Will it hurt?
Most men do not need narcotic pain medication beyond what they receive in the recovery area. Acetaminophen handles the typical day-after discomfort. The first urination after catheter removal is occasionally a bit uncomfortable but is more often described as startlingly strong.
How long until I’m back to normal?
“Substantially back to normal” by 4–6 weeks for most men. “Fully healed” by 8–12 weeks.
I’m 3 weeks out and just saw pink urine after a long walk. Should I be worried?
Almost certainly not. Late bleeding after exertion is a well-documented feature of HoLEP recovery — a small healing scab breaks loose, you see pink urine, it settles with hydration and reduced activity over a day or two. Worth knowing about so it doesn’t alarm you. If the urine becomes thick with clots, if you can’t urinate, or if heavy bright-red bleeding doesn’t slow within a few hours, that warrants a phone call.
What’s “climacturia” and should I be worried about it?
Climacturia is a small release of urine at the moment of orgasm. It is common in the first few months after HoLEP. Emptying the bladder before sexual activity usually resolves it. It is not a sign of incontinence and typically goes away over a few months.
Before surgery
How do I prepare for HoLEP?
You’ll have a consultation visit, imaging (typically transrectal ultrasound or MRI), pre-operative laboratory tests, and an anesthesia evaluation. Specific medication instructions — particularly about blood thinners — come from the surgical team. The night before surgery, nothing to eat or drink after midnight. No bowel prep is needed.
Do I need to stop my BPH medications?
Most men on tamsulosin or alfuzosin (alpha-blockers (a common prostate medication that relaxes the bladder neck, e.g. tamsulosin)) can continue them up to and after surgery. Men on finasteride or dutasteride (5-alpha-reductase inhibitors) are typically instructed to continue. Specific guidance comes from your surgeon.
Where are HoLEP procedures performed?
Dr. Quarrier operates at both Strong Memorial Hospital and Highland Hospital in Rochester, NY. The clinic for consultations and follow-up is at 158 Sawgrass Drive.
After surgery
When will I see Dr. Quarrier after surgery?
Typically a phone call at about 2 weeks to confirm you’re progressing well and review your pathology results, then an in-person visit with the team at about 3 months.
Will I need pelvic-floor physical therapy?
Most men do not. Daily Kegel exercises starting after catheter removal are encouraged. Formal physical therapy is reserved for the minority of men whose incontinence does not improve as expected.
Do I need to take antibiotics?
You’ll receive a single dose of intravenous antibiotic at the time of surgery. Some patients are given a short course of oral antibiotics for the early post-op period; this is individualized.
When can I exercise?
Walking from day 1. Light exercise (recumbent bike, easy swimming, gentle weights) generally fine by 2 weeks. Full intensity training, heavy lifting, and contact sports at 6 weeks unless your surgeon specifies otherwise.
Should I take Cialis or Viagra after surgery?
If you were on a PDE5 inhibitor before surgery (for erectile dysfunction (ED), or as a daily medication for BPH symptoms), you can usually resume it. If you were not on one and want to try one to support erection quality during recovery, discuss with your surgeon — typically reasonable.
Decision-making
Should I have HoLEP or stay on medication?
The honest answer depends on your symptoms, your medication side effects, your age, your prostate size, and your priorities. There is published evidence that the trajectory of waiting on medication is not as cost-free as it is sometimes presented — see the /early-intervention page for the data. A consultation is the right setting to decide.
Should I have HoLEP or Aquablation / UroLift / Rezum / GreenLight / iTind / PAE?
Each procedure has its place. The most-honest single comparison page on this site is /why-holep, which walks through each comparator with primary-source citations. For most men who are surgical candidates, HoLEP offers the best combination of durability, size-flexibility, and long-term outcomes. For specific situations — particularly men prioritizing short-term ejaculatory preservation — other procedures may be appropriate.
How do I know if my surgeon does HoLEP well?
The question to ask is volume. HoLEP has a documented learning curve, and surgeon volume correlates with outcomes. There is no magic number, but a surgeon performing 50+ HoLEPs per year, with formal HoLEP fellowship training, is generally past the learning curve. Dr. Quarrier completed dedicated endourology fellowship training at the University of Wisconsin, performs HoLEP as a primary clinical focus at UR Medicine Urology, and teaches the technique to other surgeons nationally.
What if I want a second opinion?
A second opinion is always reasonable, particularly for a procedural decision. If you’ve been told you’re not a surgical candidate elsewhere because of prostate size, comorbidity (other ongoing medical conditions), or anticoagulation status, an opinion at a HoLEP-experienced center is particularly worth seeking.
Logistics
Does insurance cover HoLEP?
Yes. HoLEP is covered by Medicare and by virtually all commercial insurance plans as a standard BPH surgical option.
Will I need someone to drive me home?
Yes. You should not drive after anesthesia. Plan for a friend or family member to drive you home and ideally be with you for the first 24 hours.
I live out of town. Can I still come to UR Medicine?
Yes. UR Medicine Urology sees patients from across Western and Central New York, the Finger Lakes, the Southern Tier, and beyond — and a number of men travel from out of state specifically for HoLEP. If you’re flying in for treatment, the scheduling team can help coordinate the timing of your consultation, surgery, and follow-up so the trip is as efficient as possible. Call the scheduling line at (585) 275-2838 to start the conversation, and see the Traveling to UR Medicine for HoLEP page for the practical logistics.
What to do next
To schedule a consultation, call UR Medicine Urology at (585) 275-2838.
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