Being diagnosed with an enlarged prostate can raise many questions, particularly when you are told that your prostate is significantly larger than normal. You may wonder whether medication will be enough, whether surgery is necessary, or which procedure offers the most appropriate solution.
The good news is that HoLEP (Holmium Laser Enucleation of the Prostate) is an established surgical treatment that can be used for prostates of different sizes, including very large glands.
For men with benign prostatic hyperplasia (BPH), HoLEP can provide an effective way to remove the tissue obstructing the urinary passage without an external surgical incision.
For patients researching prostate surgery abroad, it is also worth understanding how HoLEP works, when it may be recommended and what to consider when choosing a specialist.
What does it mean to have a very large prostate?
The prostate is a gland located below the bladder that surrounds the urethra, the tube through which urine leaves the body.
As men get older, the prostate commonly increases in size. This condition is known as benign prostatic hyperplasia (BPH).
When the enlarged tissue compresses the urethra, it can obstruct the flow of urine and make the bladder work harder to empty itself.
Symptoms may include:
A weak or slow urinary stream.
Difficulty starting urination.
Having to strain to urinate.
A feeling that the bladder has not emptied completely.
Frequent urination during the day.
Waking several times at night to urinate.
Urinary urgency or dribbling.
A large prostate does not always cause severe symptoms. However, when obstruction becomes significant, treatment may be necessary to improve urinary function and reduce the risk of complications.
Can HoLEP treat a very large prostate?
Yes. HoLEP is a surgical option for men with prostate enlargement across a broad range of prostate sizes.
Unlike some procedures that are generally intended for particular prostate-volume ranges, laser enucleation can be used to remove substantial amounts of obstructing prostate tissue.
During HoLEP, a holmium laser is used to separate the enlarged inner portion of the prostate from the surrounding tissue. The removed tissue is then extracted through the urinary passage.
The procedure is performed endoscopically, meaning that the surgeon works through the urethra without making an external incision.
The European Association of Urology recommends HoLEP as an alternative to transurethral resection of the prostate (TURP) or open prostatectomy for appropriate men who require surgical treatment for urinary symptoms caused by benign prostatic obstruction.
The suitability of HoLEP still depends on an individual assessment, and the surgeon's experience is an important consideration.
Why can prostate size matter when choosing surgery?
Different prostate treatments are designed for different clinical situations.
Some minimally invasive procedures are intended for selected patients within a particular prostate-size range. Other surgical techniques can remove larger amounts of obstructing tissue.
When a prostate is very large, the urologist must consider which approach can adequately relieve the obstruction while taking into account the patient's health, anatomy and treatment goals.
HoLEP is particularly relevant in this context because it can be used for large prostates without requiring an abdominal incision.
However, prostate volume is not the only factor that determines which treatment is best. Symptoms, bladder function, previous procedures, medications and general health also influence the decision.
HoLEP vs. traditional prostate surgery
Several surgical procedures are available to treat benign prostatic hyperplasia.
HoLEP
HoLEP uses a laser to separate and remove the obstructing prostate tissue through the urethra.
It can be used for a wide range of prostate sizes and is an established alternative to TURP and open prostatectomy in appropriate patients.
TURP
Transurethral resection of the prostate, or TURP, involves removing obstructing tissue through the urethra using a surgical instrument.
It remains an effective treatment for many men, although the most suitable technique depends partly on prostate size and anatomy.
Simple prostatectomy
Simple prostatectomy removes the obstructing part of the prostate through an abdominal or robotic surgical approach.
It may be appropriate for selected patients with very large prostates, depending on the clinical situation and available expertise.
HoLEP offers an alternative approach because the obstructing tissue can be removed through the urinary passage.
There is no single procedure that is best for every patient. A specialist should explain the advantages, limitations and potential risks of the available options.
What are the potential benefits of HoLEP?
For appropriately selected patients, HoLEP offers several important characteristics:
Suitable for large prostates: It can remove substantial amounts of obstructing tissue.
No external incision: The procedure is performed through the urinary passage.
Improved urinary flow: Removing the obstruction can help men empty their bladders more effectively.
A relatively short hospital stay: Many patients can leave hospital after a short period, depending on their recovery and medical circumstances.
A durable treatment option: HoLEP can provide lasting relief from obstruction, although no procedure guarantees that further treatment will never be necessary.
As with any surgery, HoLEP has potential risks and side effects. These may include temporary urinary urgency, burning, blood in the urine, temporary urinary leakage and changes in ejaculation. The possibility of these outcomes should be discussed with the treating urologist before surgery.
How do you know whether you need prostate surgery?
Not every man with an enlarged prostate needs an operation.
If symptoms are mild, monitoring or medication may be appropriate. Surgery may be considered when symptoms significantly affect quality of life, medication is insufficient or complications associated with obstruction develop.
These complications can include recurrent urinary retention, repeated urinary tract infections, bladder stones or deterioration in urinary tract function.
Before recommending surgery, the urologist will assess your symptoms, medical history and relevant test results.
The evaluation may include prostate imaging, urine tests, PSA testing when appropriate, urinary flow measurement and assessment of the urine remaining in the bladder after urination.
The purpose is to establish the cause of your symptoms and determine which treatment is most appropriate.
Is HoLEP available in Madrid, Spain?
For men considering prostate surgery in Spain, HoLEP is available at specialist urological centres in Madrid.
Patients may consider treatment in Madrid for a variety of reasons, including access to specialist surgical expertise or the opportunity to discuss a particular treatment option.
If you live outside Spain, the first step is to determine whether HoLEP is appropriate for your individual situation.
Existing medical reports, prostate measurements, previous imaging, PSA results and information about your urinary symptoms can help a specialist understand your case before you travel.
An initial consultation may also help identify whether additional investigations are required before a treatment decision can be made.
What should international patients consider before travelling for HoLEP?
Travelling abroad for prostate surgery requires planning beyond the procedure itself.
Before making arrangements, it is important to understand:
What medical information is needed for the initial assessment.
Whether further tests or an in-person consultation are necessary.
What the proposed treatment involves.
How long you may need to remain in Madrid.
What postoperative monitoring and recovery may involve.
When your medical team considers it appropriate to travel home.
How follow-up will be coordinated after your return.
There is no universal timetable for every patient. Your stay and return journey should be planned according to your clinical needs and postoperative progress.
A clear treatment plan helps ensure that the assessment, procedure, recovery and follow-up are considered together.
Choosing the right treatment for an enlarged prostate
A very large prostate does not automatically mean that you need surgery. However, if significant obstruction is present, it is important to understand the available treatment options.
HoLEP is an established option for men who require surgical treatment for benign prostatic hyperplasia, including those with large prostates.
The right decision depends on your symptoms, prostate anatomy, bladder function, medical history and personal priorities, as well as the experience of the surgeon performing the procedure.
A specialist assessment can help you understand whether HoLEP is appropriate and what to expect from treatment.
Considering HoLEP in Madrid?
If you live outside Spain and have been diagnosed with an enlarged prostate, you may wish to explore whether HoLEP could be an appropriate treatment option for you.
Dr. Alejandro González Alfaro provides information for international patients considering HoLEP in Madrid, including the assessment process, surgery, recovery and follow-up.
Learn more about HoLEP for International Patients in Madrid, Spain.
