Enlarged Prostate Treatment Options: When Is HoLEP a Good Choice?

An enlarged prostate is one of the most common urological conditions affecting men as they get older. It can cause a range of urinary symptoms, from a weak stream and difficulty starting urination to frequent trips to the bathroom at night.

For some men, these symptoms are mild and require little or no treatment. For others, an enlarged prostate can significantly affect quality of life or lead to problems such as urinary retention and recurrent urinary infections.

Fortunately, there are several effective treatments available for benign prostatic hyperplasia (BPH), including medication, minimally invasive procedures and surgery.

One of the surgical options that has become increasingly established is HoLEP (Holmium Laser Enucleation of the Prostate).

But when is HoLEP considered, and how does it compare with other treatments for an enlarged prostate?

What is an enlarged prostate?

The prostate is a gland located below the bladder that surrounds part of the urethra.

As men get older, the prostate commonly increases in size. This condition is known as benign prostatic hyperplasia, or BPH.

Despite the name, BPH is not prostate cancer. However, as the prostate grows, it can put pressure on the urethra and make it more difficult for urine to pass.

Common symptoms include:

• A weak or slow urinary stream

• Difficulty starting urination

• Having to strain to urinate

• A feeling that the bladder has not emptied completely

• Urinary urgency

• Frequent urination

• Getting up several times during the night

• Dribbling after urination

The severity of symptoms does not always correspond directly to the size of the prostate. Some men with a relatively large prostate have few symptoms, while others with a smaller prostate may experience significant urinary problems.

Does every enlarged prostate need treatment?

No.

If symptoms are mild and do not significantly affect your daily life, your urologist may recommend monitoring the condition rather than starting treatment immediately.

Simple measures can sometimes help, such as reducing fluids before bedtime, moderating caffeine and alcohol and reviewing medications that may affect urination.

However, treatment may be recommended when symptoms become troublesome or when complications develop.

The aim is not simply to reduce the size of the prostate. The goal is to improve urinary function and quality of life while preventing complications.

What are the treatment options for BPH?

Treatment depends on your symptoms, prostate anatomy, general health and individual circumstances.

Medication

Medication is often the first active treatment for men with bothersome urinary symptoms.

Some medications relax the muscles around the prostate and bladder outlet, making it easier for urine to flow. Others can reduce prostate growth over time.

Medication can be very effective, but it does not physically remove the prostate tissue causing the obstruction.

If symptoms remain significant despite medication, or if complications develop, a procedural or surgical treatment may be considered.

Minimally invasive procedures

There are several minimally invasive treatments for BPH designed to improve urinary flow while reducing the obstruction caused by the prostate.

The appropriate option depends on factors such as prostate size, anatomy, bladder function and the patient's expectations.

For this reason, the same treatment is not necessarily appropriate for every man with BPH.

TURP

TURP (transurethral resection of the prostate) is one of the established surgical treatments for an enlarged prostate.

During TURP, obstructing prostate tissue is removed through the urethra using a surgical instrument.

TURP remains an effective treatment for many men. However, advances in laser surgery have introduced additional surgical options, including HoLEP.

HoLEP

HoLEP, or Holmium Laser Enucleation of the Prostate, is a laser procedure that removes the obstructing part of the prostate through the natural urinary passage.

During the procedure, a holmium laser is used to separate the enlarged prostate tissue from the surrounding prostate capsule. The tissue is then removed through the urinary passage.

There is no external incision.

HoLEP can be used across a broad range of prostate sizes and is an established surgical treatment for BPH.

For appropriate patients, it can provide significant improvement in urinary flow and urinary symptoms.

Why is HoLEP considered for an enlarged prostate?

One of the important characteristics of HoLEP is that it can remove a substantial amount of obstructing prostate tissue while avoiding an external surgical incision.

This makes it an important option for men who require surgery for BPH, including men with significantly enlarged prostates.

Potential advantages of HoLEP include:

• A minimally invasive approach through the urinary passage

• Effective removal of obstructing prostate tissue

• The ability to treat large prostates

• Improvement in urinary flow

• A generally short hospital stay

• The possibility of returning to normal activities relatively quickly, depending on the individual patient

As with any surgical procedure, HoLEP also has potential risks and side effects. A specialist assessment is necessary to determine whether it is appropriate for a particular patient.

Can HoLEP treat a very large prostate?

Yes.

One of the reasons HoLEP has become an important option in prostate surgery is its ability to treat large prostate glands.

Historically, men with very large prostates were sometimes considered for more invasive surgical procedures. Laser enucleation techniques such as HoLEP provide an alternative approach for appropriately selected patients.

However, prostate volume is only one factor in deciding which treatment is best.

Your urologist may also consider your urinary symptoms, bladder function, previous procedures, medications and overall health.

How do you know if HoLEP is right for you?

There is no single “best” treatment for every enlarged prostate.

Before recommending HoLEP or another procedure, a urologist will usually consider several factors.

These may include:

Prostate size and anatomy
An ultrasound, MRI or other imaging may help determine the size and characteristics of the prostate.

Urinary symptoms
The type and severity of your symptoms are important when deciding whether treatment is necessary.

Urinary flow
A flow test can help assess how effectively urine is passing through the urinary tract.

Residual urine
An ultrasound can determine whether significant urine remains in the bladder after urination.

Bladder function
In some patients, the bladder itself may contribute to urinary symptoms.

Medical history and medication
Previous prostate procedures, urinary infections, blood-thinning medication and other medical conditions can influence treatment decisions.

The objective is to select the treatment that best fits the individual patient rather than simply choosing the newest or most widely discussed procedure.

HoLEP vs TURP: which is better?

HoLEP and TURP are both established surgical treatments for BPH.

The important question is not necessarily which procedure is universally “better”, but which is more appropriate for a particular patient.

HoLEP can be especially attractive when a substantial amount of prostate tissue needs to be removed, including in men with larger prostates.

The choice may depend on prostate anatomy, symptoms, previous treatment, the surgeon's expertise and the patient's priorities.

A consultation with an experienced urologist can help you understand the advantages and limitations of each option.

What happens if BPH is left untreated?

Not every man with BPH will develop complications, but significant obstruction can sometimes lead to problems.

These may include:

• Acute urinary retention

• Recurrent urinary tract infections

• Bladder stones

• Persistent difficulty emptying the bladder

• Blood in the urine

• Changes in bladder function

• In severe cases, deterioration of the upper urinary tract

This is why persistent or worsening urinary symptoms should not simply be attributed to ageing.

A urological assessment can determine whether treatment is necessary and, if so, which options are available.

Can I have HoLEP in Madrid, Spain?

For men considering prostate treatment in Spain, HoLEP is available in specialist urological centres in Madrid.

Madrid is also an important international medical destination, making it accessible to patients travelling from other European countries and from further afield.

For international patients, the process can often begin with a review of existing medical information and an initial consultation before travelling.

Useful information may include:

• Prostate measurements

• PSA results

• Previous ultrasound or MRI reports

• Urine tests

• Urinary flow measurements

• Previous treatments

• Current medications

• A description of your urinary symptoms

This information can help the urologist determine whether further assessment is needed and whether HoLEP may be an appropriate treatment option.

What if I live outside Spain?

You do not necessarily need to travel to Madrid simply to find out whether HoLEP could be suitable for you.

For international patients, an initial consultation can help review your medical history, symptoms and previous investigations before you make arrangements to travel.

If HoLEP is recommended, the next steps can then be planned around your journey to Madrid, including the preoperative assessment, procedure, recovery and postoperative follow-up.

Planning the entire pathway is particularly important for patients travelling from abroad.

Choosing the right prostate treatment

An enlarged prostate does not automatically mean that you need surgery.

And if surgery is necessary, there is no single procedure that is right for every man.

The most appropriate treatment depends on your symptoms, prostate size and anatomy, bladder function, general health and personal priorities.

For men who require surgical treatment, HoLEP is an established and effective option that is particularly relevant for patients with significant prostate obstruction and larger prostates.

The best way to determine whether it is appropriate for you is to have an individual assessment with a urologist experienced in the treatment of BPH.

Considering HoLEP in Madrid?

If you live outside Spain and are researching enlarged prostate treatment, BPH surgery or HoLEP in Madrid, you can learn more about the treatment pathway for international patients.

Our guide explains how international patients can arrange an assessment, travel to Madrid for treatment and plan their recovery and follow-up.

→ Read more about HoLEP for International Patients in Madrid, Spain