Dr. Lie Kwok Ying — Urologist Singapore

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HoLEP Surgery In Singapore

Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive procedure for treating benign prostatic hyperplasia (BPH). It removes excess prostate tissue that obstructs urine flow by cutting away enlarged tissue from the central part of the prostate while preserving the outer capsule. This is done by using a laser that ensures minimal bleeding. This restores normal urine flow and bladder emptying. HoLEP is an option for men with an enlarged prostate, offering the best long-term outcomes in terms of durability and effectiveness as compared to other prostate surgeries. It is performed without external incisions and has fewer associated complications.

Dr. Lie Kwok Ying - LKY Urology

Dr. Lie Kwok Ying

BA MBBChir (Cantab)|MRCS (Edin)|FRCS (Urol)(Glasg)|FAMS

HOLeP Surgery In Singapore HOLeP Surgery In Singapore
Indications Benefits Preparation Procedure Recovery Risks FAQ
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Indications
Benefits
Preparation
Procedure
Recovery
Risks
FAQ

Indications for HoLEP

HoLEP may be considered for men experiencing urinary issues related to an enlarged prostate, particularly in the following cases:

  • Moderate to severe urinary symptoms: Individuals with significant symptoms such as weak urine stream, hesitancy, urgency, or incomplete emptying that do not respond to medication.
  • Large prostate size: HoLEP is effective for prostates over 60–80 grams and does not have size limitations, unlike some other procedures.
  • Urinary retention: Men requiring catheterisation due to acute or chronic urinary retention caused by prostatic obstruction.
  • Failed medical therapy: Patients who do not respond to or cannot tolerate BPH medications, such as alpha-blockers and 5-alpha reductase inhibitors.
  • Recurrent urinary tract infections (UTIs): Those experiencing repeated infections due to incomplete bladder emptying.
  • Bladder stones secondary to BPH: HoLEP can remove obstructing prostate tissue and allow for bladder stone removal during the same procedure.
  • Kidney function deterioration: Patients with renal insufficiency due to prolonged bladder outlet obstruction.

Benefits of HoLEP

HoLEP offers several advantages over other surgical approaches for treating BPH. These benefits include:

  • No external incisions

    The procedure is performed entirely through the urethra, reducing trauma to surrounding tissue.

  • Shorter hospital stay

    Most patients stay in hospital for one to two days, compared to three to five days for open prostatectomy.

  • Lower bleeding risk

    The holmium laser seals blood vessels as it removes tissue, reducing blood loss and making the procedure suitable for patients on blood-thinning medications.

  • Long-lasting symptom relief

    Studies show stable symptom improvement for over ten years, with low retreatment rates.

  • Preserved continence

    The laser allows for careful separation of prostate tissue while protecting the external sphincter, reducing the likelihood of post-operative urinary incontinence.

  • Shorter catheterisation time

    Catheters are typically needed for only 24–48 hours, compared to five to seven days for open surgery.

  • Complete tissue removal

    HoLEP removes obstructing prostate tissue as effectively as open surgery, leading to lower recurrence rates.

Preparing for the Procedure

  • Medical assessment: Patients undergo tests such as ultrasound or cystoscopy to assess prostate size, urinary obstruction, and bladder health. Blood tests, including PSA levels, may be required to rule out conditions like prostate cancer.
  • Medication review: Blood-thinning medications, such as aspirin, warfarin, or direct oral anticoagulants, may need to be paused or adjusted before surgery to minimise bleeding risks. Patients should provide a full list of medications to their doctor, including over-the-counter supplements, as some may interfere with recovery.
  • Anaesthesia consultation: HoLEP is typically performed under spinal or general anaesthesia. The surgeon will review the patient’s medical history and determine the most suitable option based on overall health and preferences.
  • Fasting: Patients must stop eating solid food at least six to eight hours before surgery and limit clear liquids two to four hours before the procedure. This reduces the risk of complications during anaesthesia.

Step-by-Step Procedure

Anaesthesia and Preparation

HoLEP is performed under spinal or general anaesthesia, depending on the patient’s health and surgical considerations. Once anaesthesia takes effect, the patient is positioned, and antiseptic preparation is applied to minimise infection risk.

Cystoscopic Examination and Resectoscope Placement

A cystoscope (a thin, flexible instrument with a camera) is inserted through the urethra to assess the bladder, urethra, and prostate. This ensures there are no abnormalities, such as bladder stones or tumours, that may need attention. Once the assessment is complete, the resectoscope, which contains the holmium laser and an irrigation system for clear visibility, is inserted to begin the procedure.

Laser Enucleation of Prostate Tissue

Using the holmium laser, the surgeon separates and detaches the obstructing prostate tissue from the surrounding capsule. The laser cuts through tissue while sealing small blood vessels to minimise bleeding.

Haemostasis and Tissue Morcellation

After the obstructing prostate tissue is detached, the surgical area is examined for any bleeding points, which are sealed using the laser. The morcellation process then begins, where a specialised device cuts the removed prostate tissue into small fragments that are suctioned out through the resectoscope. This ensures complete removal of the obstructing tissue.

Catheter Placement and Post-Procedure Management

A three-way urinary catheter is inserted into the bladder to facilitate continuous irrigation, preventing blood clot formation and maintaining clear urine flow. The catheter remains in place for 24–48 hours, depending on post-surgical recovery and urine clarity.

Post-Procedure Care and Recovery

  • Hospital Stay and Catheter Removal

    Patients usually stay in the hospital for one to two days. A three-way urinary catheter is placed to help drain urine and prevent clot formation. It is typically removed within 24–48 hours, depending on recovery.

  • Activity and Hydration

    Heavy lifting, strenuous exercise, and driving should be avoided for two to four weeks. Light walking is encouraged. Drinking 2–3 litres of water daily helps flush the bladder and reduce irritation. Caffeine and alcohol should be minimised as they can worsen urinary urgency.

  • Temporary Urinary Symptoms

    Some patients may experience increased urgency, frequency, or mild burning for a few weeks. Occasional blood in the urine may occur for up to six weeks and usually resolves on its own.

  • Follow-Up Appointments

    Follow-up visits are scheduled at three to four weeks to monitor recovery.

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Potential Risks and Complications

Temporary urinary incontinence may occur but usually improves within weeks. Retrograde ejaculation is common, causing semen to flow into the bladder instead of through the urethra, which may affect fertility. UTIs can develop, often due to catheter use. Bleeding is uncommon, and transfusions are rarely required. In some cases, bladder neck contracture or urethral stricture may develop and require treatment. Erectile function is generally unaffected. Incomplete tissue removal is uncommon but may require further treatment.

Frequently Asked Questions

How long does the HoLEP procedure take?

HoLEP usually takes 60–120 minutes, depending on prostate size, tissue density, and complexity. Larger prostates or those with extensive overgrowth may require more time. Additional time is needed for anaesthesia and post-operative monitoring.

Will I still need prostate medication after HoLEP?

Most patients no longer need BPH medication, as HoLEP removes the obstructing tissue. However, some may require continued treatment for bladder dysfunction or residual symptoms. Your doctor will determine if medication is necessary during follow-up.

Can HoLEP be performed on men who have had previous prostate surgery?

Yes, but the procedure may be more complex due to scar tissue or altered anatomy from prior surgeries. Your surgeon will assess feasibility based on imaging and medical history.

Dr. Lie Kwok Ying - LKY Urology

Dr. Lie Kwok Ying

BA MB BChir (Cantab)|MRCS (Edin)|MMEd (Surg)|FRCS (Glasg)(Urol)|FAMS

Dr. Lie Kwok Ying is a Senior Consultant Urologist and pioneered the use of HoLEP (Holmium Enucleation of Prostate) for benign prostatic hyperplasia (BPH) in Singapore.

He graduated from Queens’ College in Cambridge University with triple First Class Honours and subsequently qualified in 2001 with degrees in Medicine and Surgery.

Clinical Interests in Urology

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