What is Laser Enucleation Prostatectomy (HOLEP, THULEP, THUFLEP)? Advantages and Procedure
Laser Enucleation Prostatectomy is one of the most prominent modern surgical methods in the treatment of benign prostatic hyperplasia (BPH). This technique uses high-energy lasers to remove the prostate tissue obstructing the urethra.
Advanced technology offers a low risk of bleeding, a short recovery time, and permanent results.
The three most common versions of this procedure are:
• HOLEP (Holmium Laser Enucleation Prostatectomy)
• THULEP (Thulium Laser Enucleation Prostatectomy)
• THUFLEP (Thulium Fiber Laser Enucleation Prostatectomy)
While all operate on the same principle, they differ in terms of laser energy type, depth of tissue damage, and surgical precision.
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Differences Between HOLEP, THULEP, and THUFLEP
• HOLEP is the first laser enucleation technique developed. It uses holmium laser energy. With this powerful energy, prostate tissue is removed in large pieces.
• THULEP uses thulium laser energy. The tissue cutting is more precise, allowing the surgery to proceed more controlled.
• THUFLEP is the latest version of this technology. It uses a thulium fiber laser to inflict thermal damage to the tissue to a depth of only 0.2 mm. This is considered the most advantageous method for maintaining an erection.
The goal of all three methods is to remove the portion of the prostate obstructing the urethra while preserving its anatomical boundaries and to relieve bladder outflow.
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How is Laser Prostate Surgery Performed?
The surgery is performed using a closed approach, meaning no external incisions are made.
The procedure proceeds as follows:
1. A camera (endoscope) is inserted into the urethra.
2. Laser energy cuts and separates the obstructing tissue inside the prostate.
3. Using a special device called a morcellator, these tissues are cut into small pieces and removed from the bladder.
The surgery typically lasts 60–90 minutes.
The patient typically stays in the hospital for one night, and the catheter is removed within two days.
Recovery is quite comfortable; a normal life can be resumed within a few days.
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Advantages of HOLEP, THULEP, and THUFLEP Surgery
These methods offer many advantages over traditional open or TURP surgery:
• The risk of bleeding is very low. The laser energy seals the blood vessels while cutting the tissue.
• It can be safely used in patients taking blood thinners.
• The catheterization time and hospital stay are short.
• The recurrence rate is low, and because the prostate tissue is completely removed, the likelihood of regrowth is low.
• Sexual function is preserved. The THUFLEP technique, in particular, is the safest laser method for erectile function. • Recovery is rapid. Most patients can return to their daily lives within 3–5 days.
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Who is Suitable for Laser Enucleation Prostatectomy?
This surgery is particularly suitable for patients with a prostate volume between 80–200 ml, those experiencing difficulty urinating, and those who have not responded to medication.
It can also be safely performed on individuals taking blood thinners, those who are elderly, or those at high risk for open surgery.
The doctor determines the patient's suitability after a detailed prostate examination, urine flow test, ultrasound, and PSA measurement.
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Possible Complications
As with any surgical procedure, some rare side effects may occur with laser prostate surgery:
• Mild burning sensation or frequent urination (temporary)
• Short-term bleeding during urination
• In rare cases, the development of a urethral stricture
These effects usually resolve quickly and do not negatively impact the patient's quality of life in the long term. ________________________________________
Conclusion: A New Generation Solution for Prostate Surgery
Laser Enucleation Prostatectomy (HOLEP, THULEP, THUFLEP) is among the most effective and modern methods for the treatment of benign prostatic hyperplasia.
Due to its low risk of bleeding and preservation of sexual function, it is currently recommended as the first choice by many urologists.
Technological advances have increased the power and precision of laser energy, while maximizing patient comfort, safety, and recovery time.
When performed with the right patient selection and by an experienced surgeon, this procedure can achieve permanent and satisfactory results.