HoLEP Surgery in Utah — The Definitive Treatment for an Enlarged Prostate

HoLEP is covered by Medicare, Medicaid, and all major commercial insurance plans when medically indicated. Your out-of-pocket cost depends on your specific plan's deductible, copay, and surgical facility. The office verifies your coverage and handles prior authorization before scheduling surgery so you know what to expect financially upfront.

Erectile function is preserved in the large majority of HoLEP patients. The most common sexual side effect is retrograde ejaculation — where semen travels backward into the bladder during orgasm rather than outward. This is not harmful and does not affect orgasm sensation itself, but it does affect fertility and is something every HoLEP patient should understand before surgery. Retrograde ejaculation occurs in roughly 70–80% of HoLEP patients.

If antegrade ejaculation preservation is your top priority, Rezūm, UroLift, or Optilume BPH may be more appropriate — this is discussed in detail during consultation.

Both procedures treat enlarged prostate through the urethra with no external incisions. The difference is in technique and completeness. TURP uses an electrical loop to shave tissue from the inside of the prostate. HoLEP uses a holmium laser to enucleate — cleanly remove — the entire obstructing adenoma along its natural surgical plane.

HoLEP offers less bleeding, shorter catheter time (typically less than 24 hours vs. 2–4 days), and more durable long-term results. HoLEP can also treat very large prostates (100g, 150g, 200g+) that are too large for safe TURP.

Yes — and this is actually one of HoLEP's major advantages. Because the laser seals blood vessels as it cuts, HoLEP has a substantially lower bleeding risk than TURP or open prostate surgery. Many patients on aspirin, Plavix, Eliquis, or Xarelto can undergo HoLEP with careful perioperative management. Each situation is reviewed individually with your prescribing physician.

In most cases, the catheter is removed the morning after surgery — less than 24 hours. This is one of the reasons HoLEP is preferred over TURP, which typically requires a catheter for 2–4 days. Occasionally a catheter is kept in longer for very large prostates or specific healing reasons, but this is the exception rather than the rule.

Most men with desk jobs return to work within 5–10 days. Men with physically demanding jobs typically need 2–3 weeks off to avoid heavy lifting and straining while the prostate fossa heals. Individual recovery varies — this is discussed at the pre-operative visit based on your specific situation.

No — in most cases, BPH medications like tamsulosin (Flomax), silodosin (Rapaflo), or finasteride (Proscar) are stopped after HoLEP recovery. The obstruction is physically removed, so the medications are no longer needed. This is a major quality-of-life improvement for men who have been on these medications for years and don't like the side effects.

There is no upper size limit for HoLEP — it is performed on prostates from 40g to 300g+. For prostates larger than 80g, HoLEP is clearly the best available option, as TURP and most minimally invasive procedures become less effective or unsafe at that size. For smaller prostates, HoLEP is still excellent but other options may also be reasonable depending on your priorities.

Every surgery carries risk. The main risks of HoLEP include: temporary urinary urgency or leakage during the healing phase, bleeding (usually minor), urinary tract infection, urethral stricture in a small percentage of patients, and rarely, persistent stress incontinence. Most of these risks are lower with HoLEP than with TURP. All risks are discussed thoroughly at the pre-operative visit.

HoLEP has the most durable long-term results of any BPH procedure. Because the entire obstructing adenoma is removed — not just partially shaved or heat-treated — the tissue cannot grow back in the same way. Long-term studies show the vast majority of HoLEP patients never need a second BPH procedure in their lifetime. This is a key reason the procedure is often described as "definitive."