Laser prostate surgery (HoLEP / GreenLight)
Keyhole laser surgery to relieve the urinary symptoms of an enlarged prostate by removing or vaporising the tissue that is blocking the flow of urine.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Laser prostate surgery relieves the urinary blockage caused by a benign enlarged prostate, using a telescope and laser through the waterpipe with no skin cuts.
- It treats benign enlargement, not prostate cancer, and does not prevent cancer.
- Most men go in for one night or a day case and need a catheter for a short time afterwards; control of urine usually improves over the following weeks.
- It very commonly causes 'dry' orgasms (semen passing backwards into the bladder), so ask about this and about effects on erections and fertility before agreeing.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Relieves urinary symptoms such as a weak stream, hesitancy, getting up at night and incomplete emptying
Your urinary symptoms are mainly from the bladder rather than prostate blockage, where surgery may not help.
A catheter usually drains the bladder and rinses out blood. It is often removed within a day or a few days, once the urine runs clear enough.
Clear advice on what is normal, including blood in urine and the timeline for symptom recovery.
A catheter usually drains the bladder and rinses out blood. It is often removed within a day or a few days, once...
Expect some blood in the urine, urgency, frequency and stinging. Drink plenty of fluids and avoid heavy lifting...
Urinary symptoms and control gradually improve. Pelvic-floor exercises can help if there is any leakage. Many men...
The flow and symptom improvement become clearer as healing completes. A review checks your flow, symptoms and any...
What is laser prostate surgery (HoLEP / GreenLight)?
Laser prostate surgery treats the troublesome urinary symptoms caused by a benign (non-cancerous) enlarged prostate. A telescope is passed up the waterpipe (urethra), with no cuts on the skin, and a laser is used to remove or vaporise the prostate tissue that is squeezing the urine channel.
There are two common types. HoLEP (holmium laser enucleation) peels the inner prostate tissue away whole and removes it, and tends to suit larger prostates. GreenLight (photoselective vaporisation) vaporises the tissue away and is often used for smaller-to-medium prostates and for some men on blood thinners. Both aim to give a stronger, easier urinary stream and fewer urinary symptoms.
This surgery treats blockage from a benign prostate. It is not a treatment for prostate cancer, and it does not by itself protect against developing cancer later. Tissue removed during HoLEP is usually sent to the laboratory to check.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Common options for an enlarged prostate
| Option | What it does | Notes |
|---|---|---|
| HoLEP | Lasers out the inner prostate whole | Good for large prostates; durable; dry orgasm common |
| GreenLight | Vaporises obstructing tissue | Low bleeding; useful on blood thinners; no tissue for the lab |
| TURP | Electrically resects tissue | Long-established; more bleeding than laser in some men |
| Medication | Relaxes or shrinks the prostate | Avoids surgery; symptoms can return if stopped |
The best choice depends on prostate size, your symptoms, whether you take blood thinners, and what matters most to you. Your urologist should explain the trade-offs, including effects on ejaculation.
Preparing for your surgery
- See the operating urologist, who will assess your symptoms, flow and prostate size, and confirm the symptoms are from benign enlargement rather than another cause.
- Expect checks such as a flow test, a symptom score and sometimes an ultrasound; a PSA blood test and prostate assessment help rule out cancer.
- Tell the team about blood thinners and ask which can be continued — GreenLight is sometimes chosen partly for this reason.
- Mention diabetes, heart or breathing problems and any past urinary surgery.
- You will usually fast before a general anaesthetic and may be asked to give a urine sample to check for infection.
- Arrange a lift home and help for the first day or two, and expect to go home with advice about a possible catheter.
- Discuss what matters to you about ejaculation, erections and fertility before the day.
What happens
The operation is done under general or spinal anaesthetic, with no cuts on the skin. A telescope is passed up the waterpipe to the prostate.
In HoLEP, the laser separates the inner prostate tissue, which is pushed into the bladder and removed with a small device; the tissue is sent to the laboratory. In GreenLight, the laser vaporises the obstructing tissue so there is usually no tissue to send. A catheter is placed at the end to drain urine and rinse the bladder while it settles.
Most men stay in as a day case or for one night. The catheter is usually removed after a short time, often the next day or within a few days, once the urine is clear enough. Some blood in the urine and a need to pass urine often or urgently are common in the early weeks.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your urinary symptoms are mainly from the bladder rather than prostate blockage, where surgery may not help.
- An untreated urine infection is present and should be cleared first.
- Prostate cancer is suspected and needs assessing first — this surgery is for benign enlargement.
- You are unfit for an anaesthetic, where a less invasive option or continued medication may be safer.
- Preserving normal ejaculation or natural fertility is a high priority for you and the high chance of dry orgasm is unacceptable.
Delay surgery if…
- You currently have a urine infection or unexplained fever.
- Your blood-thinning medication has not been reviewed.
- Recent flow tests, symptom scores or prostate assessment are missing.
- You cannot arrange help at home or a lift after the anaesthetic.
- A PSA or prostate concern needs investigating before elective surgery.
Alternatives to discuss
- Watchful waiting and lifestyle measures for milder symptoms.
- Medication that relaxes or shrinks the prostate, avoiding surgery.
- TURP (electrical resection) as a long-established surgical option.
- Minimally invasive options such as prostatic urethral lift or steam treatment in selected men, where ejaculation is more often preserved.
- A long-term catheter if surgery is not suitable.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Relieves urinary symptoms such as a weak stream, hesitancy, getting up at night and incomplete emptying
- Can free men who were dependent on a catheter from needing one
- Less bleeding and often a shorter catheter time than older surgery, especially with laser methods
- Useful for some men on blood thinners, particularly GreenLight
- HoLEP suits large prostates and tends to give durable, long-lasting results
- HoLEP provides tissue that can be checked in the laboratory
Risks & complications
- A 'dry' orgasm — semen passing backwards into the bladder (retrograde ejaculation) — which affects most men after HoLEP
- Blood in the urine for some weeks
- Urgency, frequency and stinging when passing urine in the early weeks
- Temporary leaking of urine until bladder control settles
- Urine infection needing antibiotics
- Temporary difficulty passing urine after the catheter comes out, needing it to be replaced
- Longer-lasting urinary leakage in a minority of men
- Narrowing of the waterpipe (urethral stricture) or bladder neck, which can need a further procedure
- Bleeding heavy enough to need a blood transfusion
- Lasting effect on erections in some men
- Need for repeat surgery if symptoms return or tissue regrows over the years
The most predictable change is retrograde (dry) ejaculation, which is very common, especially after HoLEP, and is usually permanent. If keeping the ability to ejaculate normally, or to father children naturally, matters to you, raise it before surgery. Ask specifically about your chance of dry orgasm, any effect on erections, and the small chance of longer-term leakage or needing a further procedure.
Published figures to discuss
Symptom relief is good for most men, but how much improves and which side effects occur depend on prostate size, the technique used, your bladder function and your surgeon's experience. The bands below are drawn from UK patient information and published series; retrograde (dry) ejaculation in particular is very common after HoLEP.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Retrograde (dry) ejaculation | Affects most men after HoLEP (BAUS lists it as 'almost all') | Usually permanent. Less universal with some other techniques. Discuss before surgery if ejaculation or fertility matters to you. | Guide sourcesClinical context |
| Urinary infection | About 1 in 10 to 1 in 50 (BAUS leaflet band) | Usually treated with antibiotics. | HoLEP long-term functional and quality-of-life outcomes — PMCncbi.nlm.nih.govPublished figure |
| Urinary incontinence (leakage) | Temporary leakage is common early; lasting leakage in roughly 1 in 10 to 1 in 50 (BAUS band) | Pelvic-floor exercises help. Most leakage settles within weeks. | HoLEP long-term functional and quality-of-life outcomes — PMCncbi.nlm.nih.govPublished figure |
| Urethral stricture or bladder-neck narrowing | Around 1 in 50 to 1 in 250 (BAUS band); GreenLight series report roughly 1% | Can need a further procedure. | HoLEP long-term functional and quality-of-life outcomes — PMCncbi.nlm.nih.govPublished figure |
| Need for further surgery / reoperation | Low; GreenLight series report under about 1%, and HoLEP has low long-term re-treatment rates | The prostate can grow slowly again over many years. | HoLEP long-term functional and quality-of-life outcomes — PMCncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Many men notice a stronger urinary stream soon after surgery, but bladder symptoms such as urgency, going often and some leakage often take several weeks to settle as the prostate area heals.
- A stronger urinary stream within days
- Blood in the urine on and off for a few weeks, sometimes briefly worse around 1–3 weeks
- Urgency, going often and some stinging that ease over the first weeks
- Some temporary leakage of urine until control returns
- Dry orgasms once you resume sexual activity
Aftercare
- Drink plenty of fluids to keep the urine flushing through, unless told otherwise.
- Avoid heavy lifting, straining and vigorous exercise for the first few weeks to reduce bleeding.
- Do not drive until you are comfortable and any catheter is out, and check insurance advice.
- Start gentle pelvic-floor exercises if advised, to help bladder control.
- Finish any antibiotics and take simple painkillers as needed.
- Avoid constipation and straining; ask about a stool softener if needed.
- Keep your follow-up appointment to review flow, symptoms and any tissue results.
- Urine checked for infection beforehand
- Blood-thinner plan agreed with the team
- Lift home and help for the first day or two arranged
- Painkillers and plenty of fluids at home
- Pelvic-floor exercise advice understood
- Follow-up appointment and contact number noted
Scars and how they heal
There are no cuts on the skin, so there is no external scar. Healing takes place inside the waterpipe and prostate area. A small risk of internal narrowing (a urethral stricture or bladder-neck narrowing) exists, which can occasionally need a further procedure.
⚠ Get urgent help if…
- Being unable to pass urine at all — seek urgent help
- Heavy bleeding or large clots in the urine, especially if you feel faint
- A high temperature, shivering or feeling very unwell (possible infection)
- Severe lower-abdominal pain or a painfully full bladder
- Urine that becomes thick with blood again after settling
- Calf pain, swelling or breathlessness (possible clot) after surgery
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result is a stronger, easier urinary stream with fewer daytime and night-time symptoms and better bladder emptying. Improvement in flow is often noticed early, while urgency and any leakage settle over weeks. HoLEP in particular tends to give durable results, including for large prostates.
This surgery does not treat or prevent prostate cancer. PSA testing and prostate assessment are about cancer risk and are separate from the decision to relieve benign blockage. Any tissue removed during HoLEP is usually examined in the laboratory.
Laser surgery for benign enlargement usually lasts well, and HoLEP in particular has low rates of needing repeat surgery over many years. The prostate can continue to grow slowly with age, so a minority of men need further treatment in the longer term. Symptoms that return should be reassessed rather than assumed to be a recurrence.
Combining with other procedures
Laser prostate surgery is sometimes done alongside, or instead of, other treatments for urinary problems. If symptoms are partly from the bladder rather than the prostate, your urologist may suggest tests such as bladder pressure studies first, because surgery on the prostate may not fix bladder-driven symptoms.
Follow-up & long-term care
You will usually be reviewed a few weeks after surgery to check your flow, symptoms and bladder emptying, and to discuss any laboratory results from tissue removed. Pelvic-floor advice and a plan for any ongoing leakage are part of good follow-up.
- Continue pelvic-floor exercises if leakage is settling slowly.
- Report any return of urinary symptoms for reassessment.
- Keep up routine prostate and PSA discussions with your GP as appropriate, since this surgery does not address cancer risk.
- Stay well hydrated and avoid constipation, which can worsen urinary symptoms.
Revision and secondary surgery reality
- A small proportion of men need a further procedure for a stricture, bladder-neck narrowing or returning symptoms.
- HoLEP has low long-term re-treatment rates and suits large prostates.
- Symptoms that return are not always due to regrowth and should be reassessed, including for bladder causes.
- Tissue removed during HoLEP is examined, which occasionally reveals unsuspected findings needing follow-up.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear advice on what is normal, including blood in urine and the timeline for symptom recovery.
- A named contact and urgent route for being unable to pass urine, heavy bleeding or fever.
- Pelvic-floor support and a plan for any ongoing leakage.
- Follow-up of flow, symptoms and any laboratory results from removed tissue.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon and anaesthetist fees
- Theatre and facility charges, and whether you stay overnight
- Which laser system is used (for example HoLEP versus GreenLight) and prostate size
- Laboratory analysis of removed tissue (with HoLEP)
- Catheter and any equipment, plus follow-up flow tests
- Follow-up consultations and management of any leakage or further symptoms
- The operating surgeon's and anaesthetist's fees
- Theatre, facility and any overnight stay charges
- Whether laboratory analysis of tissue is included
- Follow-up appointment and flow testing
- What happens, and what it costs, if a further procedure is needed
- Cancellation policy and cover if a complication arises
On the NHS? Surgery for an enlarged prostate is widely available on the NHS when symptoms justify it; private care is sometimes chosen for speed, timing or choice of surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- No clear discussion of dry ejaculation and its likely permanence.
- Not separating treatment of benign blockage from prostate cancer risk and PSA discussion.
- Over-stating how quickly urgency and leakage will settle.
- No mention of catheter time or the chance of not passing urine when it is removed.
- Failing to consider whether symptoms are bladder-driven before operating.
Marketing red flags
- Describing laser surgery as 'without risks' or guaranteeing perfect control of urine.
- Implying it treats or prevents prostate cancer.
- Not mentioning the high chance of dry orgasm.
- Promoting one laser as universally superior regardless of prostate size or circumstances.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What is my chance of a dry orgasm, and could it affect my fertility?
- Given my prostate size, would HoLEP or GreenLight suit me better?
- Could any of my symptoms be coming from my bladder rather than my prostate?
- How long will I likely need a catheter, and what if I cannot pass urine afterwards?
- What is my personal risk of longer-term leakage or needing a further procedure?
- How will my results and any tissue findings be followed up?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I still ejaculate normally?
Will it affect my erections?
Is this an operation for prostate cancer?
How long will I have a catheter?
HoLEP or GreenLight — which is better?
Is it available on the NHS?
Find a verified surgeon for laser prostate surgery (holep / greenlight)
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Enlarged prostate BAUS — HoLEP patient leaflet BAUS — GreenLight laser patient leaflet NICE NG141 — Lower urinary tract symptoms in men: management HoLEP long-term functional and quality-of-life outcomes — PMC GreenLight prostatectomy outcomes at up to 15 years — PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Prostate biopsy · Bladder cancer surgery (cystectomy) · Circumcision (adult) · Epididymal cyst removal · Hydrocele repair