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HoLEP India patient guide

En-bloc HoLEP: the operation in anatomical steps

En-bloc HoLEP treats the obstructing adenoma as one anatomical unit. The objective is not simply to vaporise prostate tissue, but to identify the surgical capsule and progressively free the adenoma along that plane.

By Dr Rajiv Goel · MS (AIIMS), MCh (AIIMS) · Urologist, Gurugram

1. Identify the anatomy and surgical plane

The urethra, verumontanum, prostate apex, bladder neck and ureteric orifices provide orientation. The surgeon enters the plane between adenoma and surgical capsule.

2. Develop the plane

Dissection proceeds along the capsule, using the laser for controlled separation and haemostasis. Maintaining orientation is more important than following a rigid sequence.

3. Mobilise the adenoma en bloc

Rather than creating three separate lobes, the adenoma is progressively mobilised as a connected unit. Published evidence suggests en-bloc and two-lobe techniques may improve enucleation efficiency compared with the traditional three-lobe approach, without proven superiority in functional outcomes.

4. Protect the apex and sphincter

The apical release is particularly important because the external urinary sphincter lies nearby. Sphincter-conscious technique aims to minimise unnecessary traction, thermal injury and mechanical trauma.

5. Deliver the adenoma into the bladder

Once completely released, the adenoma is displaced into the bladder while haemostasis and the prostatic cavity are checked.

6. Morcellation

The enucleated tissue is mechanically morcellated and removed from the bladder. Tissue can then be sent for histopathological examination.

The laser is not the operation. HoLEP depends on finding the correct plane, maintaining orientation, controlling bleeding, protecting the sphincter and performing safe morcellation. These are surgical skills with a recognised learning curve.

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HoLEP for large prostate  ·  All patient guides  ·  Sphincter-preserving HoLEP

References & evidence

  1. European Association of Urology. EAU Guidelines on Management of Non-neurogenic Male LUTS — Disease Management. 2026.
  2. European Association of Urology. EAU Guidelines — Diagnostic Evaluation. 2026.
  3. Tan C, Wang C, Huang J, et al. Comparative outcomes of HoLEP versus robot-assisted simple prostatectomy for BPH: systematic review and meta-analysis. J Robot Surg. 2025;19:478. PMID: 40790006.

Medical content reviewed 13 September 2026. References are provided for patient education; recommendations must be individualized.

Procedure choice should be individual

Prostate anatomy, symptoms, bladder function, medical history, priorities regarding ejaculation, durability and the experience of the treating surgeon all matter.

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