What is ThuFLEP/HoLEP?

What is ThuFLEP/HoLEP?

HoLEP (Holmium Laser Enucleation of the Prostate) and ThuFLEP (Thulium Fibre Laser Enucleation of the Prostate) are both minimally invasive surgical techniques used to treat benign prostatic hyperplasia (BPH) that is prostate gland becomes enlarged. The surgeon uses a laser to precisely remove the enlarged part of the prostate gland that is obstructing the urethra causing urinary symptoms.

During the ThuFLEP/HoLEP procedure, a surgeon inserts a small telescope called a resectoscope into the urethra and advances it to the prostate. The thulium laser is then used to precisely vaporize and remove the obstructing prostate tissue, creating a wider channel for urine to flow through the urethra. While ThuFLEP and HoLEP are similar in many ways, there are differences between the two techniques, primarily in the type of laser used and their specific characteristics like wavelength, and tissue vaporization capability.

Clinical outcomes: Both HoLEP and ThuFLEP are effective in relieving symptoms of BPH and improving urinary flow rates. Clinical studies have demonstrated comparable outcomes between the two techniques in terms of symptom relief, complication rates, and long-term durability.

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  • Initial Examination
    • The patient undergoes a comprehensive evaluation, encompassing a review of their medical history, physical examination, and urodynamic studies to evaluate the severity of BPH symptoms.
  • Day of the Procedure
    • You will NOT be allowed to eat or drink anything for at least 10 hours before your surgery. An intravenous line will be secured to inject preoperative antibiotics. The anaesthetist will take a detailed history to plan for either
      • General Anaesthesia: You will be fully asleep throughout the operation and remember nothing of it.
      • Regional Anaesthesia: e.g. Spinal, Epidural: A needle is placed into your back to inject the drug. It will numb your body from the waist down. You will be awake but sleepy and you will not feel the pain of the operation.
  • Step of Surgery Introduction of Laser Fibre: A thulium laser fibre is introduced through the cystoscope, positioned near the prostate tissue that needs to be removed.
    • Laser Enucleation: The thulium laser is used to precisely and selectively enucleate the excess prostate tissue. This involves separating the adenoma (enlarged part of the prostate) from the surrounding capsule. The laser energy is absorbed by the water in the tissue, leading to vaporization and cutting.
    • Haemostasis (Control of Bleeding): The laser used in ThuFLEP provides excellent haemostasis, meaning it helps control bleeding during the procedure.
    • Removal of Enucleated Tissue: The enucleated prostate tissue is then morcellated (cut into smaller pieces)and the fragments are removed through the cystoscope or a separate instrument.
  • Will I be Awake during the procedure?
    • You will be awake but sleepy and you will not feel the pain of the operation. You will numb your body from the waist down.
  • After the Procedure
    • You are shifted to the recovery room with the catheter in situ. Dr Ashish Saini will check your progress. Subsequently, you are shifted to your room for at least one night within the hospital environment. The duration of catheterisation is typically a few days to a week. It is crucial to maintain well-hydrated conditions post-surgery to aid in the healing process. You are advised to limit physical activity and avoid heavy lifting or strenuous exercise for some time after surgery.
Advantages of ThuFLEP/HoLEP

Advantages of ThuFLEP/HoLEP

  • Highly effective in relieving symptoms of urinary hesitancy, frequent urination, weak urine stream, and incomplete bladder emptying.
  • Minimally Invasive: It involves smaller incisions, shorter hospital stays, and quicker recovery times.
  • Reduced Blood Loss: it is a safer option for patients, particularly those with bleeding disorders or on blood-thinning medications.
  • Low Risk of Sexual Dysfunction
  • Suitable for Large Prostate Glands
  • It provides durable, long-term relief of BPH symptoms, with improvement in urinary function for years after the procedure.
  • Lower Risk of Retreatment: Compared to other BPH treatments, such as medication or minimally invasive procedures like transurethral microwave therapy (TUMT), HoLEP has a lower likelihood of requiring retreatment in the future.

Side effects of ThuFLEP/HoLEP

  • Performing HoLEP requires specialized training and expertise
  • Surgeons may require significant experience to achieve proficiency and consistently excellent results.
  • HoLEP typically takes longer to perform
  • Potential Complications: Bleeding, Infection, Urinary Incontinence, Urinary Retention, and damage to surrounding structures such as the urethra or bladder.


Indeed, there has been a marked improvement in the quality of life due to effectively alleviating symptoms associated with BPH and enhancing urinary function.

When ThuFLEP is needed?

  • Severe Symptoms: urinary hesitancy, frequent urination (especially at night), weak urine stream, and incomplete bladder emptying become severe and significantly impact quality of life despite conservative measures like medications.
  • Enlarged Prostate: typically over 30 grams in size, where other treatments may be less effective or associated with higher risks of complications.
  • Failure of Medications
  • Acute Urinary Retention: A person is unable to urinate at all, necessitating emergency intervention to relieve the obstruction.
  • Recurrent Urinary Tract Infections
  • Avoidance of Open Surgery: HoLEP is a minimally invasive procedure that offers similar efficacy to open prostate surgery (prostatectomy) but with fewer risks of complications, less pain, shorter hospital stays, and quicker recovery times

What would disqualify me from ThuFLEP Surgery?

  • Infection of the urinary tract
  • Any medical disorder like uncontrolled Hypertension, Diabetes and heart problems where anaesthesia is risky

Why choose Excel Advanced Urology Centre for ThuFLEP/HoLEP Surgery?

Excel Advanced Urology Centre has a specialized team led by senior urologist Dr Ashish Saini who has performed numerous , surgeries that significantly enhance the success rates and safety of the procedure.

Dr. Ashish Saini

Dr. Ashish Saini

Meet your Urologist

Dr Ashish Saini is an exceptional and highly skilled genitourinary surgeon(urologist) whose capabilities in the operating room are truly commendable. Dr Ashish Saini did his MBBS, MS from King George Medical College (KGMC), and he completed his M.Ch in Urology from All India Medical Sciences (AIIMS) New Delhi. Known for his meticulous attention to detail, Dr Ashish Saini with 15 + years of experience approaches each surgical case with a thorough understanding of the patient’s unique needs and tailors his approach accordingly. Dr Ashish Saini has completed 21000+ Urology and Sexology Surgeries. Beyond his surgical skills, Dr Saini fosters a sense of trust and reassurance among his patients. His clear communication, both pre-and post-surgery, helps the patient feel informed and at ease throughout their medical journey. Dr Ashish Saini’s commitment to patient-centred care contributes to a positive overall experience for those under his supervision.

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