02 8382 6980 | Raji.Kooner@svha.org.au
St Vincent's Private Hospital | Mater Hospital, North Sydney | Bowral Office Staff Portal
Urology NSW
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Holmium Laser for BPH Treatment

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Here at Urology NSW, we are passionate about Holmium Laser treatment for BPH (Benign Prostatic Hypertrophy).

I believe that it offers significant advantages to a standard prostate resection1.

What we do is we put a telescope in through the eye of the penis.

We have a laser fibre that is inserted through the resectoscope.

The laser then works on the prostate and it cuts and seals at the same time.

It also uses saline for irrigation, the same thing we put in a drip, so if that absorbs into the system, there’s no issue as opposed to a standard TURP (Transurethral Resection of the Prostate)2.

The Holmium Laser also cuts at the plane between the adenoma – the abnormal growing, central part of the prostate – and the capsule, so we get a wide clearance when we resect this.

This tissue is then removed piecemeal through the bladder and through the urethra, so there’s no incision.

I’ve been doing the Holmium Laser now for more than 20 years*, and I’ve been extremely happy with the clinical outcomes, which is consistent with a large prospective registry-based patient cohort study in 20243.

There is less bleeding, quicker recovery, shorter catheterisation and fewer complications.3

I believe this is now the platinum standard for BPH4, and this technique will be increasingly used throughout the world and Australia.

The main stumbling block is a steep learning curve5, and the cost of the laser.

* This is the transcript of the video above. It has been lightly updated in April 2026 to reflect Dr Kooner’s current 20+ years of HoLEP experience.

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Holmium Laser for BPH Treatment

How the Holmium Laser is used for BPH

Urology NSW is passionate about Holmium Laser treatment for BPH (Benign Prostatic Hypertrophy), a technique that in Dr Kooner’s experience offers significant advantages over a standard prostate resection.1

The procedure is performed entirely through the urethra, with no abdominal incision:

  • A telescope (resectoscope) is passed through the urethra.
  • A laser fibre is inserted through the resectoscope and used to treat the prostate.
  • The laser cuts and seals tissue at the same time, and works along the natural plane between the adenoma (the overgrown central part of the prostate) and its capsule - giving a wide, clean clearance.
  • Tissue is then removed piecemeal through the bladder and urethra.

Saline is used for irrigation throughout - the same fluid used in an IV drip - so there are no concerns about absorbing irrigating fluid into the body, which can occasionally be an issue with a standard TURP.2

Outcomes

Dr Kooner has been performing Holmium Laser treatment for over 20 years and has completed over 3,000 holmium laser procedures, with very positive clinical outcomes - consistent with a large prospective registry-based cohort study published in 2024.3 Reported benefits include less bleeding, quicker recovery, shorter catheterisation, and fewer complications.3 This technique is now regarded by many as the platinum standard for BPH4 and is increasingly used worldwide.

Why it isn’t used everywhere yet

The main barriers to more widespread adoption are the steep learning curve for surgeons5 and the cost of the laser equipment itself.

Enlarged Prostate Patient Information Brochures

Male lower urinary tract symptoms (LUTS) PDF International prostate symptom score (I-PSS) PDF TURP for benign disease PDF Holmium laser enucleation of the prostate (HoLEP) PDF Greenlight laser prostatectomy PDF Open removal of the prostate for benign disease (Millin's prostatectomy) PDF Aquablation for benign prostate enlargement PDF Urolift procedure PDF Rezum steam ablation of the prostate PDF The prostate and bladder problems Continence Health Australia - PDF
References
  1. Myeong Jin Woo, Yun-Sok Ha, Jun Nyung Lee - Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity - Int Neurourol J. 2017 Mar; 21(1): 46–52 - doi: 10.5213/inj.1732640.320
  2. Songzhe Piao, Min Soo Choo, Myong Kim - Holmium Laser Enucleation of the Prostate is Safe for Patients Above 80 Years: A Prospective Study - Int Neurourol J 2016; 20(2): 143-150 - DOI: https://doi.org/10.5213/inj.1630478.239
  3. Hyomyoung Lee, Sangwon So, Min Chul Cho - Clinical outcomes of holmium laser enucleation of the prostate: A large prospective registry-based patient cohort study under regular follow-up protocol - Investig Clin Urol. 2024 Jul;65(4):361-367. doi: 10.4111/icu.20240080
  4. Edward J Bass, Ben J Challacombe - HoLEP: a platinum standard for modern benign prostatic hyperplasia treatment - 28 May 2024 https://doi.org/10.1002/tre.969
  5. Jungbum Bae, Seung-June Oh, Jae-Seung Paick - The learning curve for holmium laser enucleation of the prostate: a single-center experience - Korean J Urol. 2010 Oct;51(10):688-93. doi: 10.4111/kju.2010.51.10.688.