Laser Procedure Brings New Hope for Men with Enlarged Prostates

For many men, urinary problems are an uncomfortable and often unspoken part of getting older. Difficulty starting or maintaining urine flow, frequent nighttime trips to the bathroom, or even reliance on a catheter can significantly disrupt daily life. These symptoms are commonly caused by an enlarged prostate, a condition that affects most men as they age.

However, a highly specialized laser procedure now available in Palm Beach County is offering long-term relief for men with enlarged prostates — particularly those with more severe cases. Known as HoLEP (Holmium Laser Enucleation of the Prostate), the minimally invasive surgery removes the benign prostate tissue blocking urine flow, allowing the bladder to empty normally again.

Joshua Heiman, M.D., a fellowship-trained urologist at Boca Raton Regional Hospital, part of Baptist Health, is one of the only physicians in the area to offer this advanced treatment. He says HoLEP offers dramatic results for patients with enlarged prostates.

“HoLEP uses a laser to completely remove the portion of the prostate that’s causing obstruction,” says Dr. Heiman. “For the right patients, it can dramatically improve urinary symptoms and overall quality of life.”

A Proven Technology with Specialized Training

Although HoLEP may be new to many patients locally, the technology itself has been used for decades. The procedure was developed in New Zealand in the 1990s and introduced in the United States in the early 2000s. Despite its long track record, HoLEP has not been widely available because of the advanced training required to perform it effectively.

“It’s not that the procedure is riskier. It’s that it’s harder to learn,” Dr. Heiman explains. “HoLEP isn’t part of standard urology training. Surgeons need specialized experience and a high case volume to become proficient.”

Dr. Heiman received his HoLEP training at Indiana University, where the first HoLEP procedure in the United States was performed. He also completed additional fellowship training at the University of Florida. That advanced background allows him to offer the procedure to patients in Palm Beach County who previously would have had to travel elsewhere for care.

How HoLEP Works

To help patients understand the procedure, Dr. Heiman often uses a simple analogy.

“Think of the prostate like an orange,” he says. “The inner fruit is the part that grows and blocks urine flow, while the rind is the outer portion. HoLEP cores out that inner tissue completely, leaving the outer shell intact.”

Unlike traditional prostate surgeries that shave down excess tissue, HoLEP removes the obstructing tissue in its entirety. This makes the procedure especially effective for men with very large prostates and reduces the likelihood that symptoms will return.

The procedure typically takes about 60 to 90 minutes, depending on prostate size. According to Dr. Heiman, most patients stay in the hospital overnight, though some may go home the same day. A catheter is usually removed within one to two days.

Who Is a Good Candidate for HoLEP?

HoLEP is considered the gold standard for men with very large prostates, typically those larger than 80 grams. It is also a strong option for patients who may not be good candidates for other prostate procedures.

“Men on blood thinners often do very well with HoLEP because the laser allows us to control bleeding more effectively,” Dr. Heiman says. “Older patients, including those in their 70s and 80s, also tend to tolerate the procedure well because it’s minimally invasive.”

HoLEP can also benefit men undergoing treatment for prostate cancer. Patients planning to receive radiation therapy who are experiencing urinary obstruction may benefit from having the prostate unblocked beforehand, as radiation can worsen urinary symptoms.

Meaningful, Life-Changing Results

Some of the most dramatic improvements are seen in patients who were previously unable to urinate on their own.

“We see men who are dependent on a Foley catheter just to empty their bladder,” Dr. Heiman says. “When they’re finally able to urinate normally again, it’s incredibly liberating.”

Helping patients regain such a basic function is one of the most rewarding parts of his work, he adds. “It has a huge impact on independence and quality of life. Those patients are often the most grateful.”

Expanding Access to Advanced Care

Dr. Heiman began offering HoLEP at Boca Raton Regional Hospital in recent months and the program continues to grow as more patients learn about the option.

“Many men don’t realize there are advanced treatments available beyond medication or traditional surgery,” he says. “HoLEP gives us another powerful tool to help patients feel better and live more comfortably.”

Click here for more information about urology conditions and treatments available at Baptist Health.