Prostate surgery built to last. Coming to Victoria.
HoLEP — holmium laser enucleation of the prostate — removes the obstructing inner tissue rather than shaving a channel through it, which is why its results hold up for decades. No skin incisions, and most men are home the next day.
Enlarged prostate (BPH)
Sound familiar?
By age 60, roughly half of men have an enlarged prostate; by 85, it's up to 90%. The gland slowly squeezes the urethra — and life gets organized around bathrooms. If several of these are your normal, it's worth a conversation.
Up all nightWaking two, three, four times a night to urinate — and never feeling rested.
A weak, stop-start streamHesitating, straining, dribbling — and taking twice as long as everyone else.
Never quite emptyThe feeling that your bladder hasn't finished, minutes after you've left the bathroom.
Sudden urgencyPlanning trips, golf games, and flights around the nearest washroom.
Pills that stopped workingMedications helped for a while — then the symptoms crept back, with side effects.
Catheter or retentionAn emergency visit where you couldn't urinate at all is a turning point — not a life sentence.
The procedure
Think of the prostate as an orange.
The tissue that blocks urine flow is the fruit. The capsule around it is the rind. Older surgeries shave the fruit a little at a time and leave plenty behind to regrow. HoLEP removes the fruit completely, along the natural plane of the rind — which is why it lasts.
No skin incisions
A slender scope passes through the urethra — your body's natural passage. Nothing is cut through skin or muscle.
Laser enucleation
A holmium laser works along the exact plane between inner tissue and capsule, freeing the obstructing lobes whole — the anatomical removal that makes HoLEP so durable.
Tissue out, tissue tested
The freed tissue is drawn into the bladder, finely divided, and removed — then sent to pathology, so nothing is assumed and everything is checked.
Home in about a day
Most men go home the next morning, and the catheter typically comes out within 24 hours. The laser seals as it works, so blood loss is minimal.
Why HoLEP
Why urologists call it the gold standard
Major guidelines — the American Urological Association and the European Association of Urology — recommend laser enucleation as a first-line surgical option for enlarged prostate, including glands too large for older techniques. The numbers explain why.
of HoLEP patients need repeat surgery for recurrent obstruction within 10 years in long-term studies — among the lowest retreatment rates in BPH surgery.
and beyond. HoLEP remains an option for very large glands that exceed the safe range of TURP and most newer techniques — suitability is confirmed at assessment.
is the typical catheter time. Most men are home the day after surgery, many the same evening.
skin incisions. And because the laser seals blood vessels as it works, HoLEP is often an option for men on blood thinners.
An honest comparison
HoLEP vs. the alternatives
Every option has a place. Here's how the main paths stack up — including where HoLEP asks more of you (a longer anaesthetic, and a surgeon with specialized training).
| Feature | HoLEP | TURP | Medication | Water-vapour / implants |
|---|---|---|---|---|
| How it works | Laser removes the entire obstructing tissue along its natural plane | Electric loop shaves tissue from the channel outward | Daily pills relax or slowly shrink the gland | Steam or tiny implants open a channel through the tissue |
| Prostate size | Wide range — including very large glands | Best for small-to-moderate glands | Any, but effect is modest | Small-to-moderate glands only |
| Need another procedure | ~1% at 10 years | Roughly 1 in 10 within 8–10 years | Symptoms usually progress; many men eventually need surgery | Higher retreatment within 5 years |
| Hospital & catheter | ~1 night; catheter ~24 hours | 1–2 nights; catheter 1–3 days | None — but lifelong daily medication | Day procedure; catheter often several days |
| Ejaculation | Retrograde ejaculation is common — orgasm and sensation are unchanged | Retrograde ejaculation is common | Some medications reduce ejaculate or libido | Usually preserved — a genuine advantage for some men |
| The trade-off | Longer operation; few surgeons are trained to offer it | Widely available; less complete tissue removal | No surgery, but no fix either — and side effects add up | Gentler recovery; less durable, size-limited |
Retreatment figures reflect ranges reported in long-term comparative studies and guideline reviews of BPH surgery. Your anatomy, health, and priorities matter more than any table — that's what a consultation is for. Sources: AUA Guideline on Management of BPH; EAU Guidelines on Non-neurogenic Male LUTS.
Two-minute check
Score your symptoms
This is the International Prostate Symptom Score (IPSS) — the same seven questions urologists use worldwide. Answer for the past month, and bring your score to your appointment or family doctor.
The surgeon
Meet Dr. Bruce Gao
Bruce M. Gao
MD, FRCSC · Urologist
- Medical degree — University of Calgary, Cumming School of Medicine
- Urology residency — University of Toronto
- Fellowship in Endourology & Minimally Invasive Surgery — UC Irvine
- Assistant Professor of Urology — UC Irvine School of Medicine
- Faculty — UC Irvine HoLEP Masterclass, teaching the technique to other urologists
- Researcher — dozens of peer-reviewed publications in urology
HoLEP has a reputation as the hardest prostate surgery to learn. That's one reason so few men are ever offered it — and why Dr. Gao spends part of his time teaching it to other urologists.
Dr. Gao earned his medical degree at the University of Calgary's Cumming School of Medicine and completed his urology residency at the University of Toronto, followed by a fellowship in endourology and minimally invasive surgery at UC Irvine. He is now an Assistant Professor of Urology at the UC Irvine School of Medicine and serves on the faculty of the UC Irvine HoLEP Masterclass, the hands-on course where urologists come to learn enucleation.
That matters for a simple reason: HoLEP outcomes track the surgeon's experience more closely than almost any other prostate procedure — and there is no substitute for a surgeon who also teaches the operation to his peers.
Dr. Gao is now planning to bring that practice to British Columbia. HoLEP Victoria is being built around one idea: Island men shouldn't have to fly to California — or settle for a lesser procedure — to get the gold standard.
Verify credentials: Dr. Gao's profile · UC Irvine HoLEP course faculty agenda (PDF)
What to expect
From referral to recovery
Once consultations open, most men will arrive the same way — a family doctor's referral, or a direct request after doing their own research. Here's the whole path, with nothing held back.
Consultation
Symptom score, flow test, ultrasound sizing, and an unhurried conversation about options — including not operating. Bring your questions and your IPSS score.
Surgery day
A general or spinal anaesthetic, typically 1–2 hours in the operating room depending on gland size. No skin incisions. Most men are up walking the same evening.
Catheter out
The catheter comes out about 24 hours after surgery — for most men, the milestone they're happiest to reach. Discharge home once you're voiding well.
The new normal
Some urgency and light pink urine are normal early on and fade steadily. Most men are back to desk work in a week; full symptom benefit settles in by about three months.
For referring physicians
Refer with confidence
Once referrals open, your patient gets a guideline-concordant option many BC men currently travel out of province — or out of country — to receive. You'll get a consult letter back fast, and a surgeon who picks up the phone.
Who to send
- Failed or intolerant of medical therapy
- Large glands (80g+) — the classic HoLEP candidate
- Urinary retention, catheter-dependent
- Recurrent UTI, bladder stones, or renal impact from BPH
- Men on anticoagulation needing surgery
What to include
- IPSS and flow rate, if available
- Prostate volume (ultrasound or imaging)
- PSA history and any biopsy results
- Current medications, especially anticoagulants
- Relevant cardiac / anaesthetic history
How it flows
When referrals open, fax and e-referrals will be reviewed within two business days, with consults typically offered within 2–4 weeks and a full consult letter back to you after the visit and after surgery.
Physicians: referral details will be posted here at launch. In the meantime, reach us at care@holepvictoria.com.
Straight answers
Questions every man asks
HoLEP is an insured surgical service in British Columbia when performed in a hospital setting — there is no charge to the patient for the operation itself. Your consultation will confirm the specifics of your situation, including any uninsured options you might elect.
Very likely, yes — this is HoLEP's home turf. It's the one technique guidelines endorse for essentially any gland size, including glands well over 150 grams that are beyond the safe range of TURP and most office-based procedures. Size is a reason to choose HoLEP, not a reason to rule it out.
Erections and orgasm sensation are typically unchanged, because the nerves that govern them run outside the tissue being removed. What does change for most men is ejaculation: semen travels backward into the bladder instead of forward (retrograde ejaculation). It's harmless and painless, but it's permanent — and it's the trade-off men weigh most carefully. Ejaculation-preserving techniques exist and can be discussed where fertility or this function matters to you.
Often, yes. Because the holmium laser seals blood vessels as it works, HoLEP has the strongest safety record of any BPH surgery for men on anticoagulation. Your plan — whether to pause, bridge, or continue your medication — is made together with your prescribing physician.
HoLEP treats benign enlargement — but because the entire inner gland is removed and sent to pathology, incidental cancers are sometimes found that biopsies missed. That tissue examination is a genuine advantage over channel-opening procedures that leave most tissue in place and untested. If cancer is found, you'll be guided into appropriate follow-up care.
Honestly? Because it's hard to learn. HoLEP has a famously steep learning curve, long equipment lists, and requires a hospital willing to invest in the laser platform — so even though the evidence has favoured it for years, few surgeons offer it. Men in BC have historically travelled to Toronto, the US, or further. HoLEP Victoria is being built to close that gap on Vancouver Island.
Most men take about a week before desk work and light activity feel routine. Expect some urgency, frequency, and occasional light blood in the urine for the first few weeks — that's healing, not a complication. Strenuous exercise and heavy lifting wait about a month. By three months, most men describe the result simply: "I pee like I'm 25 again, and I sleep through the night."
HoLEP Victoria · Opening soon
Start the conversation
The practice is being established in Victoria. Leave your details and you'll be first to know when consultations open — questions are welcome in the meantime.
Victoria, British Columbia
Clinic address to be announced
The clinic phone line opens at launch — email is the fastest way to reach us until then.
Referral details will be posted here at launch.
Referral guide →
In BC you can also ask your family doctor about HoLEP by name — or join the interest list and we'll help you navigate the path in once bookings open.