Holmium laser enucleation of the prostate (HoLEP): a narrative review of sexual side effects

Background and Objective: Benign prostatic hyperplasia (BPH) is one of the most prevalent urological conditions. Holmium laser enucleation of the prostate (HoLEP) has emerged as a durable, effective, and minimally invasive treatment option for men with BPH. Despite the success of HoLEP in men with BPH, it is not without postoperative side effects, both sexual and non-sexual. This narrative review compiles existing evidence of side effects associated with HoLEP. The review mostly covers sexual side effects but also discusses some non-sexual side effects. There can be significant overlap between sexual and non-sexual side effects; thus, both were included. Methods: A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews on HoLEP and its sexual side effects. Key Content and Findings: Due to the nature of BPH and HoLEP, sexual side effects are significant considerations in patients undergoing HoLEP. Multiple studies have shown the commonality of retrograde ejaculation (RE) and ejaculatory dysfunction after HoLEP. Other studies have shown some effect on the orgasm itself, but overall unchanged sexual satisfaction. Conclusions: HoLEP is a durable, effective, and safe option for men with BPH. It has high rates of RE, which can affect sexual health and orgasmic function. However, the effects typically are not largely impactful to the overall sexual health and satisfaction of men.