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HoLEP: What to Expect on the Day of Surgery
Dr. Fernando Gómez Sancha · ICUA
Dr. Fernando Gómez Sancha · YouTube
Language: English. Editorial classification in the patient catalog.
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Anaesthesia is an individual choice
Spinal anaesthesia may offer benefits such as less nausea, vomiting or drowsiness. This does not mean it always has fewer risks or guarantees a faster recovery than general anaesthesia.
The choice depends on the operation and the patient’s health. The anaesthetist assesses benefits, risks and preferences; general anaesthesia may be needed in some cases.
Editorial clarification based on the cited sources. It does not establish a new medical review of the video.
About this video
Are you about to have prostate surgery and don't know what to expect on the day? In this video I walk you through, step by step, exactly what happens on the day of your laser prostate surgery — so you arrive informed and calm. No surprises, no drama.
I've watched thousands of patients arrive nervous to the operating theatre, and I always say the same thing: the ones who handle it best are the ones who know what's coming.
🔹 The night before — light dinner, fasting from midnight, which regular meds to take and which to skip
🔹 Arriving at the hospital — reception, your room, gown, IV line and review of your history
🔹 The operating theatre and spinal anaesthesia — what that "small prick in the back" is, why it isn't general anaesthesia and why recovery is faster
🔹 The procedure (Holmium Laser Enucleation, HoLEP) — no cuts, no incisions, everything through the urethra, and how long it takes depending on prostate size
🔹 Immediate post-op — bladder catheter with continuous irrigation, recovery room, then your room
🔹 Discharge — what medication you take home (stomach protector, anti-inflammatory and antibiotic for a few days) and when the follow-up appointment is
🔹 Tissue analysis — we always send tissue to Pathology to rule out incidental cancer
Documented details and sources
Only details explicitly stated in the sources. Missing information does not mean it did not occur.
No clinical case details have been extracted for this video.
Original title and description on YouTubeSource checked: 2026-10-04.
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Available transcript · English
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- If you're having prostate surgery, it's normal to feel nervous. The unknown is scary. Today, I'll tell you exactly what will happen on the day of your surgery, step by step, so you're calm and there are no surprises. I'm Dr. Fernando Gomez Sancha. I've been in urology for 32 years and have operated on over 10,000 prostate patients with holmium laser.
- I've seen thousands of patients arrive nervous, and I've found that those who cope best are the ones who know what to expect. So, let's get to it. Before arriving at the hospital the night before, have a light dinner.
- From midnight, fast completely. Nothing to eat or drink. If you take regular medication, your anesthetist will have told you which pills to take with a sip of water and which not to.
- If you take anticoagulants, we'll have already adjusted the schedule in advance. There's no need to shave anything. No special preparations required. Sometimes, we recommend an enema uh to clear the the rectum so there are no accidents during anesthesia or the operation.
- Arrival at the hospital. Generally, you arrive at the hospital about 2 hours before the operation. You're greeted at at hospital reception, taken to your room, changed into a typical hospital gown, and they review your history.
- They might take your vitals, and they may also insert an intravenous line. Generally, the anesthetist already knows your history, has reviewed your health status, and [music] the anesthetic plan.
- Anesthesia. In most cases, you'll go up to theater, wait a bit to enter the theater where we'll greet you, set up a line a a to introduce fluid uh into the veins, and in most cases, we'll use a spinal anesthetic. The first thing the anesthetist does is give you a sedative, so you're calm during the spinal anesthesia.
- They'll place you in a position with a curved back, usually sitting or lying down, and that spinal anesthesia is a little prick in the back that will numb you from the waist down. You won't feel pain, and you'll be conscious, though very relaxed and very sleepy.
- Many patients prefer a sensor, a mild sedation, as well, naturally, to stay calm or even fall asleep during the procedure. It's not a general anesthetic. Recovery is much faster, and the risks are lower.
- For the surgery, we'll place you in the lithotomy position, which is the childbirth position, let's say. [music] You're lying on your back with your legs slightly raised and apart.
- We're going to insert the endoscope through the urethra. There are no cuts, no incisions, no wounds on the skin. With the holmium laser, we're going to separate the tissue of the prostatic adenoma from the prostatic capsule, we'll tip it into the bladder, and with a tissue aspirator or morcellator, we'll [music] extract it to send it to the pathology lab.
- How long does it take? It depends a bit on the size of the prostate. A 50 g prostate might take us 20 or 25 minutes, and a 200 or 300 g prostate could take an hour and a half, eh? The enucleation itself is relatively quick.
- >> [music] >> Sometimes it takes us more time, especially with large prostates, to extract the tissue, the morcellation. After that, we tell you the procedure is finished. Many patients say, "Doctor, but I thought you hadn't even started, right?" Look at the state of confusion or sedation that occurs.
- Generally, it's not a bad experience for the patient. You'll have a catheter in your bladder with an irrigation system so that fluid enters the bladder and drains out, which [music] is to keep the urine clear and prevent any clots from forming that could later make it difficult [music] to urinate.
- From there, you go to recovery. You're there for about half an hour to an hour, and then you usually go to your room. Few hours later, you can eat [music] and drink normally. And the next morning, we'll remove the bladder catheter, and you'll be able to get up and walk.
- Generally, the pain is minimal. Most patients are surprised because they expected something worse. When we remove the catheter, we usually put a little fluid into the bladder beforehand so that as soon as the catheter's out, you can try to urinate.
- We ask you to urinate, we check the amount, you tell us how it went, and if all is well, you can go home that same day, eh? Usually, it's a one-night stay. In cases of very large prostates or higher-risk patients, we might decide to wait a bit longer to remove the catheter, and the hospital stay might be two nights instead of one, but that's an exception.
- What do you take home with you? A simple medication schedule, usually a stomach protector, an anti-inflammatory, and an antibiotic for a few days. The instructions or or or or your recovery process I've already explained in another video, and we'll make a follow-up appointment for a few weeks later.
- One detail that patients really appreciate, the tissue we extract is always sent for analysis, always. So, if there were any hidden incidental cancer, we'll detect it. This isn't optional. In my practice, [music] it's mandatory. As I say, no mysteries, no drama. Holmium laser enucleation surgery is minimally invasive, recovery is fast, and the results are excellent.
- The most important thing is that you arrive informed and calm. I always try to reassure patients when they arrive at the operating theater because, well, it's stressful, isn't it? Going into theater, especially for the first time, but the experience isn't that bad. And all patients, well, they tend to view it positively, and many tell me, "Gosh, if I'd known, I'd have done it sooner." Subscribe to the channel, and if you like this information, well, you'll receive more more news from me.