Finding the Best HoLEP Surgeon: What to Look for and Why Experience Matters

Dr. Fernando Gómez Sancha · Medical Director, ICUA · Clínica CEMTRO, Madrid, Spain
Last updated: March 2026

HoLEP is arguably the most surgeon-dependent technique in urology. Having a good laser is not enough — you need to know how to use it. The learning curve is real, and the difference between an experienced surgeon and one who is just starting out can mean longer operating times, higher complication rates, and worse functional outcomes.

If you are looking for a surgeon to perform your prostate operation with HoLEP, this article will help you ask the right questions and understand what distinguishes a centre of excellence from one that simply has the equipment.

Why HoLEP depends more on the surgeon than on the machine

Laser enucleation of the prostate is not like programming a robot or pressing a button. It is a manual technique that requires three-dimensional understanding of prostatic anatomy, recognition of the plane between the adenoma and the capsule, sphincter protection, and real-time decision-making when the anatomy is not as expected. Every prostate is different, and the surgeon must adapt.

Published studies indicate that 20 to 50 procedures are needed to achieve basic competence with HoLEP, depending on the technique used and whether an experienced mentor provides supervision. But basic competence is not the same as mastery. A study from the University of Mannheim following 500 consecutive en bloc cases showed that surgeon efficiency continued to improve even after hundreds of procedures — without reaching a plateau.

In practical terms, this means: the more procedures your surgeon has performed, the better your outcome is likely to be.

Five questions you should ask your surgeon before deciding

1. How many enucleations have you performed?

This is the most important question. A surgeon who has done 50 enucleations does not have the same capability as one who has done 500, and that surgeon is not comparable to one who has done 5,000 or 10,000. Cumulative surgical volume is the best predictor of outcomes.

Do not just ask how many HoLEP procedures they do per year — ask how many they have done in total. A surgeon doing 100 per year for two years has a very different experience level from one who has been performing this technique for 20 years.

2. Have you published your own results?

Any surgeon can claim their outcomes are good. But publishing results in a peer-reviewed scientific journal means the data have been verified and validated by independent experts. Ask whether they have PubMed-indexed publications with their own HoLEP data — complication rates, continence outcomes, retreatment rates.

3. Do you train other surgeons?

A surgeon to whom other urologists come to learn has, by definition, a level of mastery that goes beyond competence. Teaching forces systematisation, an understanding of nuances, and the ability to solve problems that a less experienced surgeon has never encountered. Ask whether they receive visitors to their operating theatre, whether they run training courses, whether they proctor (supervise) at other hospitals.

4. Which technique do you use?

Not all HoLEP variants are equal. The en bloc enucleation technique with early apical release has been shown to be faster, more efficient, and to provide better continence protection than the classic three-lobe technique. Ask your surgeon which technique they use and why.

5. Can you operate on prostates of any size?

A HoLEP centre of excellence should be able to handle prostates of any volume — from small to very large, 200, 300 grams or more. If you are told your prostate is "too big for HoLEP," you are probably not at a centre with the necessary experience. One of HoLEP's greatest advantages is precisely that it has no size limit.

ICUA and Dr. Gómez Sancha: objective data

I do not intend this article to be a self-promotional exercise. What I will share are verifiable data — published in peer-reviewed international scientific journals, accessible on PubMed for anyone who wishes to check them.

Surgical experience

• Over 10,000 prostatic enucleations performed since 2003.
• Laser prostatectomy since 2003 — first with GreenLight, then with holmium laser (HoLEP).
• We operate on prostates of any size, including the very largest (300–500 grams).

Published technique

• GreenLight en bloc enucleation (GreenLEP): described and published in World Journal of Urology in 2015. The first description of en bloc enucleation with this energy source.
• En bloc HoLEP with early apical release and sphincteric mucosal preservation: published in World Journal of Urology in 2019 (137-patient series). Mean operative time 47 minutes, stress incontinence 0.7% at 6 months.
• 754-patient consecutive series: published in World Journal of Urology in 2025. Stress incontinence at 6 months: 0.15% for normal-sized prostates, 0.9% for large prostates. Postoperative PSA reduced by 93–94%.

International registries

• REAP Registry: co-author of the largest global multicentre database for prostatic enucleation — 6,193 patients from 10 centres in 7 countries, published in World Journal of Urology in 2023.
• Multicentre early apical release study: co-author of a 4,392-patient study evaluating the impact of early apical release, published in Urology in 2024.

International training

• Over 60 countries represented in our operating theatres in Madrid (ICUA, Clínica CEMTRO) and Sofia (Hill Clinic, Bulgaria).
• Active training programme since 2007: weekly surgical sessions with 5 procedures per session, open to international visitors.
• Training courses in Spain, Bulgaria, Mexico, Philippines, and other countries.
• Invited regularly to perform live surgery in the European annual congress and other minor events
• Published textbook: Manual de HoLEP en Bloque (ISBN 978-84-09-81888-4, 2026) — a 352-page practical manual with the step-by-step technique.

All of these data are verifiable. The publications are on PubMed, the visitors are real, the book has an ISBN. This is not marketing — these are facts.

What makes a centre of excellence?

A HoLEP centre of excellence is not simply a hospital that owns a holmium laser. It is a centre where several factors converge:

• Volume: enough procedures per year to maintain and improve the team's skill.
• Accumulated experience: the surgeon has long surpassed the learning curve and has operated on prostates of every description.
• Published data: the centre has verifiable, published results — not just internal statistics.
• Teaching capacity: other surgeons come to the centre to learn, demonstrating peer recognition.
• Complete team: it is not just the surgeon — it is an anaesthesia, nursing, and follow-up team that knows the protocol inside out.

A personal note: Do not choose your surgeon based on the lowest price or the first Google search result. HoLEP, done well, solves the problem permanently. Done poorly, it can leave you with complications requiring further procedures. The difference between these two scenarios is, almost always, the experience of the person holding the endoscope.

Would you like us to evaluate your case?

At ICUA we treat patients from across Spain and around the world. Send us your medical reports for a personalised assessment.
📞 +34 91 435 28 44 · ✉ icua@icua.es

Scientific references

1. Saitta G, Becerra JEA, Del Álamo JF, et al. 'En Bloc' HoLEP with early apical release in men with benign prostatic hyperplasia. World J Urol. 2019;37:2451-2458. PubMed
2. Iscaife A, Rodríguez Socarrás M, Talizin TB, et al. Contemporary results of En Bloc HoLEP for large prostates. World J Urol. 2025;43:401. PubMed
3. Gomez Sancha F, Rivera VC, Georgiev G, et al. Common trend: move to enucleation — Is there a case for GreenLight enucleation? World J Urol. 2015;33:539-547. DOI (Open Access)
4. Gauhar V, Gómez Sancha F, Enikeev D, et al. Results from a global multicenter registry of 6193 patients (REAP). World J Urol. 2023;41:3033-3040. PubMed
5. Gauhar V, Lim EJ, Fong KY, et al. Influence of early apical release on outcomes in endoscopic enucleation of the prostate: 4392 patients. Urology. 2024;187:154-161. DOI
6. Wenk MJ, Hartung FO, Egen L, et al. The long-term learning curve of HoLEP in the en-bloc technique: 500 consecutive cases. World J Urol. 2024;42:436. PubMed
7. Li P, Wang C, Tang M, et al. The en bloc method is feasible for beginners learning to perform HoLEP. Transl Androl Urol. 2023;12(3):379-390. PubMed Central

Related articles

→ What Is HoLEP? A Complete Guide to Holmium Laser Enucleation of the Prostate → HoLEP Prostate Surgery: What to Expect Before, During and After → International Patients: Prostate Surgery in Madrid with Dr. Gómez Sancha → How Much Does HoLEP Surgery Cost?