HoLEP (Holmium Laser Enucleation of the Prostate) is a minimally invasive surgical treatment for men with any degree of prostate enlargement who have urinary symptoms and men who are suffering from retention of urine, repeated urine infections or bleeding due to an enlarged prostate.
https://www.cambridgeurologypartnership.co.uk/urology-info-for-patients/prostate/holep-urolift/

HoLEP is a multi stage procedure.

1) The urethra must be able to accept calibration up to 30 F easily using Van Buren sounds to broaden the urethra. A 26–28 F continuous flow resectoscope (thin metal tube containing a light, camera, etc) is inserted into the urethra.
Saline irrigant is then run into the resectoscope.
2) A camera and Holmium:YAG (Yttrium Aluminum Garnet) laser with penetration of energy approximately 0.2 mm into prostatic tissue with simultaneous coagulation of blood vessels is used to separate (peel off) the prostatic tissue from the containing prostatic capsule/casing in lobes. Each lobe is pushed through into the bladder. The camera image appears large on a screen although the hand to instrument movement is 1 to 1.

3) Once all lobes have been dissected free and pushed into the bladder, the laser settings should be changed to achieve optimal coagulation. The capsular surface is then inspected carefully. Any capsular bleeders should be coagulated by first defocusing the laser and then activating it until hemostasis is achieved.
4) The final stage involves using a morcellator to chop up the lobes and suck them out of the bladder. The expelled tissue can then go for pathology analysis. HoLEP can be used on any size prostate.
This describes it in detail...
https://www.endourology.org/education-articles/holmium-laser-enucleation-of-the-prostate
Note the Pirhana Morcellator :-)

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Discusses stages in detail

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC165416/

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Actual camera footage by Dr Oh (54 ml size prostate)
https://www.youtube.com/watch?v=Z2T8_vVjkdc

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HoLEP Information for Patients. (Cambridge Urology Partnership)
*** "HoLEP has replaced standard TURP completely and unreservedly in our hospital. There is nothing out there that has been shown to be better"
"HoLEP represents a paradigm shift in the surgical management of BPH and is endorsed by all the leading urological organizations world-wide. We have used this technique exclusively with over 2,000 patients since it evolved in the late 1990's. Once learned, HoLEP replaces both TURP and open prostatectomy, providing superior outcomes in prostates of all sizes!"
"Self-catheterisation or permanent catheter to empty bladder if the bladder is weak (1%)"
Some patients, particularly those with small prostate glands, are unable to pass urine at all after the operation due to temporary swelling of the prostate area.
"it is usual not to have any pain" = it is unusual to have any pain
The laser is used to separate the obstructing prostate tissue from its surrounding capsule
Removal of your prostate
if the prostate is fully enucleated
Finding unsuspected cancer in the removed tissue which may need further treatment (5%)

https://www.cambridgeurologypartnership.co.uk/wp-content/uploads/HOLEP-info-sheet.pdf

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https://bphsurgeon.co.uk/holep/
HoLEP was developed by 2 New Zealand Urologists, Peter Gilling and Mark Fraundorfer, in the 1990′s. Since then it has been extensively researched and a large number of published clinical trials support it as the new “Gold Standard” for treating BPH.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380818/
24 Mar 2017
Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity (DU)
In the present study, we showed that HoLEP was superior to TURP with regard to postoperative Qmax, PVR, symptomatic improvement and QoL.
With the resolution of outflow obstruction, voiding is possible with low bladder detrusor muscle contractility, resulting in postoperative benefits in urinary symptoms and reduced PVR.
Both the TURP and HoLEP groups showed improvements in voiding symptoms and in other postoperative data, including QoL, IPSS, Qmax, and PVR.
Both TURP and HoLEP can be effective in patients with BPH and DU. However, our data demonstrated that patients in the HoLEP group showed significantly greater improvements than patients in the TURP group in the other parameters
HoLEP..including a lower rate of complications, less blood loss, reduced catheterization time, and shorter hospitalization.
One of the major and most common complications of TURP is the risk of bleeding.
Decreased postoperative bleeding has been one of the main advantages of HoLEP. ***
...which was ascribable to the improved efficiency of obstruction removal using HoLEP
HoLEP showed better efficacy than TURP in improving voiding symptoms, Qmax, PVR, medication requirements and in minimizing postoperative complications.

https://afju.springeropen.com/articles/10.1186/s12301-021-00230-1
10 September 2021 Study of studies.
Mainly of interest with Detrusor Underactivity (DUA) due to impaired contractility.
A previous study was conducted in determining the effect of HoLEP in patients with non-neurogenic impaired bladder contractility, and the results recommend HoLEP to be performed in those patients.
There is no evidence that there is a benefit for TURP in patients with DUA.
Patients with HoLEP surgery had better outcomes in the follow-up in the form of IPSS, Qmax, PVR, and catheter-free rate.
HoLEP showed better improvement in IPSS scores in patients with DUA. HoLEP can be considered to be performed in the BPH patients with DUA for better outcomes for the patients.

https://www.ics.org/2020/abstract/412
In one of these studies, 95% of patients were voiding spontaneously following HoLEP without the need to do Clean Intermittent self-Catheterization (CIC) while investigators in the other study found that 73% of patients achieved catheter-free status following HoLEP and the remaining patients needed to do CIC for high post-void residuals. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and Bladder Outflow Obstruction (BOO).
*** Our review suggests that more than 80% of men with DU and BOO are likely to void spontaneously after HoLEP. This may be explained by the comprehensiveness of prostate tissue enucleation attainable with HoLEP, permitting voiding through a wide-open channel in the prostatic urethra.

https://pubmed.ncbi.nlm.nih.gov/33763730/
HoLEP for acute and non-neurogenic chronic urinary retention (NNCUR) how effective is it? Tevita Aho et al. World J Urol. 2021 Jul.
*** 98.8% with NNCUR were catheter-free 3 months after HoLEP.
 

https://www.ouh.nhs.uk/urology/services/documents/holep.pdf

"It is unusual to require a blood transfusion after laser surgery"

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Internal sphincter muscle of urethra...is the primary muscle for prohibiting the release of urine.
https://en.wikipedia.org/wiki/Urethral_sphincters
 

females are more at risk of problems with their urinary continence, as they have a short urethra and only one bladder neck sphincter (that they go on to call the External Sphincter even though it's situated at the pelvic floor)
https://www.futurelearn.com/info/courses/understanding-continence-promotion/0/steps/46068

(With Anteroposterior dissection by Tokyo group) the transient stress urinary incontinence rate was significantly improved by 2.7% compared to 25.2% with the conventional (Classic 3-lobe technique) method.
(With En bloc technique with anteroposterior dissection by Chiba, Japan) It is also important to note that the authors made significant efforts to develop the technique to preserve the sphincter.
(At Seoul) based on the three-lobe technique - it was modified to better preserve the sphincter
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722407/
 

At this step, some white and shiny circular fibers could be seen at 0.5 cm from the bladder neck, which were visually different from hyperplastic gland. This is exactly the bladder neck and internal sphincter that need to be preserved
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844485/