Benign prostatic hyperplasia (BPH) is the kind of condition that quietly wears patients down. Symptoms accumulate — frequency, urgency, nocturia, hesitancy — until a patient finally brings them up in a routine visit. By that point, the impact on daily life is clear, and conservative strategies may no longer be enough.
For Varun Vijay, MD, a board-certified general urologist with Garden State Urology at Morristown Medical Center, BPH care is a central part of his clinical work.
“Urinary issues are a major issue that men can experience as they age,” he shares. “And I found it to be really satisfying to kind of guide people through that journey.”
Physicians referring to him know how challenging that journey can be. Many men manage symptoms for years, only seeking more definitive care once their routines, sleep, or overall well-being have eroded. And increasingly, for those patients, Holmium Laser Enucleation of the Prostate (HoLEP) has become an important next step.
Understanding the Full Clinical Picture of BPH
While patients usually present because of urinary bother, the underlying pathophysiology of BPH often extends beyond symptoms alone. Dr. Vijay notes that BPH manifests across a spectrum — urgency, slow stream, nocturia — but he also watches for complications that signal a need for more aggressive management.
“There are other important factors like frequent infections, compromise to their renal function, hematuria,” he explains.
This broader clinical picture is what drives many referrals. Some men continue to struggle despite medication, while others begin developing bladder dysfunction or recurrent urinary retention. For many of these patients, delaying surgical intervention risks further deterioration.
What HoLEP Offers to the BPH Population
HoLEP is an endoscopic procedure performed using a holmium laser to enucleate obstructing prostate tissue.
“We use small cameras to enter into the prostate, into the bladder, and then we can use a holmium laser to enucleate the prostate tissue… allowing us to effectively remove all of the tissue that could be causing obstruction, and symptoms to a patient, with the highest success and best durability.”
For referring physicians, there are several advantages worth highlighting:
- It is effective across all prostate sizes.
This is one of HoLEP’s distinguishing features. “It can really apply to any patient with BPH symptoms. It’s a gland size independent treatment, meaning that it will apply to anyone of any prostate of any size,” Dr. Vijay says.
Men with particularly large glands — historically among the most difficult to treat — are often ideal candidates.
- It removes more tissue and offers strong long-term durability.
The thoroughness of HoLEP’s enucleation leads to durable symptom relief.
“We found that HoLEP has been really more effective in removing more tissue, meaning patients are less likely to need medications in the future and they’re less likely to have bleeding issues or complications,” says Dr. Vijay about the procedure.
This completeness also matters for men who have undergone prior procedures. Many of Dr. Vijay’s referrals fall into this category — men who have had TURP, minimally invasive therapies, or earlier endoscopic procedures but continue to struggle with obstruction.
Patient Outcomes in Previously Treated or Medically Refractory BPH
Among the most compelling HoLEP outcomes are those seen in men who arrive frustrated and discouraged after multiple rounds of care.
“I’ll often get patients referred to me who have had previous surgeries and they come to me saying that they haven’t seen any relief or their symptoms have come back,” Dr. Vijay explains. “When I see them back, even one month out or two months out, they’re thrilled. They feel like it’s a life-changing operation.”
For referring physicians, these stories are not uncommon. HoLEP offers a definitive endpoint for men who have been on a long, frustrating path of partial improvements and recurring symptoms.
Training and Experience Matter
Although HoLEP has existed for decades, widespread adoption has been limited. The procedure carries a learning curve, and hasn’t been widely adopted, often due to the technical skills required for precise laser enucleation take time to develop. But he knows the benefits of the procedure and the major advances in the laser technology that have developed.
To ensure he could offer the procedure at a high level, he sought additional training beyond residency.
“I always felt like I wanted to be able to offer the best surgical technique for my patients, so I did seek out additional training and am able to smoothly implement it into my practice.”
For physicians referring complex or high-volume patients, this kind of focused expertise is meaningful.
A Predictable, Collaborative Referral Experience
Most referring physicians prioritize communication as much as clinical skill. Dr. Vijay approaches referrals with transparency and timely updates.
“I always send them my notes,” he says. “If I ever make any changes to their plan of care, I try to discuss it with them and I’m always happy to see the patient as soon as I can.”
This helps ensure continuity, especially for patients who have struggled for years and require coordinated long-term management.
He also emphasizes the importance of early action, stating that bladder health can only worsen over time if the prostate symptoms aren’t managed. Because of this, he is an advocate for earlier treatment and interventions for the right patients.
When to Consider HoLEP for a Referral
Patients may benefit from HoLEP when they:
- Continue to experience moderate to severe LUTS despite medication
- Have recurrent urinary retention, infections, or hematuria
- Have large prostates not well suited for office-based procedures
- Experience recurrence after previous BPH surgery
- Show signs of declining bladder function from chronic obstruction
These are often the men who feel the most dramatic change after HoLEP.
A Clearer Path Forward in BPH Care
BPH can impose limitations on every part of a patient’s routine — sleep, work, travel, daily comfort. For many, HoLEP provides an opportunity to move beyond those limitations with a safe solution that effectively addresses the underlying obstruction rather than temporarily reorganizing it.
For referring physicians, that means a reliable option at Atlantic Health for patients whose symptoms, anatomy, or previous procedures have left them without good alternatives.
To refer a patient to Dr. Vijay or learn more about our urology services at Atlantic Health, call us at 973.539.0333.