Jennifer Robles, MD, outlines barriers to widespread HoLEP adoption

A recent study published in the Journal of Endourology showed that while HoLEP utilization increased from 2018 to 2022, there are still areas across the US with limited access.¹

Specifically, the investigators reported that only 34 states had at least 1 active HoLEP surgeon, which they defined as those who performed at least 10 annual HoLEP procedures.

In a recent interview with Urology Times®, lead study author Jennifer A. Robles, MD, MPH, outlines several key barriers that may be preventing widespread HoLEP adoption. Robles is an assistant professor of urology at Vanderbilt University Medical Center and the chief of urology at the Tennessee Valley (VA) Healthcare System in Nashville, Tennessee.

During the discussion, Robles outlines 3 key factors that may be inhibiting more widespread adoption of HoLEP across the US. The first, she notes, may be lack of exposure and training.

“The fact that 31% of states don't have a single active HoLEP surgeon means that about 31% of residents potentially are not being exposed to HoLEP at all, and people have no one around them necessarily that's doing it that can help train them,” she explained.

Another key barrier is reimbursement. Robles noted that compared with other procedures for benign prostatic hyperplasia, the RVU per hour is relatively low for HoLEP. According to Robles, this provides a lack of incentive for people to devote time and energy into learning the new procedure.

This ties into the 3^rd key barrier that Robles outlined, which is the perceived learning curve associated with HoLEP.

She added, “There has been this built-up idea that HoLEP is so hard to learn and has such a significant learning curve that it's not even worth trying. I think that with modern technology and modern training methods, I consider this a myth.”

REFERENCE

1. Robles J, Shin YE, Rojanasarot S, Miller NL. Niche No More? Mapping US Trends and Regional Disparities in Holmium Laser Enucleation of the Prostate from 2018 to 2022. J Endourol. 2025.doi:10.1089/end.2025.0188