Holmium laser enucleation of the prostate (HoLEP) is a well-established alternative to transurethral resection of the prostate (TURP) for men with non-neurogenic lower urinary tract symptoms (LUTS), offering more favorable perioperative outcomes. However, its adoption in Indonesia has faced challenges, including higher complication rates, slow technological advancement, limited energy resources, and longer procedure times. This study explores the milestones, obstacles, and progress in implementing HoLEP in Indonesia, emphasizing its clinical outcomes and learning curve.

A retrospective cross-sectional study was conducted using medical records of HoLEP patients treated between 2023 and 2025 at Cipto Mangunkusumo Hospital (RSCM). Total sampling was applied to include all eligible cases. Data variables collected included patient demographics, prostate volume, operative time, and estimated blood loss. Descriptive statistical analysis was performed to evaluate trends in surgical efficiency and patient outcomes.

A total of 29 HoLEP cases were analyzed from 2023 to 2025. The median operative time decreased from 142.5 minutes in 2023 to 120 minutes in 2025, while estimated blood loss declined from 30 mL to 25 mL. The median prostate volume resected increased from 37 mL in 2023 to 50.5 mL in 2025, reflecting improved surgical precision and efficiency. The increasing number of cases over time suggests greater surgeon familiarity and a growing acceptance of HoLEP as a viable treatment option. These improvements coincide with the expansion of structured training programs, which have facilitated a more standardized approach to prostate enucleation in Indonesia.

Despite initial challenges, HoLEP has demonstrated promising growth in Indonesia. Improvements in perioperative metrics, alongside the expansion of structured training programs, have contributed to its wider adoption. Continued advancements in technique, mentorship programs, and resource allocation are essential for ensuring sustained progress in laser enucleation of the prostate across Indonesia.