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When BPH Demands More Than Medications: Why HoLEP Has Become a Go-To Referral Option at Atlantic Health

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:

1. 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.

2. 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 .

Email

Subject: When BPH Requires More Than Medication: HoLEP at Atlantic Health

Hi [Physician Name],

Some BPH patients reach a point where medications and office-based procedures no longer provide relief. For those cases, HoLEP can offer complete removal of obstructing tissue — regardless of gland size — with durable outcomes.

In our latest article, Varun Vijay, MD, outlines:

Read the full feature here [Insert Link], or call us to refer a patient at 973.539.0333

Regards,

Josh Schoonover

Education that empowers | medlive.com | Dr. prasad

Are you or someone you care about facing bladder cancer? You’re not alone. Join us for a free online session where leading bladder cancer doctors and a patient advocate talk about new ways to treat low-grade, intermediate-risk, non-muscle-invasive bladder cancer (NMIBC) without surgery

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Bladder cancer is the costliest and sixth most common cancer in the U.S. and 10th most common cancer worldwide. Transurethral resection of bladder tumor (TURBT) has been the standard of care for decades. Now, with a breakthrough in uro-oncology, the estimated 59,000 adult patients in the U.S. with recurrent LG-IR-NMIBC have a new treatment option.

“A critical component of our urologic oncology program is our robust research programs aiding in the development and evaluation of novel treatments,” said Sandip Prasad, MD, M.Phil., Director of Genitourinary Surgical Oncology at Morristown Medical Center and principal investigator of the ENVISION trial. “We are proud to help bring about this clinical innovation, which treats bladder cancer without surgery.”

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Today U.S. News & World Report released its 2024-2025 Best Hospitals Rankings and Ratings. I am pleased to share that Atlantic Health System continues to shine with best-in-state hospitals and high performing programs across the system. These rankings, along with numerous other acknowledgements, demonstrate that Atlantic Health System continues to achieve national recognition and is New Jersey’s best choice for high-quality, safe care.

Morristown Medical Center has been recognized as the best hospital for Orthopedic care in New Jersey, with U.S. News ranking it #16 nationally. Other national rankings MMC received include, Urology #31, Gastroenterology & GI Surgery #44, and Cardiology, Heart & Vascular Surgery #49. Morristown Medical Center was also ranked #10 in the New York Metro area.

Overlook Medical Center was ranked the #5 hospital in New Jersey and #20 in the New York Metro area. Overlook was recognized as high performing in four adult specialties, including Gastroenterology and GI Surgery, Neurology and Neurosurgery, Orthopedics, and Urology.

Newton Medical Center was recognized as high performing in two areas: COPD and Stroke, and Hackettstown Medical Center received one high performing rating for Kidney Failure. Atlantic Health System partner, CentraState Medical Center, was recognized as high performing in three areas: COPD, Pneumonia, and Stroke.

Congratulations to all our team members for the extraordinary care you provide and the continued recognition you bring to Atlantic Health System.

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This message is from Trish O’Keefe, PhD, RN, President, Morristown Medical Center:

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Witnessing the cardiac arrests of young athletes like Damar Hamlin and Bronny James has shown the importance of CPR training and AED accessibility. At MMC, our cardiovascular teams recently cared for JJ, a high school senior and captain of the wrestling team, who went into sudden cardiac arrest while training on the treadmill. Immediately, his friends jumped into action, performing CPR until EMS arrived to transport him to CentraState, where he was stabilized before moving to MMC. Thanks to the extraordinary care and support he received here, JJ was able to attend his senior prom and graduate high school this week. You can read more about his incredible story on Workplace.

Newsweek has released a number of lists highlighting America’s Best Specialists and Surgeons for 2024 and several of Morristown Medical Center physicians were included. Congratulations to:

Dr. George Naseef – Best Spine Surgeons
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Dr. Adam Berman – Best Prostate Cancer Oncologists

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I hope everyone is staying cool and hydrated in the hot and sunny weather we’re experiencing this week. With the official start of summer upon us, please be sure to work with your manager to take some PTO to relax, recharge and spend time with family and friends.

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Nonmuscle-Invasive Bladder Cancer News - American Urological Association

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