MiLEP – A Unique Method for Enlarged Prostate Removal

The technique of Minimally Invasive Laser Enucleation of the Prostate (MiLEP), performed with smaller-caliber endoscopes, was introduced for the first time in Bulgaria by the team at Hill Clinic. The procedure utilizes the latest-generation Magneto laser system.

Dr. Georgi Georgiev, urologist at Hill Clinic, demonstrated the technique for the first time at an International Congress on Minimally Invasive Surgery in Hungary in March 2025. The innovation is the result of advancements made by Dr. Felipe de Figueiredo, with whom Dr. Georgiev has a personal professional connection.

Laser prostate enucleation via the transurethral route significantly improves urinary symptoms, increases urine flow, and alleviates discomfort in patients suffering from benign prostatic hyperplasia (BPH). The method delivers long-lasting results comparable to open prostatectomy, but with lower intraoperative risk and shorter hospital stays. MiLEP is suitable regardless of prostate size and can be safely used even in patients with a high risk of bleeding.

MiLEP is performed using smaller endoscopic tools, which reduce the risk of urethral trauma and postoperative strictures. Although enucleation may cause strictures in a small percentage of cases (2–9%), these miniaturized instruments further decrease this risk while improving visibility and reducing trauma to the urethra.

The procedure uses lower energy laser settings and longer pulse durations, contributing to less bleeding and improved hemostasis. A key element of MiLEP is the “non-contact technique,” which minimizes tissue damage and enables precise dissection with minimal effort.

This method, combining non-contact laser enucleation and smaller-diameter scopes (18.5Ch and 22Ch), helps protect muscle and tissue structures surrounding the prostate, promoting faster recovery and reducing the risk of early postoperative incontinence. Additionally, it preserves the integrity of the lissosphincter, which is vital for a quick return to urinary continence.

By employing smaller-caliber endoscopes, the Hill Clinic surgical team minimizes trauma while enhancing the effectiveness of prostate enucleation. This makes MiLEP suitable for patients with varying prostate sizes and lowers the risks of complications such as strictures and incontinence.

MiLEP with early apical release is technically more demanding but entirely feasible. The method holds the potential to bring significant advances in surgical practice by reducing complications and improving recovery times.

Why should men choose MiLEP for prostate treatment?
With MiLEP, patients can expect improved quality of life, minimal risk, and a shorter recovery period. It is the ideal choice for those seeking relief from the symptoms of an enlarged prostate with a gentle, highly effective approach. We believe this technique represents the future of urology, and we are proud to be the first to offer it in Bulgaria.

For more information and appointments: +359 2 439 3131