HoLEP vs TURP: Choosing Surgery for an Enlarged Prostate
HoLEP and TURP both remove the part of an enlarged prostate that blocks urine. For a gland under about 80 ml, they work similarly well.
For a larger gland, however, HoLEP removes more tissue and rarely needs repeating. TURP, in turn, is easier to find and slightly kinder to ejaculation.
Medically reviewed by Assoc. Prof. Dr. Tuncay Taş, urologist. Updated November 2026.
This guide compares the two operations point by point. It also shows where Rezum and UroLift fit. Finally, it lists the questions that decide the choice for most men.
The short answer
Both operations treat benign prostatic hyperplasia (BPH), the non-cancerous growth that squeezes the urine channel. Both also go through the penis, so there is no cut on the skin. The difference lies in how much tissue each one can remove, and how.
Prostate under 80 ml: both work well, so recovery, ejaculation and local experience decide.
Prostate over 80 ml: HoLEP usually suits better, because TURP has a size limit.
A middle lobe or a catheter already in place: both can help, although HoLEP removes a large middle lobe more completely.
Blood thinners: HoLEP is often easier to plan, since the laser seals vessels as it cuts.
Keeping ejaculation is the top priority: neither is ideal, so a smaller gland may suit Rezum or UroLift instead.
How TURP works
TURP stands for transurethral resection of the prostate. The surgeon passes a thin telescope through the urethra. Then an electric wire loop shaves the blocking tissue from the inside, strip by strip.
The chips wash out at the end, and they go to the laboratory for checking. As a result, a channel opens through the middle of the gland. The outer part of the prostate stays in place.
Monopolar and bipolar TURP
Older monopolar TURP uses a special rinsing fluid. If the body absorbs too much of it, the blood salt level can drop. Doctors call this TUR syndrome.
For that reason, the operation has a time limit, which also limits the gland size.
Today, many surgeons use bipolar TURP instead. It uses saline, so TUR syndrome is very rare.
Assoc. Prof. Taş has published research on bipolar transurethral vaporization for BPH. This method is a close relative of bipolar TURP.
How HoLEP works
HoLEP stands for holmium laser enucleation of the prostate. It also uses a telescope through the urethra. However, instead of shaving the tissue, the laser lifts the whole inner prostate off its outer shell.
Think of peeling an orange from the inside. The laser follows the natural plane between the two layers, so the freed lobes drop into the bladder. Next, a second instrument called a morcellator cuts them up and suctions them out.
Because the whole blocking part comes out, the result does not depend on gland size. In addition, all the tissue reaches the pathologist, just as with TURP.
Operating time and anaesthesia
Both operations take place under general or spinal anaesthesia. A spinal keeps you awake but numb from the waist down. Your anaesthetist helps you choose.
TURP usually takes about 1 hour. HoLEP, in comparison, takes about 1 to 2 hours, depending on gland size. In practice, the extra time in a large gland buys a more complete result.
After both, a catheter rinses the bladder for some hours. This stops clots from forming while the raw surface settles. Then the rinse stops once the urine turns light pink.
HoLEP vs TURP at a glance
The figures below are typical ranges from published series and guidance. Your own figures depend on your prostate, your bladder and your general health.
Feature | HoLEP | TURP |
Prostate size | Any size, including over 80 ml | Usually 30 to 80 ml |
Tissue removed | The whole inner, blocking part | A channel through the middle |
Anaesthetic | General or spinal | General or spinal |
Hospital stay | Usually 1 night | Usually 1 to 2 nights |
Catheter | About 1 day | Usually 1 to 3 days |
Bleeding needing transfusion | Rare | Uncommon, more likely in larger glands |
Dry orgasm | About 3 in 4 men | About half or more |
Early leakage | Some men, usually for a few weeks | Less common |
Retreatment by 5 years | About 1 to 2% | About 5 to 6% |
Availability | Fewer trained surgeons | Offered in most hospitals |
Prostate size: the deciding factor
Size usually settles the question first. An ultrasound measures the gland in millilitres, and the result often points to one operation.
Under 80 ml
In this range, both operations give a similar gain in flow and symptom scores. So the choice often comes down to the surgeon's experience and your priorities.
For example, some men prefer the shorter catheter time of HoLEP. Others, in contrast, prefer the lower rate of dry orgasm after TURP.
Over 80 ml
Above this size, TURP becomes harder to complete safely in one session. In the past, such glands needed open or robotic simple prostatectomy through the abdomen. HoLEP, by contrast, removes even very large glands through the urethra, so it avoids an abdominal cut.
Guidance reflects this. In the UK, NICE lists both TURP and HoLEP as standard operations for an enlarged prostate. It also advises that HoLEP takes place in centres with experience in the technique.
Recovery: the first weeks
Recovery after both operations follows a similar path. Still, HoLEP usually has a slightly quicker start, because bleeding is lower and the catheter comes out sooner.
Recovery point | HoLEP | TURP |
Catheter removal | After about 1 day | After 1 to 3 days |
Desk work | After about 1 to 2 weeks | After about 2 weeks |
Driving | After about 1 to 2 weeks | After about 2 weeks |
Sex | After about 3 to 4 weeks | After about 3 to 4 weeks |
Heavy lifting and gym | After about 4 weeks | After about 4 to 6 weeks |
Urgency and stinging settle | Usually within 6 to 12 weeks | Usually within 6 to 12 weeks |
After both, light bleeding often returns in the second or third week, as small scabs fall away. Usually it clears with extra water and rest. Likewise, constipation deserves early attention, because straining can restart bleeding.
Side effects compared
Both operations are well established. Even so, each carries some risk, and the pattern differs slightly between them.
Ejaculation and orgasm
After both operations, semen often flows back into the bladder at climax, which doctors call retrograde ejaculation. Orgasm itself still happens. However, it happens more often after HoLEP, in about 3 in 4 men, because more tissue comes out.
Erections
Erections usually stay the same as before surgery. In fact, large studies show no clear difference between HoLEP and TURP here. So erection worries alone rarely decide the choice.
Continence
Some men leak a little when they cough or lift in the first weeks after HoLEP. In most cases, pelvic floor exercises fix it within weeks to a few months. Meanwhile, permanent leakage is rare after both operations, because the surgeon protects the sphincter muscle below the prostate.
Bleeding and scarring
Serious bleeding is less common after HoLEP, especially in large glands. On the other hand, both operations can rarely leave scar tissue that narrows the urethra or the bladder neck. If that happens, a small procedure usually solves it.
How long the results last
Durability is where HoLEP stands out most. Since it removes the whole inner prostate, regrowth that needs another operation is uncommon. In published series, only about 1 to 2% of men need further treatment within 5 years.
After TURP, the figure is higher, at about 5 to 6% by 5 years. That still means most men never need another operation. However, a younger man with a large gland may value the longer margin of HoLEP.
PSA also changes after surgery, because the inner prostate makes much of it. As a result, the level falls after both operations, usually more after HoLEP. So a new PSA baseline a few months later makes future checks easier to read.
Where Rezum and UroLift fit
Not every man needs tissue removal. In fact, two less invasive methods suit some smaller glands, especially when keeping ejaculation matters most.
Treatment | How it works | Suits | Ejaculation | Retreatment by 5 years |
HoLEP | Laser removes the inner prostate | Any size | Dry in about 3 in 4 | About 1 to 2% |
TURP | Wire loop shaves a channel | 30 to 80 ml | Dry in half or more | About 5 to 6% |
Rezum | Water vapour shrinks tissue over months | 30 to 80 ml, no large middle lobe | Usually preserved | About 4.4% |
UroLift | Small implants hold the lobes apart | Under 80 ml, no middle lobe | Preserved | About 13.6% |
TURP vs UroLift
UroLift places small implants that pull the prostate lobes apart, like tiebacks on a curtain. Because no tissue comes out, ejaculation stays and recovery is quick. NICE supports it for selected men with smaller glands.
On the other hand, the opening is narrower and less lasting than after TURP. So more men need a second procedure within 5 years. It also does not suit a middle lobe, and no tissue reaches the laboratory.
Rezum
Rezum uses steam to shrink the blocking tissue over 3 to 6 months, and it usually preserves ejaculation. However, the catheter stays a few days and the benefit arrives slowly, as our Rezum recovery timeline explains. The Rezum treatment page covers who suits it.
How to choose: questions for your urologist
A good decision combines tests with your own priorities. So bring these questions to the consultation.
How large is my prostate, and do I have a middle lobe?
Does my bladder still squeeze well, according to the flow test and residual urine?
How important is keeping ejaculation to me, now and in the future?
Do I take blood thinners, and can they be paused safely?
How many HoLEP or TURP operations does the surgeon perform each year?
What happens if symptoms return in 5 or 10 years?
Before any prostate surgery, a PSA test also screens for cancer. If the PSA is raised, the urologist may advise an MRI and a targeted biopsy first. Removing benign tissue does not treat prostate cancer.
Planning surgery from the US, Canada or the UK
Both operations are planned procedures, so you can organise the trip calmly. Typically, men having HoLEP stay in Istanbul for about 4 to 5 days. That covers the tests, the operation, catheter removal and a check that you pass urine well.
Bring recent PSA results, ultrasound reports and a list of your medicines. Also ask your doctor at home how to pause any blood thinners. During the flight home, drink water, walk the aisle and choose an aisle seat.
The HoLEP surgery page explains the stay with Assoc. Prof. Taş step by step, including candidacy and tests.
When to see a urologist
See a urologist if a weak stream, night-time trips or urgency disturb your sleep or work. Likewise, do not wait if tablets no longer help or cause side effects.
Some signs need prompt care. These include retention, blood in the urine and repeated infections. Bladder stones and a fever with urinary symptoms also count.
In particular, blood in the urine always needs a check of the bladder too.
To plan an assessment in person, book a consultation with Assoc. Prof. Taş or message the team on WhatsApp. After the consultation, patients from the US, Canada and the UK receive a personal plan and quote. Then the coordinator arranges the days in Istanbul.
Frequently asked questions
Is HoLEP better than TURP?
Neither is better for every man. For a prostate under about 80 ml, both relieve the blockage well. For a larger gland, HoLEP removes more tissue and rarely needs repeating, so it usually has the edge.
Which has a faster recovery, HoLEP or TURP?
HoLEP usually has a slightly faster start, with about one day of catheter and one night in hospital. After TURP, the catheter often stays 1 to 3 days and the stay is 1 to 2 nights. Full healing inside takes several weeks after both.
Does HoLEP or TURP cause erectile dysfunction?
Usually not. Erections tend to stay the same after both operations. The common change is dry orgasm, in which semen flows into the bladder instead of out.
Is dry orgasm more common after HoLEP than after TURP?
Yes, slightly. About 3 in 4 men have a dry orgasm after HoLEP, compared with about half or more after TURP. The feeling of orgasm itself stays after both.
Can I have HoLEP if I had TURP before?
Yes. Regrowth after an earlier TURP is a common reason for HoLEP. The laser follows the same natural plane inside the prostate, so earlier surgery does not usually prevent it.
How does TURP compare with UroLift?
TURP removes tissue, so the opening is wider and lasts longer. UroLift places small implants that hold the lobes apart without removing tissue. It protects ejaculation in smaller glands, but more men need another procedure within 5 years.
Is HoLEP safe if I take blood thinners?
Often yes, because the laser seals vessels as it works. Even so, any change to blood thinners needs a plan agreed with your cardiologist or family doctor before surgery.
Sources
About the reviewer
Assoc. Prof. Dr. Tuncay Taş is a urologist in Istanbul with more than 20 years of experience and patients from over 60 countries.
He graduated from Istanbul University in 2004 and trained at Taksim Training and Research Hospital. Then he completed a uro-oncology and laparoscopy fellowship at Heidelberg University, and he belongs to the EAU and the Endourological Society. Read his full profile.
Comments