HoLEP vs TURP

Two operations, one goal

Both TURP and HoLEP are done through the urethra. Both remove obstructing prostate tissue. The goal in each case is a wider outlet and an easier urine stream.

They differ in how they do it. TURP shaves tissue into small chips with a wire loop. HoLEP uses a laser to peel whole lobes away from the capsule.

Your surgeon, your gland, and your circumstances all shape which is offered.

Symptom relief

Both operations improve the IPSS score and the peak flow. Many men feel the change within the first weeks.

Long-term symptom relief is durable with either technique. The amount of tissue removed tends to be larger with HoLEP, which can matter for very large glands.

Bleeding and transfusion

The holmium laser seals small vessels as it cuts. That sealing effect keeps bleeding low during HoLEP.

TURP uses electrical current to cut. Bleeding tends to be higher than with HoLEP, especially in larger prostates or men on blood thinners.

Transfusion is uncommon after either operation. It is less common after HoLEP in the published comparisons[¹].

Catheter time and hospital stay

Catheter time after HoLEP is often a day, sometimes two. Hospital stay can be as short as a same-day discharge in selected cases.

TURP catheter time is usually two to three days. Hospital stay is often slightly longer.

These differences matter for men who want to return home quickly.

Durability and re-operation

A 2024 meta-analysis of 13 randomised controlled trials directly comparing HoLEP and TURP reported broadly similar symptom relief at one year, with HoLEP showing slightly better IPSS at twelve months and lower postvoid residual at six and twelve months[¹]. Long-term comparative durability is less well characterised. Most randomised trials follow men for two years or less.

A separate 2026 systematic review found lower rates of bladder-neck contracture after laser enucleation than after classic TURP, along with lower re-operation for contracture over follow-up[²]. Bladder-neck contracture is one of the main reasons men return after TURP, and its lower rate after HoLEP contributes to the technique's durability.

Ejaculation, continence, and erections

Retrograde ejaculation — semen going backward rather than out — is common after both operations. It is not considered physically harmful, and sensation is usually unchanged.

Temporary stress leaks happen in a small minority after either technique. They tend to ease within weeks, and pelvic-floor exercises speed recovery.

Erectile function usually does not change after either operation. New erectile problems can occur but are uncommon.

What your surgeon's training means

TURP has been taught for decades and is available in many urology centres worldwide. HoLEP has a steeper learning curve and is more concentrated in high-volume centres.

Experienced hands matter for either technique. Published outcome figures typically come from centres with high case volumes, and results elsewhere can vary with operator experience.

When TURP is the right choice

TURP remains a sensible option for medium-sized glands in centres where HoLEP is not available. It is a well-understood operation with a large evidence base.

Men whose anatomy or comorbidities rule out a longer anaesthetic for laser enucleation may still be candidates for a brief TURP.

When HoLEP pulls ahead

Very large glands, men on blood thinners, men in retention with a catheter, and men who value short stay and low bleeding often do better with HoLEP. The technique scales across small and very large glands without a dramatic change in approach.

Plain bottom line

TURP and HoLEP both deliver durable symptom relief. HoLEP tends to offer lower bleeding, shorter catheter time, a shorter stay, and less contracture over time.

The right technique for you depends on your gland, your circumstances, and your surgeon's training.