Which Is Better for an Enlarged Prostate in 2025: HOLEP or TURP?

Enlarged prostate (Benign Prostatic Hyperplasia or BPH) is extremely common in men above 50. It causes symptoms like weak urine flow, frequent night-time urination, burning, urgency, and a constant feeling of not emptying the bladder fully. For decades, TURP was the gold-standard surgery for BPH. But in the last 10–12 years, a newer laser-based treatment — HOLEP — has become increasingly popular.

This guide explains the differences in simple language so you can understand which option may be right for you.

1. TURP: The Traditional Approach

TURP is performed through the urinary passage using an electrical cutting loop. It removes small pieces of the enlarged prostate to improve urine flow.

Benefits of TURP

● Trusted procedure used for over 50 years
● Good relief in symptoms
● Works well for small to medium-sized prostates
● Available at most hospitals

Limitations of TURP

● More bleeding compared to laser procedures
● Risk of TUR syndrome (a rare fluid imbalance)
● Longer catheter and hospital stay
● Removes the gland in pieces, not fully
● Higher chance of repeat surgeries in large prostates (>80–100 g)

2. HOLEP: The Modern Laser Option

HOLEP uses a Holmium laser to remove the entire block of enlarged tissue. The tissue is then taken out through a special device called a morcellator.

Benefits of HOLEP

● Very minimal bleeding
● Works safely for any prostate size — even very large ones (100–300 g)
● Shorter catheter time (usually <2 days)
● Faster recovery and quick return to routine
● Lowest chance of regrowth because the whole blocking tissue is removed
● Safe for patients on blood thinners
● Long-term durability similar to open surgery, without the large incision

Limitations of HOLEP

● Needs a highly trained surgeon and advanced equipment
● Availability varies by hospital and urologist experience

3. HOLEP vs TURP: A Quick Comparison

Feature	HOLEP	TURP
Bleeding	Minimal	Moderate
Prostate size	Any size	Small–medium
Catheter time	2–3 days	4–5 days
Hospital stay	2–3 days	4–5 days
Need for repeat surgery	Very low	Higher
Safe on blood thinners	Yes	Usually not
TUR syndrome	None	Possible
Recovery	Fast	Moderate
Sexual function	Generally preserved	Similar outcomes
Cost	Slightly higher	Lower

4. Is HOLEP Better Than TURP in 2025?

For most patients — yes, HOLEP is a strong option. It is particularly recommended if you have:

A large prostate (>80 g)
Repeated urinary retention episodes
Failed medical treatment
Heart history or are on blood thinners
Frequent urinary infections due to blockage
Poor urine flow despite medications
Previous prostate surgery with recurrence

HOLEP is the only endoscopic surgery that completely removes the blocking tissue, similar to open surgery — but with minimal blood loss.

5. What About Sexual Function?

Both HOLEP and TURP can cause retrograde ejaculation (semen flowing backward into the bladder). This is common in most BPH surgeries. However:

Erectile function is usually preserved
HOLEP in experienced hands has very low risk of incontinence
Most men feel their quality of life improves due to better urinary flow

6. Which Surgery Is Safer for Elderly Patients?

For men aged 65–80+, especially those with diabetes, high BP or heart problems:

HOLEP is safer due to minimal blood loss
Can be done without stopping blood thinners
Quicker recovery reduces hospital-related risks

This makes HOLEP the preferred option for older patients.

7. Recovery: What to Expect After Each Surgery

After HOLEP

Catheter removed in 2–3 days
Mild burning for 5–7 days
Light activities from the next day
Return to work in 5–7 days
Urine flow improves significantly once the catheter is removed

After TURP

Catheter stays for 4–5 days
Burning for 7–14 days
Routine activities in 1–2 weeks
Flow improvement may vary depending on how much tissue was removed

8. Cost Comparison (Mumbai Perspective)

Costs vary by hospital category, technology, and prostate size. Although HOLEP costs slightly more upfront, it becomes more economical over time because:

Shorter hospital stay
Minimal complications
Very low chance of needing repeat surgeries
Eliminates need for open surgery in large prostates

9. How to Decide Which Surgery Is Right for You

Consider the following:

Your age
Prostate size
Other medical conditions
Whether you’re on blood thinners
How quickly you want to recover
Experience of the surgeon
Long-term durability of the result

In simple terms:

For medium–large prostates, faster recovery, or blood thinner use → HOLEP wins
For smaller prostates and lower cost → TURP works well

10. Conclusion: Why HOLEP Leads in 2025

Across India and globally, HOLEP is now considered the new gold standard — especially for moderate to large prostates. It matches or outperforms TURP in every key aspect:

Safety
Bleeding
Recovery
Long-term durability

As more hospitals adopt this technology, HOLEP is expected to replace TURP in most major centres.

Frequently Asked Questions

1. Is HOLEP painful?

No. It is performed under anaesthesia. Mild burning can occur for a few days afterward.

2. Will HOLEP affect my sexual function?

Erections are usually unaffected. Retrograde ejaculation may happen — the same risk exists with TURP.

3. Can HOLEP treat very large prostates?

Yes. Even prostates 150–300 g can be safely treated.

4. Is HOLEP safe for heart patients?

Yes. It is one of the safest options for men on blood thinners.

5. How long do results last?

Because the entire blocking tissue is removed, HOLEP offers long-lasting relief with almost no repeat
surgeries needed.