TURP vs HoLEP: Choosing Based on Prostate Size

TURP and HoLEP are two of the most effective surgical treatments for BPH. While both provide excellent outcomes, prostate size significantly influences which procedure is optimal. Understanding this relationship helps you have informed discussions with your surgeon.

First, calculate your prostate weight using our Weight Calculator to understand where you fall.

Overview of Each Procedure

TURP (Transurethral Resection of the Prostate)

• A wire loop shaves tissue from inside the prostate
• Done through the urethra (no external incisions)
• ~1 gram of tissue removed per minute
• The "gold standard" for 40+ years

HoLEP (Holmium Laser Enucleation of the Prostate)

• Holmium laser removes entire adenoma in one piece
• Also transurethral (no external incisions)
• Tissue morcellated (cut up) for removal
• Newer but increasingly preferred for large glands

Prostate Size Recommendations

Why Size Matters for TURP

Time Limitations

TURP becomes problematic beyond 60-90 minutes due to:

• TUR Syndrome Risk: Irrigation fluid absorption increases with time
• Blood Loss: Scales with resection volume
• Incomplete Resection: Surgeon may not remove all obstructing tissue

At ~1g/minute, a 100g prostate would require 90+ minutes of resection—pushing limits.

Staged Procedures

Very large prostates may require two TURP sessions (staged TURP), increasing:

• Total anesthesia exposure
• Hospital stays
• Time to symptom relief

Why HoLEP Handles Large Prostates

Size-Independent Efficiency

HoLEP enucleates the adenoma as a whole, regardless of size:

• 100g prostate: ~90 minutes
• 200g prostate: ~120 minutes (only 30 minutes more)

The technique scales better than resection.

Lower Blood Loss

Laser energy coagulates vessels as it cuts:

• Blood loss 50-70% less than TURP for equivalent sizes
• Lower transfusion rates
• Safer for patients on anticoagulation

Complete Removal

HoLEP removes nearly 100% of adenoma tissue:

• Lower retreatment rates (1-2% at 5 years vs. 5-10% for TURP)
• More durable symptom relief

Head-to-Head Comparison

Other Considerations

Anticoagulation

HoLEP's lower blood loss makes it preferred for men on blood thinners who cannot safely stop medication.

Surgeon Experience

HoLEP has a learning curve. An experienced TURP surgeon may achieve better results than a novice HoLEP surgeon.

Ejaculatory Function

Both procedures commonly cause retrograde ejaculation (75-90%). Alternative procedures (UroLift, Rezum) preserve ejaculatory function better.

Questions to Ask

1. What is my prostate weight?
2. Which procedure do you recommend and why?
3. How many HoLEP procedures have you performed?
4. What are the expected outcomes for my size?
5. Should I consider referral to a HoLEP specialist?

Key Takeaways

Calculate your prostate weight with our Weight Calculator to see which procedure range you fall into.