There is no single best operation for every enlarged prostate. TURP (transurethral resection of the prostate) remains effective and well-established. Laser procedures such as HoLEP offer specific advantages in certain circumstances. The right choice depends on prostate size, bladder function, medications, sexual priorities and surgeon expertise.
There is no single “best” operation for every enlarged prostate. The useful comparison is not simply laser versus traditional—it is which technique best matches the prostate, symptoms, bladder function, medicines and sexual priorities.
What traditional surgery usually means
TURP removes obstructing tissue through the urethra using an electrical loop. It remains an established and effective treatment, particularly for appropriately sized prostates.
What laser surgery can mean
Laser is an umbrella term. HoLEP and similar enucleation procedures separate the obstructing tissue from the prostate capsule; photoselective vaporisation vaporises tissue. Their benefits and side-effect profiles are not identical.
Benign prostatic hyperplasia (BPH) affects around 50% of men over 50 and up to 90% of men in their eighties. Surgery is considered when medication is ineffective, not tolerated, or when there are complications such as urinary retention.
How options can differ
- Suitable prostate size and anatomy
- Bleeding and transfusion risk
- Time with catheter and in hospital
- Likelihood of needing retreatment
- Risk of retrograde ejaculation
- Temporary urgency or burning
- Risk of urethral stricture or bladder-neck contracture
- Availability of experienced surgeons
What about Aquablation, Rezūm and other treatments?
Newer treatments may preserve ejaculation more often or offer shorter recovery for selected men, but may have limits based on prostate size, median lobe, urinary retention and desired durability. Marketing terms should not replace a full evaluation.
Sexual side effects deserve an explicit discussion
Many tissue-removing operations commonly cause dry or retrograde ejaculation. Erectile dysfunction is less common but possible. Men should be asked what matters to them rather than assuming that urinary relief is the only outcome.
Questions that lead to a better decision
- What is my prostate volume and anatomy?
- Is my bladder muscle still functioning well?
- What is the expected chance of stopping medication or catheter use?
- How will ejaculation and erections be affected?
- What are your retreatment and complication rates for this exact procedure?
Frequently asked questions
No. Both can be excellent when appropriately selected and expertly performed.
Enucleation procedures or simple prostatectomy may be considered, depending on anatomy, availability and expertise.
Some minimally invasive options have higher ejaculation-preservation rates, but suitability and durability vary.
Temporary urgency or leakage can occur; persistent stress incontinence is uncommon but possible, with risk varying by procedure and patient.
Removing benign tissue often lowers PSA, but ongoing prostate-cancer risk assessment may still be needed.
Speak to Mr Torath Ameen
If you have concerns about urological symptoms or would like an expert opinion, book a consultation at our London or Hertfordshire clinics.
This article is intended for general patient education only. It does not constitute medical advice and may not apply to every individual's circumstances. Clinical decisions should always be made in consultation with a qualified healthcare professional. If you are concerned about your health, please seek prompt medical assessment.