Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 6 June 2026
For men in Melbourne weighing up surgery for an enlarged prostate (BPH), the two procedures most often discussed are HoLEP (Holmium Laser Enucleation of the Prostate) and TURP (Transurethral Resection of the Prostate). TURP has been the historical gold standard for over 50 years. HoLEP is the modern laser equivalent and, for most men, the better long-term operation — particularly for larger glands, men on blood thinners, and those who want a shorter catheter time.
This guide compares HoLEP and TURP head-to-head: how each works, recovery times, bleeding risk, hospital stay, sexual side effects, and durability of results. For a step-by-step look at laser BPH surgery, see our HoLEP procedure page.
What Is TURP?
TURP uses an electrified wire loop passed through a resectoscope (a telescope inserted via the urethra) to shave the obstructing inner prostate tissue away in small chips. The chips are then washed out of the bladder. Modern TURP is usually performed using bipolar energy in saline irrigation (safer than the older monopolar technique). TURP remains a very effective operation in prostates up to around 60–80 grams.
What Is HoLEP?
HoLEP (Holmium Laser Enucleation of the Prostate) uses a high-powered holmium laser to dissect the entire obstructing adenoma (inner prostate) away from the surgical capsule — endoscopically replicating what an open or robotic simple prostatectomy achieves. The enucleated tissue is pushed into the bladder and removed with a morcellator. Because the laser seals blood vessels as it cuts, bleeding is minimal and HoLEP can be performed safely on virtually any prostate size and in men on blood thinners.
HoLEP vs TURP — Side-by-Side Comparison
| Factor | TURP | HoLEP |
|---|---|---|
| Energy source | Electrocautery (loop) | Holmium laser |
| Prostate size limit | Best up to ~60–80 g | No upper size limit |
| Tissue removed | Chips — partial | Whole adenoma — complete |
| Blood loss | Moderate | Very low |
| Safe on blood thinners | Usually requires stopping | Yes — can continue |
| Catheter time | 2–3 days | ~24 hours (often same day) |
| Hospital stay | 1–3 nights | Day case or 1 night |
| Re-treatment at 5–10 yrs | ~10–15% | ~1–5% |
| TURP syndrome risk | Rare with bipolar; possible with monopolar | None (saline irrigation) |
| Retrograde ejaculation | ~65–75% | ~60–75% |
Recovery — What to Expect
After TURP, men typically stay 1–3 nights in hospital with continuous bladder irrigation while the prostate bed heals. The catheter comes out at day 2–3, and most men resume light activity within 1–2 weeks. Mild blood in the urine and urinary urgency are common for several weeks. Our catheter care guide covers daily bag emptying, leg-strapping tips, and red-flag symptoms to watch for.
After HoLEP, most men are discharged either the same day or the next morning, with the catheter removed at around 24 hours. Light activities can usually resume within a few days, and full recovery takes 2–4 weeks. Urinary urgency and occasional stress incontinence settle over the first 4–8 weeks as the prostate bed re-lines with bladder mucosa. See our detailed HoLEP recovery guide for the full timeline, and our catheter care guide for practical tips on managing a urinary catheter at home.
Long-Term Outcomes
The strongest argument for HoLEP over TURP is durability. Because HoLEP removes the entire obstructing adenoma rather than chipping at it, regrowth requiring repeat surgery is uncommon. Randomised trials and long-term registries consistently show:
- Equivalent or superior peak urinary flow rates and IPSS symptom scores at 12 months
- Lower re-treatment rates at 5 and 10 years (HoLEP ~1–5% vs TURP ~10–15%)
- Lower transfusion rates with HoLEP
- Shorter catheter time and hospital stay with HoLEP
Who Is Each Procedure Best Suited To?
TURP is reasonable when:
- The prostate is small to moderate (under ~60–80 g)
- HoLEP is not available locally
- The patient is not on blood thinners and is fit for a 1–2 night hospital stay
HoLEP is the preferred option when:
- The prostate is larger than ~60–80 g (no upper size limit)
- The patient is on warfarin, clopidogrel, apixaban or other anticoagulants
- A short catheter time and day-case discharge is important
- The patient is in urinary retention and wants the most durable result
- A previous TURP has regrown
For men who specifically want to preserve forward ejaculation, Dr Dias also offers ejaculation-sparing HoLEP. For very large prostates above 200 g, see our comparison of HoLEP vs robotic simple prostatectomy.
Frequently Asked Questions
What is the main difference between HoLEP and TURP?
TURP removes obstructing prostate tissue in small chips using an electrified loop, leaving the outer capsule behind. HoLEP uses a holmium laser to enucleate the entire inner adenoma in one piece (much like the robotic open approach, but endoscopically). HoLEP is size-independent and removes more tissue more completely, with less bleeding and a shorter catheter time.
Is HoLEP better than TURP in Melbourne?
For most men with bothersome BPH — and especially for larger prostates over 60–80 grams, men on blood thinners, or those in urinary retention — HoLEP offers better long-term outcomes than TURP: superior flow rates, lower re-treatment rates at 5–10 years, less bleeding and shorter catheter time. TURP remains an excellent option in smaller prostates when HoLEP is not available.
How long is the catheter in after HoLEP vs TURP?
After TURP, the catheter is typically removed at 2–3 days. After HoLEP, most men have the catheter removed at 24 hours (often the morning after surgery) — many are discharged the same day as a day case. For practical advice on catheter management at home, see our catheter care guide.
Which procedure has a lower risk of needing repeat surgery?
Long-term studies consistently show HoLEP has lower re-treatment rates than TURP at 5 and 10 years. Because HoLEP removes the entire adenoma rather than chipping at it, regrowth requiring repeat surgery is uncommon.
What is TURP syndrome and does HoLEP have the same risk?
TURP syndrome is a rare but serious dilutional hyponatraemia caused by absorption of the hypotonic irrigation fluid used in monopolar TURP. HoLEP uses normal saline irrigation, so TURP syndrome cannot occur with HoLEP. Modern bipolar TURP also uses saline and largely avoids this complication.
Will I have retrograde ejaculation after HoLEP or TURP?
Retrograde ('dry') ejaculation occurs in roughly 60–75% of men after both standard TURP and HoLEP. If preserving forward ejaculation matters to you, Dr Dias also offers ejaculation-sparing HoLEP, which preserves antegrade ejaculation in the majority of selected patients.
Can I have HoLEP if I am on blood thinners?
Yes — HoLEP is the recommended endoscopic prostate procedure for men on warfarin, clopidogrel, apixaban or other anticoagulants because the laser seals blood vessels as it cuts. TURP carries a much higher bleeding risk on these medications.
Related BPH Treatments in Melbourne
HoLEP and TURP are not the only options for enlarged prostate. Depending on your prostate size, symptoms, and lifestyle goals, Dr Dias also offers:
- Rezum water vapour therapy — a minimally invasive office-based treatment using sterile water vapour to shrink the prostate, ideal for men wanting to preserve sexual function and avoid surgery.
- UroLift — a implant system that holds the obstructing prostate lobes apart without cutting or heating tissue, preserving sexual function with rapid recovery.
- iTIND — a temporary implant that reshapes the prostate over 5–7 days, then is removed, leaving no permanent device behind.
- Ejaculation-sparing HoLEP — for men who want the durability of HoLEP with a high chance of preserving forward ejaculation.
About Dr Dias and HoLEP in Melbourne
Dr Brendan Dias is a Melbourne-based consultant urologist with subspecialty fellowship training in HoLEP and robotic prostate surgery. He offers HoLEP, ejaculation-sparing HoLEP and TURP across leading Melbourne hospitals, and will help you decide which operation best fits your prostate size, anaesthetic profile and lifestyle goals.
For a clear, unhurried discussion of HoLEP vs TURP for your situation, book a consultation with Dr Dias.