HoLEP is not the only surgical treatment for benign prostatic hyperplasia. The main alternatives each have a role in the right patient. This page compares them at a glance and links to a short summary of each.
| Procedure | How it works | Typical gland size | Ejaculation preserved? | Durability | Notes vs HoLEP |
|---|---|---|---|---|---|
| HoLEP (reference) | Transurethral laser enucleation of whole lobes. | Any size, including giant glands. | No (retrograde ejaculation in most men). | High - approximately 95% free of reoperation at 10 years.8 | Reference. |
| TURP | Electrosurgical shaving of the prostate from the lumen. | Up to about 80 g. | No. | Good, but higher retreatment than HoLEP at 10 years.17 | Higher bleeding rate and hospital stay than HoLEP.9 |
| UroLift | Small implants pin the lateral lobes open. | Under 80 cc, no median lobe in original indication. | Yes (usually). | Moderate - higher retreatment rate than HoLEP over 5-10 years. | No tissue removed; less symptom relief for severe obstruction. |
| Rezum | Steam ablation of prostate tissue. | 30-80 cc, limited with large median lobe. | Often (70-80%). | Moderate at 5 years; long-term data still accruing. | Less complete tissue removal than HoLEP; not for very large glands. |
| iTind | Temporary implant reshapes bladder neck and prostatic urethra over 5-7 days. | Small to medium, no middle lobe. | Yes (most men). | Emerging - follow-up out to several years with retreatment rate under 10% in published series. | Device-led procedure; Dr Kooner is the highest-volume iTind implanter in Australasia. |
| Aquablation | Robotic high-pressure saline ablation. | 30-150 cc. | Often. | Good at 5 years; longer-term data less mature than HoLEP. | Capital-intensive; not universally available in Sydney. |
| Open simple prostatectomy | Open abdominal operation to shell the adenoma out by hand. | Very large / giant prostates (historical). | No. | Good. | Largely replaced by HoLEP; more bleeding, longer stay, abdominal wound.4, 5 |
Transurethral resection of the prostate - the traditional "gold standard".
Prostatic urethral lift with small permanent implants.
Water-vapour (steam) thermal therapy.
Temporary implant; device-led 5-7 day reshape.
Robotic saline ablation of prostate tissue.
Historical operation for very large glands.
You can ask for a second opinion on your symptoms, flow studies and prostate size before deciding between medication, HoLEP, GreenLight, TURP, UroLift, Rezum or iTind.