Laser surgery for the prostate uses light energy delivered through a cystoscope to relieve the obstruction from a benign prostatic enlargement. Different lasers do different things - some cut tissue out (enucleation), some vaporise it, some incise a tight bladder neck. Choosing between them depends on prostate size, bladder condition, blood-thinner status and symptom pattern.
Pick a laser technique below to read a dedicated patient-information page. All four are day-surgery or overnight procedures performed through the urethra with no external skin incision.
Holmium Laser Enucleation of the Prostate. The flagship procedure - size-agnostic, safe on blood thinners, with the best long-term durability data.
Photoselective vaporisation with the 532 nm KTP (GreenLight) laser. Excellent haemostasis in small-to-medium glands; higher retreatment rate than HoLEP long-term.
Holmium Laser Incision of the Bladder Neck. A short targeted procedure for a tight bladder neck in a small prostate or after previous BPH surgery.
Thulium fibre / Tm:YAG laser. Continuous-wave beam, very shallow depth of penetration. Used for enucleation (ThuLEP) as an alternative to HoLEP at selected centres.
| Laser | Wavelength | Action | Tissue sent to pathology? | Typical gland size | On anticoagulants? |
|---|---|---|---|---|---|
| HoLEP | Holmium:YAG, 2,100 nm (pulsed) | Enucleation of whole lobes. | Yes. | Any size, including giant glands. | Appropriate for most men on anticoagulants.1, 11, 12 |
| GreenLight | KTP, 532 nm (continuous) | Photoselective vaporisation. | No - tissue vaporised. | Small to medium (under about 80 cc). | Good bleeding control; used selectively on anticoagulants.21, 22 |
| HoLBNI | Holmium:YAG, 2,100 nm (pulsed) | One or two targeted incisions at the bladder neck. | Incidental biopsy only. | Small glands (often under 30 cc) with a tight bladder neck. | Usually yes - the laser coagulates as it cuts. |
| Thulium | Thulium:YAG 2,013 nm or thulium fibre 1,940 nm (continuous) | Enucleation (ThuLEP) or vapo-enucleation. | Yes. | Most sizes. | Selected centres report haemostasis similar to HoLEP. |
Non-laser options - TURP, UroLift, Rezum, iTind, aquablation and open prostatectomy - are summarised on the alternatives hub. A full reference list sits on the evidence page.
Very large and giant glands (over 100 cc) are almost always best served by HoLEP or thulium enucleation. Vaporisation lasers struggle to clear enough obstructing tissue at the top end of the size range.4, 5
Men on aspirin, clopidogrel, warfarin or a DOAC can usually have HoLEP or GreenLight with limited interruption to their medication. Classical TURP is often not considered in this setting.1, 11
A small prostate with a tight bladder neck can be opened with a targeted HoLBNI incision rather than a full enucleation. Previous prostate surgery with recurrent obstruction often responds to a repeat HoLEP.
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.