Dr. CARLO BRAVI Urologist and Andrologist
Prostate Reduction Surgery
Dr. Bravi specializes in advanced surgical treatments for relieving symptoms of prostate enlargement (benign prostatic hyperplasia – BPH). When medications are no longer effective or when symptoms significantly affect quality of life, surgical prostate reduction can provide long-lasting relief.
This page highlights two highly effective, minimally invasive procedures performed by Dr Bravi:
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Holmium Laser Enucleation of the Prostate (HoLEP)
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Transurethral Resection of the Prostate (TURP)
Both procedures relieve urinary symptoms by removing or reducing excess prostate tissue that is blocking the flow of urine. Both HoLEP and TURP are endoscopic procedures performed through the urethra, with no external incisions. After either procedure, hospital stay is generally 1 to 2 nights, and most patients can return to normal daily activities within 1 to 2 weeks, depending on the surgery and individual healing.
What is TURP Surgery?
TURP (Transurethral Resection of the Prostate) is a common surgical treatment for benign prostatic hyperplasia (BPH)—a condition where the prostate becomes enlarged and squeezes the urethra, making it difficult to urinate.
The procedure is done without any external incisions. A thin instrument called a resectoscope is inserted through the penis to access the prostate. Using a small electric loop, the overgrown prostate tissue is shaved away piece-by-piece to relieve the pressure on the urethra and to create a channel.
The removed tissue is flushed into the bladder and then washed out at the end of the procedure. Transurethral Resection of the Prostate (TURP) has been used successfully for many years and remains a widely trusted and effective treatment for benign prostatic hyperplasia (BPH).
It is considered the gold standard for managing small to medium-sized prostates (30–80 cc) and serves as the benchmark against which new BPH interventions are evaluated in prospective clinical trials.
What is Aquablation Surgery?
Aquablation is a minimally invasive surgical procedure used to treat an enlarged prostate (benign prostatic hyperplasia, or BPH). Like Transurethral Resection of the Prostate (TURP) and Holmium Laser Enucleation of the Prostate (HoLEP), it is performed without any external incisions. ​​During the procedure, a thin telescope-like instrument (called a scope) is passed through the urethra (the tube that carries urine through the penis) to reach the prostate.
Unlike traditional procedures that use heat or a laser to remove prostate tissue, Aquablation uses a high-pressure, heat-free jet of sterile water to precisely remove the enlarged prostate tissue causing the blockage. The treatment is guided by real-time ultrasound imaging and robotic technology, allowing the surgeon to create a personalised treatment plan while preserving important surrounding structures.
By removing the tissue that is obstructing the flow of urine, Aquablation relieves urinary symptoms while reducing the risk of damage to surrounding tissues. It is particularly beneficial for men with larger prostates and for those wishing to preserve sexual function, including ejaculation, where appropriate.
Which option is the best one for me?
Choosing between TURP and Aquablation depends on several individual factors, including prostate size, medical history, and personal preferences. For prostates in the 30 to 80 cc range, both TURP and Aquablation are effective and widely accepted treatment options, offering comparable outcomes in symptom relief and improvement of urinary flow.
TURP is a well-established and trusted procedure with a long history of success. Aquablation, while newer, is equally effective within this size range – at the same time, it may offer additional advantages such as reduced bleeding and suitability for patients with prostates larger than 80 cc, sizes that were considered less suitable for TURP.
Ultimately, the best option for you will depend on your specific clinical circumstances and overall health. It’s important to discuss these considerations with your urologist, who can guide you to the most appropriate treatment based on your individual needs.
