Dr. CARLO A. 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 HoLEP Surgery?
Holmium Laser Enucleation of the Prostate (HoLEP) shares many similarities with Transurethral Resection of the Prostate (TURP), including indications and minimally invasive nature. Like TURP, the procedure is performed without any external incisions. A thin, tube-like instrument (called a scope) is inserted through the urethra via the penis to access the prostate.
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However, unlike TURP—which removes prostatic tissue piece by piece—HoLEP uses a precise laser to enucleate the overgrown inner portion of the prostate in a single, continuous section. This relieves pressure on the urethra while preserving the outer part of the prostate.
​​A helpful way to picture this is like scooping out the fruit of an orange while leaving the peel behind. Once the tissue is removed, a special device called a morcellator breaks it into small pieces—similar to a tiny food processor—and suctions it out from the bladder.
​​Because the dissection in HoLEP follows the natural anatomical plane between the inner and outer zones of the prostate, the size of the prostate is less of a limiting factor. As a result, while HoLEP remains highly effective for small to mid-size (30–80 cc) prostates, it can be effectively used for larger prostates (>80 cc), which were traditionally managed with open surgery due to being unsuitable for TURP.
Which option is the best one for me?
Choosing between TURP and HoLEP 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 HoLEP 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. HoLEP, 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.
