Very minimal risk of impotence from TURP. Radical prostatectomy (where they remove the outer portion of the prostate where most cancers originate but also contains sensitive nerve bundles and blood vessels) is where there is more significant risk for problems. I didn’t realize the difference between the two, otherwise I would have done TURP a long time ago.
BTW, before TURP I had a HORRIBLE experience with the steam injection treatment (called Rezum). Four months of pain (whereas before I had no pain, just obstruction), even worse urinary symptoms, and finally back to baseline with zero improvement.
I had a TURP in 2020 but unfortunately my prostate issues have since returned. I’ve just been prescribed finasteride and tamsulosin in the hope of avoiding another surgery.
FWIW: I had " Green Light Laser Therapy" more than 25 years ago and haven’t had to see a urologist since the procedure. I experienced minimal side effects. The procedure was done outpatient. GreenLight laser therapy is a minimally invasive surgical procedure that uses a high-powered laser to vaporize and remove excess prostate tissue that is blocking the flow of urine. The treatment is used to relieve the symptoms of benign prostatic hyperplasia (BPH), or enlarged prostate.
How the procedure works
During the GreenLight procedure, a urologist inserts a thin, flexible fiber-optic scope through the urethra to access the prostate. A laser fiber is then passed through the scope to deliver the laser energy, which rapidly heats and vaporizes the obstructive prostate tissue.
Anesthesia: You will typically be given a general or spinal anesthetic for the procedure.
Minimal bleeding: The high-energy laser instantly cauterizes the tissue as it is vaporized, resulting in minimal blood loss. This makes it a suitable option for men who take blood-thinning medication.
Outpatient: Many patients are able to go home the same day and do not require an overnight hospital stay.
Catheter: You will have a catheter inserted to drain your bladder, which is usually removed within 24 hours.
Benefits of GreenLight laser therapy
GreenLight is often compared to the traditional surgical treatment, transurethral resection of the prostate (TURP), and offers several advantages:
Rapid relief: Most patients notice a significant improvement in urinary symptoms within 24 hours.
Reduced complications: There is a lower risk of bleeding, infection, and erectile dysfunction compared to traditional surgery.
Faster recovery: Recovery time is typically shorter, with most patients resuming normal activities within a few days and more strenuous exercise within two weeks.
Suitable for higher-risk patients: The low risk of bleeding makes it a safe option for those on anticoagulants or with heart pacemakers.
Risks and side effects
As with any surgical procedure, there are potential side effects and risks:
Irritative urinary symptoms: In the weeks following the procedure, it is common to experience frequent or urgent urination, a burning sensation, or bladder spasms. These issues usually resolve as the prostate heals.
Blood in the urine: It is common to see a small amount of blood in the urine in the initial days or weeks after surgery. This is expected and typically resolves with increased fluid intake.
Outpatient: A common side effect is retrograde ejaculation, where semen enters the bladder instead of exiting through the penis during orgasm. This does not affect orgasm sensation but does cause “dry orgasms” and impacts fertility.
Other risks: Rare complications can include urinary tract infections, severe bleeding, and the formation of scar tissue in the urethra.
GreenLight vs. TURP
While TURP was long considered the gold standard, GreenLight laser therapy offers comparable long-term results with a better short-term side effect profile. A key difference is that GreenLight removes tissue through vaporization, while TURP removes it as small shavings. This means that a tissue sample for cancer screening is generally available with a TURP, but not with GreenLight. The best option depends on your specific health condition, the size of your prostate, and a discussion with your urologist.
No, “GreenLight and HOLEP are not the same; they are two different laser procedures for treating benign prostatic hyperplasia (BPH), or enlarged prostate. The main difference is that GreenLight vaporizes excess prostate tissue, while HOLEP removes it in a single piece, offering greater durability.”
It appears that HOLEP might be superior for most people. The main downside is the longer recovery time.
How the procedures differ
Feature
GreenLight (PVP)
HOLEP
Laser type
Uses a KTP (potassium titanyl phosphate) laser that emits a green light.
Uses a Holmium laser.
Method
Aims to vaporize, or melt away, excess prostate tissue using a laser.
Aims to enucleate, or core out, the obstructing prostate tissue in a single piece, similar to peeling an orange. The tissue is then removed with a separate instrument called a morcellator.
Tissue removed
The vaporized tissue is completely destroyed, which means it cannot be collected for analysis.
The removed tissue can be sent to a lab for pathology analysis, which can detect potential cancer cells.
Prostate size
Recommended for small to moderately enlarged prostates.
Suitable for any size prostate, including very large ones.
Durability
Offers durable results for many, but re-treatment may be needed over time as some tissue can regrow.
Provides highly durable, long-lasting relief with very low re-treatment rates.
Bleeding risk
Has a lower risk of bleeding, making it a good option for patients on blood thinners.
Involves a slightly higher risk of bleeding, but is still considered a safe option for patients on blood thinners.
Recovery
Often involves a shorter hospital stay, with a quicker return to normal activity.
Offers a relatively quick recovery, with most men resuming normal activities within a couple of weeks.
Bladder stones
Primarily targets prostate tissue.
Bladder stones can be removed during the same procedure.
Which treatment is right for you?
The best procedure depends on your specific condition, including the size of your prostate, your symptoms, and your overall health.
GreenLight may be a good choice for men with a smaller prostate who prioritize a faster, simpler procedure with less bleeding.
HOLEP is generally preferred for men with larger prostates or those seeking the most durable, long-term solution.
You should discuss these and other options with your urologist to determine the most appropriate treatment plan.
I am interested in the UroLift procedure. My urologist does them and says they are a good choice for certain patients. (I’m not at a point yet were i need any procedure but likely will need one soon). There is also a newer procedure, Aquablation, which looks encouraging.
sudiki, I’ve heard about the UroLift procedure for years, but still don’t know any doctor locally that does it. Other than leaving behind some implants that are not generally removable it just seems to be the least complicated method. However, what if a TURP, green light, or HOLEP was needed in the future? Those implants could be a big problem!
Unless you’re paying for it yourself, you may be limited by what procedures your insurance will pay for.
Have you considered Rezūm Water Vapor Therapy?
"is a minimally invasive treatment for benign prostatic hyperplasia (BPH), or enlarged prostate, that uses sterile steam to shrink excess prostate tissue. Performed in a doctor’s office or outpatient setting, the procedure helps relieve urinary symptoms with minimal risk to sexual function.
How it works
The Rezūm procedure is typically performed with local anesthesia and takes less than 30 minutes.
A urologist inserts a slender device with a small camera through the urethra until it reaches the prostate.
A tiny needle on the device delivers nine-second, targeted injections of heated water vapor into the obstructive prostate tissue.
The steam condenses, releasing the energy stored in the water to destroy the excess prostate cells.
Over time, the body’s natural healing response absorbs the treated tissue, causing the prostate to shrink.
Benefits
Minimally invasive: The procedure requires no incisions and can be done under local anesthesia, eliminating the need for a hospital stay.
Preserves sexual function: Clinical studies show that Rezūm has a low risk of sexual side effects, including erectile and ejaculatory dysfunction, which are common risks associated with other BPH procedures.
Lasting relief: Studies have shown that the relief from symptoms can last for five years or more for the majority of patients.
Symptom improvement: Patients typically experience noticeable improvement within two weeks, with the maximum benefit seen around three months after the procedure.
Quick recovery: Most patients can return to normal, non-strenuous activities within a few days.
Potential side effects
While most side effects are mild and temporary, they can include:
Painful or frequent urination
Blood in the urine or semen
A decrease in ejaculatory volume
Urinary tract infection (UTI)
Temporary inability to urinate or empty the bladder completely, which may require a catheter for a few days.
Who is a candidate?
Rezum therapy is approved for men aged 50 and older who have symptomatic BPH. It is an effective option for men who:
Are dissatisfied with or wish to stop taking BPH medications.
Prefer to avoid major surgery.
Want to preserve their sexual and ejaculatory function.
Have a prostate volume generally between 30 and 80 cubic centimeters.
Rezum is typically not recommended for men with very large prostates (over 80 grams), advanced kidney disease, or certain prostate implants."
Rezum was an absolute nightmare for me. I was in pain for months, had to be re-catherized after they took out the original catheter, and it did absolutely nothing for my symptoms even after I finally healed from it after 3 months. I eventually had TURP, which worked (so far), but I wish I’d known about HoLEP at the time because I’m sure that would have worked even better and been easier to recover from.
Maybe. There are risks with every procedure, and patient response is always going to be somewhat variable. Seemed like a reasonable idea at the time, a relatively simple in-office procedure vs “real” surgery. Being a relatively newer procedure, they probably don’t have much long-term data for Rezum i.e. steam treatment, but if the patient is eventually going to end up needing surgery anyway, might as well take the plunge now and get it done with HoLEP. I certainly wish I’d done that.
Peter Attia has a great interview with a urologist where he goes in depth about HoLEP, that came out about a month after I’d had my TURP. Late 2023 I think it was.
I think the laser surgery is good. I had mine around the year 2000 and as I said, I haven’t visited a urologist since. The HoLEP procedure was not on offer when I had mine done.
"2008–2014: Studies show that while HoLEP volume and regional adoption increased in the U.S., it still only accounted for about 4% of BPH procedures by 2014.
“2020s: With significant advancements in laser and morcellator technology, HoLEP’s efficiency improved, leading to a surge in interest and availability. It is now considered a size-independent gold standard for BPH treatment and is endorsed by major urological guidelines.”