The main types of laser surgery
All laser operations are done through the urethra with a telescope, so there are no cuts on the skin. They differ in how the obstructing tissue is removed.
| Technique | How it works | Best suited to |
|---|---|---|
| HoLEP | A holmium laser separates the enlarged inner part of the prostate from its outer shell. The tissue is pushed into the bladder and removed with a morcellator. | Moderate to very large prostates; very durable |
| ThuLEP | A similar enucleation technique using a thulium laser. | Similar to HoLEP |
| GreenLight | A high powered laser vaporises the tissue layer by layer (photoselective vaporisation). | Small to medium prostates; some men who cannot stop blood thinning medication |
What to expect
Laser enucleation removes a large volume of tissue with little bleeding, which makes it well suited to very large prostates and gives long lasting results. Most men stay in hospital for one night and go home once the catheter is out.
Very common after HoLEP and ThuLEP
Dry orgasm (retrograde ejaculation)
Semen passes back into the bladder instead of out. Orgasm is still felt, but most men lose visible ejaculation after enucleation.
Common, temporary
Urgency and stinging
Frequency, urgency and discomfort passing urine for the first few weeks while the prostate heals.
Common early, usually settles
Leakage
Some men have stress leakage for the first weeks or months. Pelvic floor exercises help, and lasting leakage is uncommon.
Uncommon
Scarring
Narrowing of the urethra or bladder neck occurs in a small number of men and can be treated if it develops.
Results after laser surgery depend heavily on the surgeon's experience with the technique, particularly for HoLEP, which is why NICE advises it is performed in specialist centres.
Laser surgery compared with Aquablation
| Factor | HoLEP / ThuLEP | GreenLight | Aquablation |
|---|---|---|---|
| Prostate size | Any size | Small to medium | 30 to 150 ml |
| Ejaculation | Lost in most men | Often reduced | Best preserved of any surgical option |
| Live ultrasound and robotic execution | No | No | Yes |
| Hospital stay | Usually one night | Day case or one night | One to two nights |
| Catheter | 1 to 2 days | Often 1 day or less | 24 to 48 hours |
| Long term durability | Excellent | Retreatment more likely over time | Durable 5 year results |
Why Mr Ameen now favours Aquablation. For most men, Mr Ameen now favours Aquablation over laser treatments. Live ultrasound guidance and robotic execution give a precise, reproducible result, with the best preservation of ejaculation of any surgical option. He performs Aquablation at The Wellington Hospital and Spire Bushey. If laser surgery would suit you better, for example with an exceptionally large prostate, he will explain why and arrange the most appropriate treatment. Read the full Aquablation guide
Which operation suits you?
- If keeping normal ejaculation matters to you, Aquablation has the best record of any surgical option
- If your prostate is exceptionally large, above around 150 ml, HoLEP is often the better choice
- If you cannot safely stop blood thinning medication, GreenLight may be considered
- If you would prefer to avoid a general anaesthetic, Rezum steam therapy may be an option for smaller prostates
- If your symptoms are mild, medication may be enough for now
The size of your prostate, measured by ultrasound at your consultation, is one of the most important factors in this decision.
Frequently asked questions
For most men the symptom improvement is similar. HoLEP removes more tissue with less bleeding and suits larger prostates, while TURP remains a reliable standard for small and medium prostates.
After HoLEP or ThuLEP most men have a dry orgasm, with semen passing back into the bladder. Orgasm is still felt. If preserving ejaculation matters to you, Aquablation is usually the better choice.
Most men go home after one night, with the catheter out within a day or two. Light activity is fine after a week or so, with a return to most normal activities by 2 to 4 weeks.
GreenLight in particular can sometimes be performed without stopping blood thinning medication. This needs individual assessment, and you should never stop these medicines without advice.
For most men, Mr Ameen now favours Aquablation over laser treatments, because it combines live ultrasound guidance with robotic precision and preserves ejaculation better than any other surgical option. If laser surgery would suit you better, he will explain why and arrange the most appropriate treatment.