Is simple prostatectomy major surgery?

Yes. It is the most invasive of the BPH procedures, done under anesthesia with a hospital stay and a catheter, and it involves more bleeding and a longer recovery than endoscopic options like TURP or HoLEP. A robotic approach can reduce blood loss and shorten the stay compared with open surgery.

What is the difference between simple and radical prostatectomy?

Simple prostatectomy removes only the obstructing inner portion of an enlarged prostate to relieve BPH and leaves the outer shell. Radical prostatectomy removes the entire prostate to treat prostate cancer. They have different goals, risks, and recovery, so it is worth confirming which one applies to you.

Who is a candidate for simple prostatectomy?

It is generally for men with a very large prostate, often over about 80 to 100 grams, whose gland is too big for the usual endoscopic procedures to clear well, especially if bladder stones or a large diverticulum need fixing at the same time. For many large glands, a urologist first considers HoLEP.

Simple prostatectomy or HoLEP for a very large prostate?

Both work at any prostate size. HoLEP treats the gland through the urethra with no incision, usually less bleeding, and a shorter stay, so it is often preferred when an experienced surgeon is available. Simple prostatectomy is chosen for exceptionally large glands or when an endoscopic option is not a good fit.

What are the downsides of simple prostatectomy?

More blood loss with a possibility of transfusion, a longer hospital stay and catheter time, and the usual retrograde (dry) ejaculation. Other risks include infection, scarring over time, temporary urinary leakage while the bladder recovers, and the general risks of anesthesia and inpatient surgery.

How long does simple prostatectomy last?

It is one of the most durable BPH treatments. Because it removes a large amount of obstructing tissue at once, relief is typically long-lasting and the need for a repeat procedure is low.

What does simple prostatectomy cost?

It depends on whether it is done robotically or open, the length of the hospital stay, the surgeon, and your insurance. Most plans cover it for symptomatic BPH; confirm pre-authorization and ask which facility, anesthesia, and surgeon charges are in-network before scheduling.

Simple Prostatectomy for Very Large Prostates (BPH)

The short answer

Simple prostatectomy surgically removes the obstructing inner core of a very large enlarged prostate, usually one over about 80 to 100 grams, while leaving the outer shell. It is the most invasive BPH procedure — more bleeding and a longer recovery than endoscopic options — but gives a definitive, durable result. For glands this size, a urologist first considers HoLEP.

Where simple prostatectomy fits among BPH procedures

Simple prostatectomy

Very large prostates (often over 80 to 100 g), especially with bladder stones or a large diverticulum to address at the same time; wants one definitive, durable result.

Is my prostate genuinely large enough to need this rather than HoLEP, and is a robotic approach available?

HoLEP

Also works at any size, including very large glands, with no incision and usually a shorter stay — often the first choice this size when an experienced surgeon is available.

Could HoLEP treat my prostate instead, and does a high-volume HoLEP surgeon serve my area?

Aquablation

Robotic waterjet that is also size-independent and aims to preserve sexual function; a less-invasive resective alternative for large glands.

Is Aquablation an option for my size, and how does its durability compare for me?

TURP

Standard resection for moderate-to-large prostates, but generally not ideal for the very largest glands where it is slower and bleeds more.

Is my prostate too large for a standard TURP to clear effectively?

Simple prostatectomy is for BPH — and is not radical prostatectomy

Simple prostatectomy treats benign enlargement (BPH). The surgeon removes the bulky inner adenoma that is squeezing the urinary channel and leaves the outer prostate shell and surrounding structures in place. The goal is to open the channel, not to treat cancer.

Radical prostatectomy is a different operation: it removes the entire prostate to treat prostate cancer and carries its own distinct risks to continence and erections. If you have seen the word 'prostatectomy' and are unsure which one applies to you, that is an important thing to clarify with your urologist, because the decision, risks, and recovery are not the same.

Why size is the whole point — and when HoLEP is preferred instead

Simple prostatectomy earns its place with the very largest prostates, frequently those over about 80 to 100 grams, where endoscopic procedures can struggle to remove enough tissue in a reasonable, safe operating time. It is also useful when something else needs to be fixed in the same setting, such as large bladder stones or a sizeable bladder diverticulum.

For many prostates this large, however, a urologist first considers HoLEP (holmium laser enucleation), which can treat any size through the urethra with no incision, usually less bleeding, and a shorter hospital stay. The honest trade-off is availability and operator skill: HoLEP is technically demanding, so where an experienced HoLEP or Aquablation surgeon is available, an endoscopic option is often preferred, and simple prostatectomy is chosen when those are not a good fit or the gland is exceptionally large.

The honest downsides: this is the most invasive BPH surgery

Because tissue is removed surgically rather than through the urethra, simple prostatectomy involves more blood loss than endoscopic options, with a real possibility of transfusion, a longer hospital stay, and a catheter for longer afterward. A robotic approach reduces blood loss and stay compared with open surgery, but it remains a bigger operation than any office or endoscopic procedure.

Retrograde (dry) ejaculation is expected afterward, as with other resective prostate surgery. Other recognized risks include infection, urethral or bladder-neck scarring over time, temporary urinary leakage as the bladder recovers, and the general risks of anesthesia and inpatient surgery. These are reasons it is reserved for prostates that genuinely need it.

Recovery, durability, and choosing a surgeon

Plan for a hospital stay and a catheter measured in days to a couple of weeks depending on approach and healing, followed by several weeks of avoiding heavy lifting, strenuous exercise, and sexual activity while the inside heals. Recovery is longer than for endoscopic options — that is the cost of the trade.

The upside is that simple prostatectomy is definitive and durable: it removes a large amount of obstructing tissue at once, and the need for a repeat procedure is low. Because results and bleeding control depend on technique, it is reasonable to ask a surgeon how often they perform large-gland surgery and whether they offer a robotic approach.

There is no single best enlarged-prostate procedure. The right choice depends on prostate size, how much you want to protect ejaculation, whether you take blood thinners, how durable a result you need, and your anesthesia preference. A urologist who offers more than one option can compare them for your anatomy.

What shapes simple prostatectomy cost and out-of-pocket

Robotic vs open approach: A robotic (minimally invasive) simple prostatectomy usually means less blood loss and a shorter hospital stay than the traditional open operation, but it depends on robotic equipment and surgeon experience, which affect both availability and facility cost.
Hospital stay and recovery length: This is inpatient surgery with a hospital stay and a catheter for longer than endoscopic options. The length of stay and recovery support are real cost and time inputs that less-invasive procedures avoid.
Surgeon volume and specialization: Removing a very large prostate safely is technique-dependent. Outcomes track with how often a surgeon performs large-gland surgery, so a higher-volume urologist is a fair thing to ask about before scheduling.
Insurance and pre-authorization: Most plans cover simple prostatectomy for symptomatic BPH, but anesthesia, facility, pathology, and surgeon fees are often billed separately. Confirm pre-authorization and which charges are in-network before the date.

Questions to ask your urologist

01
Is simple prostatectomy major surgery?
Yes. It is the most invasive of the BPH procedures, done under anesthesia with a hospital stay and a catheter, and it involves more bleeding and a longer recovery than endoscopic options like TURP or HoLEP. A robotic approach can reduce blood loss and shorten the stay compared with open surgery.
02
What is the difference between simple and radical prostatectomy?
Simple prostatectomy removes only the obstructing inner portion of an enlarged prostate to relieve BPH and leaves the outer shell. Radical prostatectomy removes the entire prostate to treat prostate cancer. They have different goals, risks, and recovery, so it is worth confirming which one applies to you.
03
Who is a candidate for simple prostatectomy?
It is generally for men with a very large prostate, often over about 80 to 100 grams, whose gland is too big for the usual endoscopic procedures to clear well, especially if bladder stones or a large diverticulum need fixing at the same time. For many large glands, a urologist first considers HoLEP.
04
Simple prostatectomy or HoLEP for a very large prostate?
Both work at any prostate size. HoLEP treats the gland through the urethra with no incision, usually less bleeding, and a shorter stay, so it is often preferred when an experienced surgeon is available. Simple prostatectomy is chosen for exceptionally large glands or when an endoscopic option is not a good fit.
05
What are the downsides of simple prostatectomy?
More blood loss with a possibility of transfusion, a longer hospital stay and catheter time, and the usual retrograde (dry) ejaculation. Other risks include infection, scarring over time, temporary urinary leakage while the bladder recovers, and the general risks of anesthesia and inpatient surgery.
06
How long does simple prostatectomy last?
It is one of the most durable BPH treatments. Because it removes a large amount of obstructing tissue at once, relief is typically long-lasting and the need for a repeat procedure is low.
07
What does simple prostatectomy cost?
It depends on whether it is done robotically or open, the length of the hospital stay, the surgeon, and your insurance. Most plans cover it for symptomatic BPH; confirm pre-authorization and ask which facility, anesthesia, and surgeon charges are in-network before scheduling.

Ask a urologist whether your prostate is large enough to need simple prostatectomy

Start with the practice directly. Do not send sensitive medical details through public forms; the office can move the conversation into the right intake process.

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Simple prostatectomy for a very large prostate: the most invasive option, and when it is the right one