A simple prostatectomy removes the enlarged internal adenoma while leaving the outer prostate capsule. It is different from radical prostatectomy for cancer, which removes the entire prostate and seminal vesicles.
Simple prostatectomy is usually considered for very large glands, often above 80–100 mL, especially when HoLEP or another endoscopic enucleation is unavailable, when anatomy favors an abdominal approach, or when a bladder stone or diverticulum needs simultaneous treatment.
Robotic, laparoscopic, and open approaches
Robotic and laparoscopic techniques use small abdominal incisions and may reduce blood loss and length of stay compared with open surgery. Open simple prostatectomy remains effective and may be appropriate in selected very large or complex cases.
The operative approach should be matched to surgeon experience, prior abdominal surgery, gland size, bladder pathology, anticoagulation, and institutional resources—not selected solely because a robot is available.
How it compares with HoLEP
Both operations can provide powerful, durable relief and a large pathology specimen. HoLEP is performed through the urethra and usually has a shorter catheter and hospital course. Simple prostatectomy may have a more familiar learning curve for some reconstructive or robotic surgeons and can facilitate simultaneous bladder surgery.
There is no universal winner. The better choice depends heavily on local expertise. A center with a high-volume HoLEP surgeon may rarely need simple prostatectomy for BPH alone; a center without endoscopic enucleation may achieve excellent outcomes robotically.
Recovery and functional outcomes
Patients should plan for hospital-based surgery, a catheter for several days, fatigue, abdominal and urinary discomfort, blood in the urine, and several weeks of lifting restrictions. Bleeding, transfusion, infection, urine leak, bladder-neck contracture, and incontinence are recognized risks.
Dry or retrograde ejaculation is expected after standard adenoma removal. Erectile function is often preserved, but major pelvic surgery and baseline comorbidity affect outcomes.
Capability questions
- Why is simple prostatectomy preferred over HoLEP or Aquablation in my case?
- Will the approach be robotic, laparoscopic, or open?
- How many simple prostatectomies does the surgeon perform each year?
- What are the transfusion, urine-leak, readmission, and persistent-incontinence rates?
- Can any bladder stone, diverticulum, or other problem be addressed during the same operation?
Bottom line
Simple prostatectomy is a definitive large-gland operation. Its appropriateness depends as much on available enucleation capability and coexisting bladder pathology as on prostate volume alone.
Sources and evidence
Open the original guideline, regulatory record, or study. Evidence was last checked August 14, 2026.
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AUA Guideline (2026) Part III: Procedural/Surgical Management The Journal of Urology · professional guideline · 2026
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Disease Management — Management of Non-neurogenic Male LUTS European Association of Urology · professional guideline · 2026