Purpose To evaluate the effect of prostate tissue density (PTD) on perioperative Holmium laser enucleation of prostate (HoLEP) outcomes. Methods Two hundred fourteen patients underwent HoLEP between December 2016 and August 2018 (group 1: PTD < 1 g/mL and group 2: PTD >= 1 g/mL). Enucleation time (ET), morcellation time (MT), total operation time (TOT), total laser energy (TLE), efficiency of laser (EL), efficiency of enucleation (EE), efficiency of morcellation (EM), enucleation rate (ER), and enucleated tissue weight (ETW) were recorded. Results The mean ages of the groups 1, 2 were 61.36 +/- 5.92 and 63.1 +/- 7.52 years, respectively. TOT (76.4 vs 86.21 min), ET (69.18 vs 79.94 min), EE (0.80 vs 0.91 g/min), and ETW (55.8 vs 70.23 g) were not significantly different between the two groups. However, the MT was longer in group 2 (11.27 +/- 8.57 min and 7.22 +/- 5.46 min, p = 0.0001). Furthermore, EM was higher in group 1 (9.81 +/- 5.61 g/min and 7.45 +/- 4.14 g/min, p = 0.0003). The EL and TLE were similar in both groups. PTD positively correlated with MT (rho = 0.272, p = 0.0005) and negatively correlated with EM (rho = - 0.315, p = 0.0001). No correlations were identified between the PTD and EL or EE. Conclusions PTD is a factor that influences the HoLEP on perioperative outcomes. The PTD particularly affects the morcellation phase of the surgery. Patients with higher PTD will have a longer duration of MT and lesser EM. Future studies with the use of different imaging methods will give insight into the duration and difficulty of the HoLEP.