<b><i>Introduction:</i></b> Holmium laser enucleation of the prostate (HoLEP) is considered a size-independent gold standard for benign prostatic hyperplasia (BPH), and there is no upper limit of prostate weight that can be treated. Tissue retrieval can be time-consuming in cases of significant prostatic enlargement, which may lead to intraoperative hypothermia. As there are few studies on perioperative hypothermia in HoLEP, we conducted a retrospective study of patients who underwent HoLEP at our hospital. <b><i>Methods:</i></b> The data of 147 patients who underwent HoLEP at our hospital were retrospectively collected and analyzed for the occurrence of intraoperative hypothermia (temperature &#x3c;36°C); age, body mass index (BMI), anesthesia method, body temperature, total fluid infusion, operation time, and irrigation fluid were the explanatory variables. <b><i>Results:</i></b> Intraoperative hypothermia was observed in 46 of 147 patients (31.3%). Simple logistic regression analysis showed that age (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.01–1.13, <i>p</i> = 0.021), BMI (OR: 0.84, 95% CI: 0.72–0.96, <i>p</i> = 0.017), spinal anesthesia (OR: 4.92, 95% CI: 1.86–14.99, <i>p</i> = 0.002), and surgical time (OR: 1.04, 95% CI: 1.01–1.06, <i>p</i> = 0.006) were predictors of hypothermia. The decrease in body temperature was more pronounced with longer-duration surgery and reached 0.58°C at 180 min. <b><i>Conclusion:</i></b> General anesthesia, instead of spinal anesthesia, is recommended in high-risk patients with advanced age or low BMI to avoid intraoperative hypothermia during HoLEP. Two-stage morcellation may be considered for large adenomas, when a prolonged operative time and hypothermia are anticipated.