Prof. Dr. Emel Akoğlu
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- 57+years exp.
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Prostate
Da vinci prostatic adenomectomy
What da Vinci prostatic adenomectomy is, how the robotic system removes the inner part of a very large benign prostate through the bladder or capsule, how it compares with HoLEP, laser and TURP, who needs it, approximate costs in Turkey against the UK, US and Germany, catheter and recovery stages, risks such as retrograde ejaculation, and how to check a hospital.
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Prof. Dr. Zerrin Biçik Bahçebaşı
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- 37+years exp.
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Da Vinci prostatic adenomectomy in Turkey: what it is and how it works
Da Vinci prostatic adenomectomy, also called robotic simple prostatectomy, is an operation for a benign (non-cancerous) enlarged prostate that is too big for most endoscopic treatments. The surgeon controls the da Vinci robotic system from a console and works through a few small keyhole incisions. Only the inner, overgrown part of the prostate (the adenoma) is removed; the outer shell of the gland, called the capsule, is left in place. This differs from a radical prostatectomy for cancer, in which the whole gland is taken out. The aim is to open the channel so urine flows normally again. Hospitals in Turkey perform it in centres that have the robotic system, usually for glands of roughly 80 to 100 ml or more.
This guide explains how the operation works, when it is chosen over laser or open surgery, what it costs in Turkey compared with the UK, US and Germany, what the catheter and recovery period are like, and what to ask a hospital. It is general information, not medical advice. For the wider range of treatments see our urology treatments in Turkey overview.
Why does a very large prostate need a different operation?
Benign prostatic hyperplasia (BPH) is a common growth of the prostate with age. It squeezes the urethra and causes a weak stream, frequent urination, getting up at night, a feeling that the bladder is not empty and, in some men, retention, bladder stones or kidney strain. Medicines and many minimally invasive procedures work well for small and medium glands. When the prostate is very large, scraping or vaporising it takes too long or removes too little, and the need for a second procedure rises. For these glands, guidelines such as those of the European Association of Urology describe enucleation with a laser (HoLEP) or a simple prostatectomy done openly, laparoscopically or with a robot as the options.
How is da Vinci prostatic adenomectomy performed?
The operation is done under general anaesthesia and normally takes between one and three hours depending on the size of the gland. Small incisions are made in the lower abdomen for the camera and instruments. The surgeon reaches the adenoma either through the bladder (transvesical) or through the front of the prostate capsule, separates the adenoma from the capsule with the robotic instruments, removes it through a port and closes the openings with stitches. A urinary catheter is left in place and, in some centres, a small drain. The wristed instruments and 3D view help the surgeon control bleeding and suture precisely in a small space, which is why robotic or laparoscopic routes are preferred to a large open incision when the team has the expertise.
Does robotic adenomectomy work, and how does it compare with HoLEP, laser and TURP?
For very large glands the results are good: urinary flow improves markedly in most men and the symptoms score falls, and because the whole adenoma is removed, regrowth requiring a repeat operation is uncommon. Reviews comparing robotic with open simple prostatectomy report similar functional results with less blood loss, shorter hospital stays and quicker recovery, though the robot adds cost and, in some series, operating time. There is less research comparing it directly with HoLEP, which achieves comparable relief with no abdominal incisions at many centres. The choice often depends on what the hospital offers and on additional problems such as a large bladder stone or bladder diverticulum that can be treated in the same operation.
| Operation | Best suited to | Typical limits |
|---|---|---|
| Robotic adenomectomy (da Vinci) | Very large glands, bladder stones or diverticula in the same session | Abdominal incisions; higher cost; needs a robotic centre |
| HoLEP / laser enucleation | Medium to very large glands, no abdominal cuts | Needs an experienced laser surgeon; steep learning curve |
| TURP (scraping through the urethra) | Small to medium glands | Longer operation and more bleeding as size increases |
| Open simple prostatectomy | Very large glands where robot or laser is not available | Larger incision, longer stay and recovery |
If you are comparing laser techniques, see our guides to laser prostate surgery and GreenLight laser prostate vaporisation, and for an overview of the gland itself, prostate treatments.
Who is a candidate, and who is not?
Candidates are men with troublesome symptoms or complications from a large, benign prostate who have not been helped enough by medicines, or who have retention, recurrent infection, bladder stones, blood in the urine from the prostate or reduced kidney function related to the blockage. Before surgery the urologist will measure the gland with ultrasound or MRI, check the PSA and, where needed, arrange a biopsy to exclude cancer, and review urine flow and bladder function. The operation is not for prostate cancer, so a cancer diagnosis needs a different plan. It may not suit men who cannot have a long general anaesthetic or who need blood-thinning treatment that cannot be paused. If fertility matters, discuss retrograde ejaculation first.
Da Vinci prostatic adenomectomy cost and price in Turkey
The figures below are approximate ranges for the operation including the hospital stay, not hospital quotes. Each hospital confirms its own price in writing after reviewing your scans and test results.
| Country | Approximate cost range |
|---|---|
| Turkey | €5,500 – €11,000 |
| United Kingdom | €9,000 – €18,000 |
| United States | €15,000 – €35,000 |
| Germany | €8,000 – €16,000 |
The price changes with the size of the gland and length of the operation, the number of nights in hospital, the surgeon, whether another procedure (such as a bladder stone removal) is done in the same session, and the pre-operative tests. Ask what a package includes: the scans and blood tests, the anaesthetist, the surgeon's fee, the single-use robotic instruments, hospital nights, medicines, the pathology report on the removed tissue, transfers and a post-operative review. Check who pays if a complication needs additional treatment.
How should you prepare, and what happens before the operation?
Expect a urology review with a flow test, an ultrasound or MRI of the prostate, blood tests including PSA and kidney function, a urine test to exclude infection and a heart and anaesthetic check. Tell the surgeon about every medicine, especially blood thinners, and about medicines for the prostate such as alpha-blockers or finasteride, which may be continued or stopped depending on the plan. Stop smoking if you can, and bring your previous scans and reports so the team can compare them.
What are the catheter, hospital stay and recovery stages?
Most men stay in hospital for two to four nights. A catheter remains for roughly three to seven days and is removed once the urine is clear and the surgeon is satisfied with healing; some surgeons keep it longer. Passing blood-tinged urine in the first days and weeks is common, and drinking plenty of water helps. Plan to stay in Turkey for about seven to ten days so that the catheter is out, you are passing urine and you have been checked before flying.
In the first two weeks walk daily but avoid lifting, straining and driving. Most men return to desk work after two to three weeks and to heavy exercise or lifting after six to eight weeks, if the surgeon agrees. Urgency and some leakage can continue for weeks as the bladder adapts, and the full benefit is judged after about three months. Pelvic floor exercises are commonly advised. Avoid flying until the surgeon has cleared you, and keep walking and drinking water during the flight to reduce clot risk.
What are the risks and side effects?
Every operation carries risk. Common effects are blood in the urine, burning or urgency, a short period of urinary leakage and retrograde ejaculation (semen passes into the bladder rather than out), which is very common after removal of an adenoma and usually permanent. Less common problems are bleeding that needs a transfusion, urinary infection, narrowing of the urethra or bladder neck (stricture), blood clots in the legs or lungs, hernia at an incision, injury to nearby structures and anaesthetic complications. Lasting incontinence and erectile problems are uncommon after adenomectomy, but they are possible. Ask the surgeon for the figures from the hospital's own practice and for what happens if you need further treatment. The NHS and the European Association of Urology both advise discussing the benefits and risks of each option with a urologist before choosing.
How do you choose a hospital, and what are the red flags?
Look for a urologist who performs robotic surgery regularly, a hospital with an intensive-care unit and blood bank, and a clear plan for the catheter and follow-up once you are home. Red flags include a quote given without scans or PSA results, no discussion of alternatives such as HoLEP, promises that you will certainly keep sexual function or ejaculation, pressure to pay a deposit quickly and no named surgeon. Read how our process works and send your scans, PSA and symptom history through the free quote page, so the hospital can propose a procedure and give a written price.
Questions to ask the clinic
- Is a robotic adenomectomy or HoLEP more suitable for my gland size, and why?
- How many robotic adenomectomies does my surgeon perform each year?
- How long will the catheter stay in, and can I fly with it if needed?
- What is my risk of retrograde ejaculation and incontinence?
- Which tests are included, and will the removed tissue be examined for cancer?
- Who looks after me and treats complications once I am back home?
Hospitals with Urology in Turkey
Frequently asked questions
It is a robot-assisted operation that removes the inner, overgrown part of a very large benign prostate through small keyhole incisions, leaving the outer capsule. It is also called robotic simple prostatectomy and is not an operation for prostate cancer.
Adenomectomy removes only the benign adenoma from inside the prostate to relieve blockage. A radical prostatectomy removes the entire gland for cancer and carries a different set of risks and recovery.
It is usually considered for very large prostates, roughly 80 to 100 ml or more, when endoscopic scraping is unsuitable and laser enucleation is not available, or when bladder stones or diverticula can be treated in the same operation.
Approximate packages run from about €5,500 to €11,000 in Turkey, compared with roughly €9,000 to €18,000 in the UK. The price depends on gland size, hospital stay and what is included, so ask for a written quote.
Usually between three and seven days, although some surgeons keep it longer. It is removed once the urine is clear and the surgeon is satisfied, and most patients stay in Turkey long enough for this to happen.
Hospital stay is typically two to four nights. Many men return to desk work after two to three weeks and to heavy lifting after six to eight weeks, with the full benefit judged at around three months.
It is very common after removal of the adenoma and is usually permanent. Semen passes into the bladder instead of out, which is harmless to health but matters if you plan to father children, so discuss this beforehand.
Neither is simply safer. Each option suits different gland sizes and settings, and outcomes depend heavily on the surgeon's experience. A urologist should explain why they recommend one for your prostate.
Because the whole adenoma is removed, regrowth that needs another operation is uncommon. The outer capsule remains, so regular PSA checks and review with a urologist are still advised.
Plan for about seven to ten days: two to four nights in hospital, catheter removal, a check that you are passing urine well and clearance to fly. Longer may be advised if you have other health conditions.
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