Prof. Dr. Emel Akoğlu
UrologyVerified
- 57+years exp.
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Prostate
Laparoscopic prostatectomy
What laparoscopic radical prostatectomy is, how the prostate is removed through keyhole incisions, what the evidence says about cancer control compared with radiotherapy and monitoring, what to expect for continence and erections, approximate costs in Turkey against the UK, US and Germany, catheter and recovery timelines, risks and how to check a hospital.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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Laparoscopic prostatectomy in Turkey: what it is and how it works
Laparoscopic prostatectomy (more fully, laparoscopic radical prostatectomy) is keyhole surgery to remove the whole prostate gland and the seminal vesicles, usually to treat prostate cancer that is still inside the gland. The surgeon makes five or six small cuts in the lower abdomen, inflates the abdomen with gas and works through a camera and long instruments. The prostate is freed from the bladder and the urethra, the bladder is joined to the urethra with fine stitches, and the gland is removed in a bag through an enlarged port incision. Nearby lymph nodes may be taken for testing in higher-risk cases.
This is cancer surgery, not a treatment for the benign enlargement of the prostate that causes weak urine flow in older men; that problem is treated differently, for example with TURP. This guide explains who suits prostatectomy, what evidence says, what to expect for continence and erections, what it costs compared with the UK, US and Germany, and what to ask a hospital. See also our urology treatments in Turkey.
Is prostatectomy the right treatment for my prostate cancer?
Surgery is one of several options for localised prostate cancer. The large UK ProtecT trial compared active monitoring, radical surgery and radiotherapy in men with screen-detected, localised cancer. After a median of about 15 years, deaths from prostate cancer were low in all three groups, but the cancer was less likely to spread in the surgery and radiotherapy groups than with monitoring. Surgery and radiotherapy had different side-effect patterns. NICE guidance therefore asks men to discuss all options, including radiotherapy for prostate cancer, with specialists before choosing.
Prostatectomy is usually suggested for men who are fit enough for a general anaesthetic, expect to live long enough to benefit (typically more than ten years) and have cancer confined to the prostate or only just outside it. A biopsy (see prostate biopsy), PSA level and MRI define the stage and Gleason grade that guide this decision.
How is the prostate removed laparoscopically, step by step?
Under general anaesthesia you lie flat, tilted head-down. The surgeon opens the space in front of the bladder, identifies the prostate, controls the blood vessels that feed it and separates it from the bladder neck. When nerve-sparing is planned and the cancer allows it, the nerve bundles that run along each side of the prostate are preserved; otherwise they are removed with the gland. The urethra is then cut, the prostate is lifted out, and the bladder is stitched to the urethra over a catheter. A drain may be left for a day or two. Operating time is typically three to four hours, and blood loss is generally lower than with open surgery.
What will happen to continence and erections?
These two functions decide most men's satisfaction, so ask for realistic numbers from the surgeon's own series.
- Urinary control. Leakage is common in the first weeks after the catheter is removed. Most men improve markedly over three to twelve months, helped by pelvic floor exercises taught before surgery. A small proportion have long-term leakage; severe cases can be helped by a sling or an artificial urinary sphincter.
- Erections. Some difficulty is frequent even with nerve-sparing surgery, because nerves are bruised. Recovery can take up to two years and depends on age, pre-operative function and whether the nerves could be spared. Tablets, injections or devices help many men.
- Fertility and orgasm. After removal of the prostate and seminal vesicles you no longer produce semen, so orgasm is dry and natural conception is not possible. Discuss sperm storage beforehand if you may want children.
Laparoscopic, robotic or open prostatectomy: which suits which patient?
Open surgery uses a lower-abdominal incision and remains common worldwide. Robotic-assisted prostatectomy is now the most widely used keyhole route in many countries; it gives a 3D view and wristed instruments. Pure laparoscopy is technically harder to learn but gives comparable cancer and functional outcomes in experienced hands, and its cost is lower. The surgeon's experience matters more than the instrument.
| Approach | Best suited to | Typical limits |
|---|---|---|
| Laparoscopic | Localised cancer; surgeon trained in laparoscopy | Long learning curve; no robotic wrist movement |
| Robotic-assisted | Localised cancer; nerve-sparing and reconstruction | Higher equipment cost; same cancer outcome in trials |
| Open | Complex or previously operated pelvis | More blood loss; longer stay and catheter pain |
| Radiotherapy | Men preferring no surgery, or higher-risk surgical patients | Bowel and urinary effects; later surgery is harder |
Laparoscopic prostatectomy cost in Turkey compared with the UK, US and Germany
The ranges below are approximate for the operation and hospital stay, not hospital quotes. Each hospital confirms its price in writing after reviewing your biopsy and MRI.
| Country | Approximate cost range |
|---|---|
| Turkey | €5,000 – €11,000 |
| United Kingdom | €10,000 – €18,000 |
| United States | €15,000 – €40,000 |
| Germany | €9,000 – €18,000 |
The price depends on nerve-sparing or not, lymph node removal, robotic or conventional equipment, the length of stay and extra imaging such as a PSMA PET scan. A package should list the pre-operative tests, surgeon and anaesthetist fees, hospital nights, catheter supplies, pathology and transfers. Check in writing whether the pathology report and a first PSA test are included.
Who is a good candidate, and who is not?
Good candidates have biopsy-proven cancer confined to the prostate, no serious illness that makes anaesthesia unsafe, and a willingness to accept the risk to continence and sexual function in exchange for treating the cancer. Surgery is less suitable if the cancer has spread to bones or distant nodes, if your life expectancy is limited by other illness, or if you have had major pelvic surgery or radiotherapy that makes the operation risky. Men with very low-risk cancer may be offered active surveillance instead, with regular PSA tests, MRI and repeat biopsy. A multidisciplinary review of your biopsy slides and MRI before you travel is worthwhile.
How long is the catheter in, and what does recovery look like?
You usually stay in hospital for two to three nights. A urinary catheter stays in for about seven to fourteen days while the join between bladder and urethra heals; the surgeon often checks the join before removing it.
| Time | What most men experience |
|---|---|
| Days 1–3 | Hospital: walking, drain removed, catheter in place |
| Days 4–14 | Rest near the hospital; catheter removed; surgeon checks before you fly |
| Weeks 2–6 | Leakage improves; light activity; no heavy lifting |
| Weeks 6–12 | Return to work for most; exercise resumes |
| 3–12 months | Continence and erections gradually recover; PSA checks begin |
Plan about ten to fourteen nights in Turkey so the catheter can be removed before you travel, or arrange catheter removal with a urologist at home. After the operation, the pathology report and the PSA level at about six weeks show whether more treatment is needed.
What are the risks of laparoscopic prostatectomy?
Besides the effects on continence and erections, risks include bleeding that needs a transfusion, infection, injury to the rectum, bowel or ureter, narrowing of the join between bladder and urethra, lymph fluid collections after node removal, hernia at a port site, clots in the legs or lungs, and conversion to open surgery. Cancer may be found at the edge of the removed prostate (a positive margin) or the PSA may start to rise again, which then calls for radiotherapy or other treatment. Information from the NHS, NICE and the European Association of Urology (EAU) sets out these risks and the expected results; read it before travelling.
How to choose a surgeon and hospital, and red flags
Look for a urological surgeon who performs radical prostatectomy regularly and can quote their own continence and margin outcomes, an operation in a licensed hospital with intensive care, a blood bank and a pathology department, and a written plan that states the approach, nerve-sparing intent and price. Red flags include a firm quote without your biopsy and MRI, no discussion of radiotherapy or surveillance, promises that function will be unaffected and pressure to pay a deposit. Read how our process works and ask for a plan through our free quote page. Our general guide to prostatectomy covers other forms of the operation.
Questions to ask the clinic
- How many radical prostatectomies does the surgeon perform each year, and what are the continence outcomes?
- Is nerve-sparing possible for my cancer, and on which side?
- Will lymph nodes be removed, and why?
- How long will I need the catheter, and who removes it?
- What is included in the price, and who reviews my pathology and PSA results?
Hospitals with Urology in Turkey
Frequently asked questions
It is keyhole surgery to remove the whole prostate and seminal vesicles, mainly for prostate cancer confined to the gland. The surgeon works through small abdominal cuts with a camera and joins the bladder to the urethra.
For cancer confined to the prostate, surgery aims to remove it completely, and large trials show low cancer death rates over 15 years. Pathology and later PSA tests show whether further treatment is needed.
Approximate ranges are €5,000 to €11,000 in Turkey against about €10,000 to €18,000 in the UK. The price depends on nerve-sparing, lymph node removal, equipment and stay; the hospital confirms it in writing.
Hospital stay is two to three nights, the catheter stays in for about one to two weeks and most men return to work after six to twelve weeks. Continence and erections keep improving for up to a year or two.
Some leakage is usual at first and improves over three to twelve months, especially with pelvic floor exercises. A small proportion have lasting leakage, and treatments such as slings or sphincters can help.
Many men regain some erectile function, more often when nerves are spared and function was good before surgery, but recovery can take up to two years. Medicines and devices help.
No. Both are keyhole operations, but robotic surgery uses a console with wristed instruments, while laparoscopic surgery uses hand-held instruments. Outcomes depend on the surgeon's experience more than the equipment.
You are asleep during surgery. Afterwards expect soreness at the cuts and discomfort from the catheter, usually controlled with prescribed painkillers and easing over the first week or two.
Yes. Trials show surgery and radiotherapy have similar cancer control for localised disease, with different side effects. Discuss both with a urologist and a radiation oncologist before deciding.
Plan about ten to fourteen nights: two to three in hospital, then rest nearby until the catheter is removed and the surgeon has checked your healing before you fly home.
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