Laser prostate surgery (HoLEP) in Turkey: what it is and how it works
Laser prostate surgery (HoLEP), short for holmium laser enucleation of the prostate, is an operation for a benign enlarged prostate that is blocking the flow of urine. No cuts are made in the skin. The surgeon passes a thin telescope through the urethra and uses a holmium laser to separate the inner part of the prostate (the adenoma, the growth that causes the blockage) from its outer shell, much as one peels the flesh from a fruit. The freed tissue is pushed into the bladder, cut into small pieces by a morcellator, and removed. Urology departments in Turkey offer it for men of all prostate sizes.
HoLEP removes the obstruction itself rather than just widening the channel. This guide explains how it works, what the guidelines and studies say, how it differs from TURP, what to expect in the first weeks, the approximate cost compared with the UK, US and Germany, and how to choose a team. For other urological services see our urology treatments in Turkey.
Laser Prostate Surgery (HoLEP) in Turkey: how it works
- 1Send your photos and questions
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- 2Get a written plan and price
A surgeon reviews your case and you receive a personal plan with the price, usually within 24 hours. Compare hospitals; nothing is paid in advance.
- 3Travel, surgery and aftercare
Airport pick-up, examination, surgery and check-ups in Istanbul, then follow-up with your surgeon after you fly home.
- Within about 2 hours
A coordinator replies in your language by WhatsApp or e-mail.
- Within 24 hours
A surgeon reviews your photos and you receive a written plan with the surgeon's name and the price.
- You decide
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Who needs laser prostate surgery (HoLEP)?
The prostate tends to grow with age. When it squeezes the urethra a man may have a weak or slow stream, a need to push, a stop-start flow, getting up at night, urgency, and a feeling that the bladder never empties. HoLEP is meant for men whose symptoms continue despite medicines such as alpha-blockers or 5-alpha-reductase inhibitors, or who cannot or do not want to take them. It is also used for complications of the blockage: repeated urinary retention needing a catheter, recurrent infections, bladder stones or bleeding from the prostate. It does not treat prostate cancer, and a man with raised PSA usually needs a prostate biopsy or MRI first.
How is HoLEP done, step by step?
The operation is done under spinal or general anaesthesia and normally takes one to two hours, depending on the size of the gland.
- Enucleation: the laser cuts along the natural plane between the adenoma and the capsule, usually in two or three lobes.
- Morcellation: the lobes are moved into the bladder and broken into pieces that are sucked out through the scope.
- Pathology: the tissue is sent to a laboratory, which can pick up a small cancer that was not suspected.
- Catheter: a urinary catheter with bladder irrigation is placed and usually removed after one or two days.
Most men spend one to two nights in hospital. As the laser seals blood vessels while it cuts, bleeding is generally low, so men taking blood thinners can often be treated with a modified plan.
Does HoLEP actually work? What the evidence says
It has one of the strongest evidence bases among prostate operations. The European Association of Urology guideline lists enucleation, including HoLEP, as an option regardless of prostate size and as an alternative to open prostatectomy for large glands, and trials with follow-up of five to ten years or more report lasting improvement in flow rate and symptom scores, with a low rate of repeat surgery. Comparisons with TURP generally show similar or greater relief, less bleeding and a shorter catheter time, with a longer learning curve for the surgeon. Results depend on the operator's experience, so the number of cases the surgeon has performed matters.
HoLEP, TURP, Rezum or open surgery?
| Option | Best suited to | Typical limits |
|---|---|---|
| HoLEP | Any prostate size; retention; men on blood thinners | Needs an experienced laser surgeon; dry ejaculation common |
| TURP | Small to medium glands (usually under about 80 ml) | More bleeding; risk of TUR syndrome in long operations |
| Rezum or UroLift | Smaller glands, men who wish to preserve ejaculation | Less tissue removed; retreatment more likely |
| Simple prostatectomy (open or robotic) | Very large glands when enucleation is not available | An abdominal incision or robotic ports; longer stay |
For very large glands the other route is surgery through the abdomen; our guide to da Vinci prostatic adenomectomy explains the robotic version. Removal of the whole gland for cancer is a different operation; see prostatectomy.
What does laser prostate surgery (HoLEP) cost in Turkey compared with the UK, US and Germany?
These are approximate ranges for the operation with a short hospital stay, not hospital quotes. The hospital confirms its own price after reviewing your tests.
| Country | Approximate cost range |
|---|---|
| Turkey | €3,000 – €6,500 |
| United Kingdom | €6,000 – €11,500 |
| United States | €9,000 – €26,000 |
| Germany | €5,000 – €9,500 |
What changes the price: prostate size and operating time, the kind of anaesthesia, the number of nights, the hospital category, tests such as ultrasound, uroflowmetry and PSA, and whether tissue pathology and medication are included. Ask whether an extra night, a repeat catheter or a bladder-stone removal during the same operation is charged separately.
Who is and is not suited to HoLEP?
Good candidates are men with benign enlargement, proven obstruction on a flow test or scan, and symptoms that affect daily life. HoLEP is less suited to men who want to preserve ejaculation, who have untreated urinary infection, an unexplained rise in PSA or a suspected cancer, a narrowed urethra that needs treatment first, or a neurological bladder problem, which can cause symptoms that surgery will not fix. Men with severe heart or lung disease need an anaesthetic assessment; spinal anaesthesia is often an option.
Laser prostate surgery (HoLEP) recovery: catheter, urine and the first weeks
The catheter is removed after one to two days in many cases, and most men urinate well before they leave hospital. The urine can be pink or contain small clots for one to three weeks, which is normal; drinking water helps. Burning, urgency and a need to pass urine often are common at first because the bladder is adapting, and they ease over about four to eight weeks. Some men leak urine for a few days or weeks, and pelvic floor exercises help. Most return to light work within one to two weeks, avoid heavy lifting and strenuous exercise for about four to six weeks, and avoid sex for about a month. The tissue result usually arrives within a week or two.
How many days in Turkey for HoLEP?
Plan about four to five nights: one to two for consultation and tests, one to two in hospital, and a final check after the catheter is out and urine is passing normally. A flight is usually allowed after that check, although the surgeon may ask you to wait until bleeding has settled. After you return, your own doctor can arrange a PSA test, a flow test and review at around three months.
Side effects and risks of laser prostate surgery (HoLEP)
Retrograde ejaculation (semen passing back into the bladder, so there is little or none at orgasm, a dry orgasm) is common and usually permanent; it does not stop orgasm or the ability to have an erection, but it does mean fertility is reduced, so tell your surgeon if you want children. Other effects include temporary stress or urge incontinence, burning when passing urine, a urinary infection, bleeding, narrowing of the urethra or bladder neck months later, and, in a few men, the need for another procedure. Erection problems are uncommon. The NHS and the European Association of Urology encourage you to discuss these before surgery. Ask what happens if you need a catheter replaced or a complication appears after you return home.
How to choose a urologist and hospital for HoLEP
HoLEP has a long learning curve, so ask how many procedures the surgeon performs each year and whether the hospital has a holmium laser and a morcellator, an anaesthetist and an intensive-care unit. Red flags include a quote without any tests, the promise of no side effects, or one-size-fits-all advice. A prostate-specific MRI or biopsy first is normal for men with raised PSA. Read how our process works and request a written plan through our free quote page. Hospitals that treat men's health also provide other urology services such as circumcision, which can be useful context but not a sign of HoLEP experience. Useful questions:
- Is HoLEP right for my prostate size, and what are the alternatives?
- How many HoLEPs has the surgeon done, and what is the repeat-surgery rate?
- Will the tissue be sent for pathology, and who tells me the result?
- What does the package include, and for how many nights?
- Who follows me up at home if I have incontinence or bleeding?
Frequently asked questions
HoLEP is holmium laser enucleation of the prostate. A laser, passed through the urethra, separates the enlarged inner prostate from its shell, and the tissue is cut into pieces and removed, so no skin incision is needed.
Yes, for benign prostate enlargement. Studies and the European Association of Urology guideline report lasting improvement in flow and symptoms, with a low rate of repeat surgery, when it is done by an experienced surgeon.
Approximate ranges are €3,000 to €6,500 in Turkey, against about €6,000 to €11,500 in the UK. The price depends on gland size, nights in hospital and tests; the hospital confirms it in a written quote.
Neither is right for everyone. HoLEP can treat any prostate size with less bleeding and a shorter catheter time, but requires a skilled laser surgeon. TURP is widely available and suits small and medium glands.
The catheter often comes out after one to two days. Urinary burning and frequency ease over four to eight weeks, and most men avoid heavy lifting for four to six weeks.
Dry ejaculation is common and usually permanent, while erection problems are uncommon. Because it affects fertility, discuss it with your surgeon beforehand if you want children.
Yes, usually for one to two days, with fluid running through it to keep the bladder clear. Some men need it longer if the bladder was weak before surgery.
No. It removes the benign inner gland, although the tissue is checked in a laboratory. Suspected cancer needs a biopsy and a different treatment plan.
It is done under spinal or general anaesthesia. Afterwards there is catheter discomfort and burning on passing urine, which most men manage with simple medicines.
About four to five nights is usual, to cover tests, one to two nights in hospital and a check after the catheter comes out and urine flows normally.