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UROLOGY · ENLARGED PROSTATE
HoLEP Laser Surgery for Enlarged Prostate
HoLEP uses a holmium laser to remove the part of the prostate that blocks urine, with no cut on the skin. It suits glands of any size. Assoc. Prof. Tuncay Taş explains who benefits, how recovery goes and what the trip to Istanbul involves.
Any size
prostate
1 night
in hospital
4 to 5 days
in Istanbul
20+ years
in urology
Hospital stay and trip length are typical for HoLEP at Safe Urology Clinic. Career figures from Assoc. Prof. Taş's clinical profile.
Medically reviewed by Assoc. Prof. Dr. Tuncay Taş, urologist · Updated November 2026
What is HoLEP?
HoLEP stands for holmium laser enucleation of the prostate. It treats benign prostatic hyperplasia (BPH), the non-cancerous growth that squeezes the urine channel as men age.
During HoLEP, the surgeon passes a thin telescope through the penis. Then a laser fibre lifts the overgrown inner prostate off its outer shell, much like peeling an orange. Finally, a second instrument breaks up the freed tissue inside the bladder and removes it.
Because the whole blocking part comes out, the channel opens widely and usually stays open. In addition, the tissue goes to the laboratory, so the pathologist can check it for cancer.
Which question brought you here?
Most men ask one of five things when they read about HoLEP. So pick the closest one and jump straight to the answer.
When an enlarged prostate needs treatment
An enlarged prostate is common, and many men live with mild symptoms. However, symptoms that disturb sleep, work or travel deserve a proper assessment.
Symptoms men notice
Weak stream: the flow starts slowly, stops and starts, or dribbles at the end.
Straining: you wait or push before urine begins.
Night-time trips: waking twice or more each night to pass urine.
Urgency: a sudden need to go, with a bladder that never feels empty.
Signs that surgery should not wait
Urinary retention: you cannot pass urine, or you need a catheter.
Repeated infections or bladder stones.
Kidney strain: swelling of the kidneys or a rising creatinine level.
Bleeding from the prostate that keeps coming back.
Above all, blood in the urine always needs a check of the bladder as well. So Assoc. Prof. Taş never assumes that the prostate alone explains it.
Treatment before surgery: lifestyle and medicines
Not every man with an enlarged prostate needs an operation. In fact, mild to moderate symptoms often improve with simple changes and tablets. So Assoc. Prof. Taş always discusses these first.
Changes that ease symptoms
Evening fluids: drink less in the two hours before bed.
Less caffeine and alcohol: both irritate the bladder and increase urgency.
Double voiding: wait a moment after passing urine, then try again.
Medicine review: some decongestants and water tablets make symptoms worse.
Medicines that work
Alpha blockers: tamsulosin or silodosin relax the prostate and usually help within days.
5-alpha reductase inhibitors: finasteride or dutasteride shrink larger glands over at least six months.
Combination: both together suit larger glands with troublesome symptoms.
Daily tadalafil: it eases urinary symptoms and also helps erections.
However, tablets control symptoms rather than remove the blockage. So when they stop working, cause side effects or need lifelong use, HoLEP becomes a reasonable next step.
Who is a good candidate for HoLEP?
HoLEP suits most men whose symptoms come from prostate blockage and who want a lasting result. In particular, it works well when other methods have limits.
Large prostates: HoLEP removes glands above 80 ml through the urethra, where other methods often need open or robotic surgery.
A middle lobe: tissue that bulges into the bladder comes out completely.
Tablets no longer help: alpha blockers or finasteride have stopped controlling your symptoms.
A catheter already in place: HoLEP often lets men with retention pass urine again.
Blood thinners: the laser seals vessels as it cuts, so selected men on these medicines can have it safely with a plan from their cardiologist.
On the other hand, some men prefer to keep normal ejaculation above all else. For them, a smaller gland may suit a gentler option, so the comparison below matters.
Tests before HoLEP
A few simple tests decide whether HoLEP is the right operation. Usually they all fit into the first visit in Istanbul.
Symptom score (IPSS): a short questionnaire grades how much the symptoms affect you.
PSA blood test: it screens for prostate cancer before any prostate surgery.
Ultrasound: it measures the prostate, shows a middle lobe and checks the kidneys.
Flow test and residual urine: they show how weak the stream is and how much urine stays behind.
Urine test: it rules out infection before surgery.
If the PSA is raised, cancer needs ruling out first. In that case, he may advise an MRI fusion prostate biopsy before any decision on HoLEP.
HoLEP vs TURP, Rezum and other options
Several procedures treat an enlarged prostate. Each one balances durability against recovery and sexual side effects. So the best choice depends on your gland and your priorities.
HoLEP laser enucleation
Prostate size: Any size
Hospital stay: 1 night
Catheter: About 1 day
Ejaculation: Dry orgasm in about 3 in 4 men
Retreatment by 5 years: About 1 to 2%
Bipolar TURP
Prostate size: Up to 80 ml
Hospital stay: 1 to 2 nights
Catheter: 1 to 3 days
Ejaculation: Dry orgasm in half or more
Retreatment by 5 years: About 5 to 6%
Rezum water vapour
Prostate size: 30 to 80 ml, no middle lobe
Hospital stay: Day case
Catheter: 3 to 7 days
Ejaculation: Usually preserved
Retreatment by 5 years: About 4.4%
UroLift implants
Prostate size: Under 80 ml
Hospital stay: Day case
Catheter: Often none
Ejaculation: Preserved
Retreatment by 5 years: About 13.6%
In short, HoLEP gives the most complete and durable opening, while Rezum and UroLift protect ejaculation in smaller glands. So if keeping ejaculation matters most and your prostate is under 80 ml, read about Rezum water vapour therapy as well.
HoLEP or robotic simple prostatectomy?
For very large glands, some centres still use open or robotic simple prostatectomy. HoLEP removes the same tissue without any abdominal cut, so the stay and the catheter time are usually shorter. Robotic surgery remains the right choice when the prostate has cancer, as explained on the robotic prostatectomy page.
How HoLEP is done
HoLEP takes place under general or spinal anaesthesia. The operation usually lasts about one to two hours, depending on the size of the prostate.
Enucleation
First, the laser separates the inner prostate from its capsule along a natural plane. Because the laser seals small vessels at the same time, bleeding tends to stay low.
Morcellation
Next, the freed lobes drop into the bladder. Then a morcellator cuts them into small pieces and suctions them out through the telescope.
Protecting continence
The muscle that keeps you dry lies just below the prostate. So Assoc. Prof. Taş takes particular care at this point, which lowers the risk of leakage after surgery.
Pathology
Finally, all the removed tissue goes to the laboratory. You receive the pathology report, usually within a week, together with your operation note.
Your HoLEP surgery in Istanbul
The whole trip usually fits into four to five days. Furthermore, you agree every step with Assoc. Prof. Taş before you book a flight.
01
Consultation and tests
First, he reviews your symptoms and repeats the key tests in Istanbul. Then he confirms that HoLEP suits your prostate.
02
Pre-operative checks
Next, routine blood tests, an ECG and an anaesthesia review take place, often on the same day. He also plans any blood thinners with you.
03
The operation
Then he performs HoLEP under anaesthesia. Afterwards, a catheter rinses the bladder while the raw surface settles.
04
Catheter removal and discharge
Finally, most men stay one night, and the catheter usually comes out after about a day. Before you fly, he checks that you pass urine well.
How long to stay in Istanbul
Plan about four to five days in total. In addition, allow an extra day or two if the catheter needs to stay longer.
Recovery after HoLEP
Most men notice a stronger stream as soon as the catheter comes out. However, the inside of the prostate takes several weeks to heal, so some symptoms settle gradually.
Catheter removal
After about 1 day
Flying home
After about 3 to 5 days
Desk work
After about 1 to 2 weeks
Driving
After about 1 to 2 weeks
Sex
After about 3 to 4 weeks
Heavy lifting, gym and cycling
After about 4 weeks
Urgency and stinging settle
Usually within 6 to 12 weeks
Simple steps that help
Drink steadily: about 2 litres of water a day keeps the urine light.
Avoid straining: treat constipation early, because pushing can restart bleeding.
Pelvic floor exercises: start them as advised to speed up control.
Expect small clots: light bleeding in the second or third week is common and usually stops with fluids.
Results you can expect after HoLEP
Because HoLEP removes the whole blocking part of the prostate, the stream usually becomes strong straight away. Most men also empty the bladder far better than before.
Night-time trips and urgency
Night-time trips usually fall over the following weeks. However, a bladder that has pushed against a blockage for years can stay overactive. So urgency sometimes takes a few months to settle.
How long the result lasts
The result is usually lasting. In fact, only about 1 to 2% of men need further treatment within five years. That rate is lower than after TURP or the less invasive methods.
PSA after HoLEP
Since the inner prostate makes much of the PSA, the level usually falls after HoLEP. Therefore, a new baseline a few months later makes future prostate checks easier to read.
Risks of HoLEP
HoLEP is a well-established operation. Even so, every surgery carries some risk, and he explains your own risks before you consent.
Dry orgasm: about 3 in 4 men no longer release semen at climax, because it flows into the bladder. Orgasm itself still happens.
Temporary leakage: some men leak a little when they cough or lift in the first weeks. In most cases, it improves with pelvic floor exercises.
Urgency and stinging: common while the area heals, and they usually fade within weeks.
Bleeding: uncommon, because the laser seals vessels as it works.
Infection: uncommon, and treated with antibiotics.
Narrowing: rarely, scar tissue narrows the urethra or the bladder neck and needs a small procedure.
Erections usually stay the same as before surgery. Moreover, HoLEP rarely needs repeating, since it removes the whole blocking part of the gland.
How much does HoLEP cost in Turkey?
HoLEP with Assoc. Prof. Taş in Istanbul typically costs $4,000 to $7,000, including the hospital stay. The final figure depends on your prostate and your health. So he confirms a personal written quote after the tests.
HoLEP laser enucleation
Istanbul, Assoc. Prof. Taş: $4,000 to $7,000
United States: $12,000 to $20,000
United Kingdom: $9,800 to $14,000
Bipolar TURP
Istanbul, Assoc. Prof. Taş: $2,500 to $4,500
United States: $7,500 to $19,000
United Kingdom: $8,800 to $12,200
Rezum water vapour
Istanbul, Assoc. Prof. Taş: $3,000 to $5,000
United States: $8,000 to $15,000
United Kingdom: $5,100 to $7,000
These are typical self-pay ranges in US dollars from October 2026. Your quote covers tests, surgery, fees, the hospital stay and pathology, and the coordinator arranges accommodation and transfers.
Travelling from the US, Canada or the UK
HoLEP is a planned operation, so you can organise the trip calmly. Still, a few steps keep your care joined up with your doctor at home.
Before you fly
Bring recent PSA results, ultrasound reports and a list of your medicines.
Ask your doctor at home how to pause any blood thinners, and share the plan with Assoc. Prof. Taş.
If you already have a catheter, bring spare bags and a letter for airport security.
On the flight home
Walk the aisle every hour and drink water regularly. Also, choose an aisle seat, because you may need the toilet more often in the first weeks.
Back home
You leave with an operation note, the pathology report and a recovery plan in English. Then your family doctor can follow your progress and repeat a urine test if needed.
Why patients choose Assoc. Prof. Tuncay Taş
Assoc. Prof. Dr. Tuncay Taş is a urologist with more than 20 years of experience. He also founded Safe Urology Clinic in Istanbul, and patients travel to him from over 60 countries.
Medical degree from Istanbul University School of Medicine, 2004
Urology residency at the University of Health Sciences, Taksim Training and Research Hospital
Fellowship in urological oncology and laparoscopic urology, Heidelberg University, Germany
Treatment in JCI-accredited partner hospitals in Istanbul
Member of the European Association of Urology and the Endourological Society
He has also published research on endoscopic prostate surgery, including bipolar transurethral vaporisation for BPH. Read his full background on the About Us page.
Frequently asked questions
Is HoLEP better than TURP?
For large glands, HoLEP removes more tissue and rarely needs repeating. For small glands, both work well, so the choice depends on your priorities.
Does HoLEP work for a very large prostate?
Yes. HoLEP removes glands of any size through the urethra, including those above 80 ml.
How long does the catheter stay after HoLEP?
Usually about one day. A very large gland or bleeding can extend it to two or three days.
Will I still have orgasms after HoLEP?
Yes. Orgasm stays, but about 3 in 4 men have a dry orgasm because semen flows into the bladder.
Does HoLEP cause erectile dysfunction?
Usually not. Erections tend to stay the same as before surgery, and some men notice no change at all.
Will I leak urine after HoLEP?
Some men leak a little in the first weeks, and in most cases it improves with pelvic floor exercises.
Can I have HoLEP if I take blood thinners?
Often yes, because the laser seals vessels, but the plan needs agreement with your cardiologist.
Does HoLEP remove the whole prostate?
No. It removes the inner, blocking part and leaves the outer shell, so it is not a cancer operation.
How much does HoLEP cost in Turkey?
HoLEP with Assoc. Prof. Taş typically costs $4,000 to $7,000, including the hospital stay.
How long should I stay in Istanbul for HoLEP?
Plan about four to five days, plus a day or two if the catheter needs to stay longer.
Sources and further reading
The medical facts on this page follow public health guidance. For general background, see these pages.
This page informs and does not replace an in-person medical consultation. So treatment decisions always follow your own examination and test results.
Talk to Assoc. Prof. Taş about HoLEP
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