HoLEP Surgery for Benign Prostatic Hyperplasia

What Is HoLEP?

HoLEP (Holmium Laser Enucleation of the Prostate) is an advanced surgical technique used to treat benign prostatic hyperplasia (BPH). During this procedure, enlarged prostate tissue is completely removed using a holmium laser.

The HoLEP technique involves carefully separating the enlarged prostate tissue from inside the bladder and then removing it after it has been fragmented using a device called a morcellator. As a minimally invasive procedure, HoLEP offers significant advantages over open surgery, including reduced blood loss, a shorter hospital stay, and faster recovery. Today, it is considered one of the most effective and durable surgical treatments for benign prostate enlargement.

When Is HoLEP Surgery Recommended?

HoLEP surgery is recommended for men whose urinary symptoms persist despite medical treatment and significantly affect their quality of life.

This procedure is particularly suitable for patients experiencing severe urinary obstruction, frequent urination, nocturia (nighttime urination),difficulty urinating, or incomplete bladder emptying. HoLEP is also recommended for individuals with recurrent urinary tract infections, bladder stones, or impaired kidney function caused by an enlarged prostate.

HoLEP is especially notable because it can be safely performed even in patients with very large prostates, making it an important advantage over many other surgical techniques.

• Significant urinary obstruction caused by benign prostatic hyperplasia (BPH)
• Frequent urination, nocturia, or difficulty urinating that negatively affects quality of life
• Residual urine in the bladder or the presence of bladder stones
• Recurrent urinary tract infections
• Failure of medication to adequately control prostate enlargement symptoms
• Acute urinary retention (inability to urinate)
• Kidney function impairment related to prostate enlargement
• When a minimally invasive alternative to open prostate surgery is preferred
• Patients at increased surgical risk due to heart disease or the use of blood-thinning medications

What Are the Advantages of HoLEP Surgery?

HoLEP surgery offers numerous advantages compared with traditional surgical techniques. One of its greatest benefits is the complete removal of the enlarged prostate tissue, which significantly reduces the likelihood of recurrence. In addition, the holmium laser simultaneously cuts and seals blood vessels, resulting in minimal bleeding and faster postoperative recovery.

Compared with open surgery, HoLEP is associated with less postoperative pain, a shorter hospital stay, and a faster return to normal daily activities. It also provides excellent long-term urinary control and significantly improves patients' quality of life.

HoLEP Surgery for Benign Prostatic Hyperplasia

HoLEP has become the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). Compared with other surgical options, it offers lower complication rates and superior long-term functional outcomes.

HoLEP is particularly effective and safe for patients with large prostate volumes. By removing the obstructing prostate tissue, it improves urine flow, allows the bladder to empty more efficiently, and substantially relieves urinary symptoms. In many cases, it also eliminates the need for long-term medication.

How Is HoLEP Surgery Performed for Benign Prostatic Hyperplasia?

HoLEP surgery is an advanced surgical procedure used to treat benign prostatic hyperplasia (BPH),allowing complete endoscopic removal of the enlarged prostate tissue. The procedure is performed under either spinal or general anesthesia. During the operation, the surgeon uses a specialized instrument called a resectoscope, which is inserted through the urethra to access the bladder and prostate.

Using holmium laser energy, the enlarged inner portion of the prostate (adenoma) is carefully separated from the surrounding prostate capsule and removed as a single piece. The detached tissue is then pushed into the bladder.

The enucleated prostate tissue is subsequently fragmented into smaller pieces using a device called a morcellator and removed from the bladder. Since the HoLEP technique for prostate treatment removes the entire adenoma, similar to open prostate surgery, it provides long-lasting symptom relief with a very low recurrence rate. The risk of significant bleeding during the procedure is minimal because the holmium laser simultaneously cuts and coagulates blood vessels. HoLEP is considered a safe and highly effective treatment option even for patients with very large prostates.

A urinary catheter is usually placed temporarily after surgery and is typically removed within a few days. Most patients are discharged within 24–48 hours after the procedure. Recovery is generally rapid, and most men regain normal urinary flow and bladder emptying within a short period.

Recovery After HoLEP Surgery for Enlarged Prostate

Recovery after HoLEP surgery is generally quick. Most patients are discharged within 24 to 48 hours and can return to their normal daily activities within a few days. Mild blood in the urine during the first few days is normal and usually resolves on its own. Temporary symptoms such as burning during urination or increased urinary frequency may also occur but generally improve within several weeks. Patients are advised to avoid strenuous physical activity and heavy lifting for several weeks. Follow-up appointments are scheduled to monitor the healing process and ensure optimal recovery.

Who Is a Good Candidate for HoLEP Surgery?

HoLEP surgery is particularly recommended for men over the age of 60 who have not achieved sufficient symptom relief with medication or who experience side effects from medical therapy. It is also an ideal treatment option for patients with significantly enlarged prostates or complications such as bladder stones and urinary retention. In addition, HoLEP can be safely performed in patients with cardiovascular disease or those taking anticoagulant (blood-thinning) medications, as the procedure involves minimal bleeding.

HoLEP Surgery Cost for Enlarged Prostate (2026)

The cost of HoLEP surgery varies depending on several factors, including the hospital, the surgeon's experience, the city, and the healthcare system in the country where the procedure is performed. While treatment at private hospitals may be more expensive, procedures performed in public hospitals or under national health insurance programs may be more affordable.

Because HoLEP requires advanced laser technology and an experienced surgeon, it may be more expensive than some alternative procedures. However, its excellent long-term outcomes and low likelihood of requiring repeat surgery often make it a cost-effective option over time. The cost of HoLEP surgery for benign prostatic hyperplasia in 2026 is expected to range between TRY 150,000 and TRY 300,000.

Things to Consider After HoLEP Surgery for Enlarged Prostate

After HoLEP surgery for prostate treatment, maintaining adequate fluid intake is essential to help flush the bladder and urinary tract. Patients should avoid heavy physical activities, sexual intercourse, and activities that place pressure on the bladder, such as cycling, for several weeks. If blood-thinning medications were discontinued before surgery, they should only be restarted according to the physician's recommendations. Mild burning during urination and urinary urgency are common after surgery and are usually temporary. However, patients should contact their physician if symptoms become severe or persist.

• Drink plenty of fluids: It is recommended to drink at least 2–2.5 liters of water per day to help keep the urinary tract clear and flush out any blood clots.
• Avoid strenuous physical activity: Heavy lifting, exercise, and physically demanding work should be avoided for the first 2–4 weeks.
• Avoid sexual intercourse: Sexual activity is generally not recommended for approximately 3–4 weeks after surgery.
• Monitor your urine: Mild blood in the urine is normal during the early recovery period; however, excessive bleeding or blood clots should be reported to your physician immediately.
• Prevent constipation: Eat a high-fiber diet and use stool softeners if necessary to avoid straining during bowel movements.
• Take medications as prescribed: Antibiotics, pain relievers, and any other prescribed medications should be taken exactly as directed by your physician.
• Catheter care: If a urinary catheter is placed after surgery, keep it clean and follow your physician's instructions regarding its removal.
• Be patient during recovery: Improvements in urinary flow and complete resolution of symptoms may take several weeks.
• Attend follow-up appointments: Do not miss your scheduled postoperative check-ups.
• Burning during urination: Mild burning is common during the first few days after surgery. However, severe or persistent symptoms should be evaluated by your physician.

Are There Any Risks Associated with HoLEP Surgery?

As with any surgical procedure, HoLEP surgery carries certain risks. These may include temporary urinary incontinence, short-term difficulty urinating, urinary tract infection, and, in rare cases, bleeding. However, these complications are uncommon and are usually temporary. Because holmium laser technology causes minimal damage to surrounding tissues, the risk of nerve injury is extremely low. When performed by experienced surgeons, HoLEP has a very low complication rate.

Are There Any Side Effects of HoLEP Surgery?

The most common side effect is temporary urinary incontinence, which usually resolves within a few weeks. Another common outcome is retrograde ejaculation, in which semen flows backward into the bladder instead of exiting through the urethra. This condition is harmless and does not affect sexual performance. In rare cases, urinary tract infections or bladder spasms may occur. Overall, HoLEP generally has a positive impact on sexual function because relieving urinary symptoms significantly improves quality of life.

How Long Does HoLEP Surgery Take?

The duration of HoLEP surgery depends on the size of the prostate but generally ranges between 60 and 120 minutes. Procedures for smaller prostates are typically shorter, while surgery for larger prostates may take longer. Despite the duration, bleeding and complication rates remain low. In experienced centers, both operative time and success rates continue to improve.

Sexual Function After HoLEP Surgery

Sexual life after HoLEP surgery is generally affected positively. Relief of urinary symptoms often improves self-confidence and makes returning to sexual activity easier. Patients are usually advised to avoid sexual intercourse for the first few weeks after surgery. Although some men experience changes in ejaculation, erectile dysfunction is uncommon. Clinical studies suggest that HoLEP has either a neutral or positive long-term effect on sexual function.

Is the Patient Under General Anesthesia During HoLEP Surgery?

Yes. HoLEP surgery is typically performed under either general anesthesia or spinal anesthesia. The choice of anesthesia depends on the patient's overall health, age, and suitability for the selected anesthetic technique. Patients do not experience pain during the procedure, and postoperative pain is generally minimal.

Differences Between HoLEP and TURP

Before the widespread adoption of HoLEP, TURP (Transurethral Resection of the Prostate) was the most commonly performed surgical treatment for benign prostatic hyperplasia. Compared with TURP, HoLEP is less invasive and provides excellent outcomes even in patients with very large prostates. While TURP removes prostate tissue using electrical energy, HoLEP utilizes holmium laser technology, resulting in significantly less bleeding.

Repeat surgery is more commonly required after TURP, whereas HoLEP provides more durable long-term results. Additionally, the prostate tissue removed during HoLEP is retrieved in a more complete form, allowing for a more comprehensive histopathological examination. In contrast, tissue obtained during TURP is removed in smaller fragments, which may limit pathological assessment.