Benign Prostate Enlargement Treatment in Türkiye: HoLEP, TURP and Other Options

A weak urine stream, difficulty starting to urinate, urgency, frequency and repeated night-time trips to the toilet may be related to benign prostate enlargement. The same symptoms can also arise from a urinary infection, bladder stone, overactive bladder, urethral stricture, diabetes, neurological disease or certain medicines. Choosing treatment from age, prostate size or one PSA result alone is therefore not advisable.

For someone travelling from Europe to Türkiye for HoLEP, TURP or another prostate procedure, the central question should not be “Which device is newest?” It should be “Has the cause of my symptoms been confirmed, and which option best fits my anatomy, health and priorities?” Prostate volume, the presence of a middle lobe, bladder function, residual urine, blood-thinning medication, anaesthetic fitness, previous procedures, sexual priorities and fertility plans may all change the recommendation.

This Clinicly guide provides general information. An examination and personalised assessment by a qualified urologist are recommended before changing medication or deciding on a procedure.

What is benign prostate enlargement?

The prostate is a gland located below the bladder and around the first part of the urethra. It can enlarge with age. Benign prostate enlargement, also called BPE or BPH, refers to non-cancerous growth. Benign prostatic obstruction means that the enlargement is actually restricting urine flow. A large prostate may produce few symptoms, while a smaller gland can sometimes cause considerable obstruction.

Benign enlargement is not prostate cancer and does not by itself mean that cancer is present. The two conditions can nevertheless occur in the same person, so possible cancer may need a separate assessment. A raised PSA is not a cancer diagnosis on its own. It is best interpreted alongside age, prostate volume, infection, recent procedures, examination findings and, when advised, imaging or biopsy.

Which symptoms may occur?

Symptoms may be grouped as follows:

• Voiding symptoms: weak or intermittent flow, hesitancy, straining, prolonged urination and a feeling that the bladder has not emptied.
• Storage symptoms: frequency, urgency, waking at night to urinate and sometimes leakage.
• Post-void symptoms: dribbling and needing to urinate again shortly afterwards.

Symptom severity does not always match prostate size. Disturbed sleep, avoiding travel, organising daily life around toilets or repeated episodes of retention may be important when considering treatment.

Which symptoms may require prompt assessment?

An inability to pass urine, urinary symptoms with fever or shaking chills, heavy or clotted bleeding, severe side or back pain, marked weakness, confusion or suspected kidney impairment may require urgent assessment. It is advisable to seek local emergency care rather than wait for planned medical travel.

Which tests may be advised before treatment?

A reliable plan should not rely only on the prostate volume shown on an ultrasound report. A urologist may recommend some or all of the following:

• A detailed history, symptom severity and effect on daily life, sometimes using a standard symptom score.
• Review of medicines, especially anticoagulants, antiplatelets and drugs that may affect urination.
• Physical examination and, when appropriate, a digital rectal examination.
• Urinalysis and a culture if infection is suspected.
• PSA and kidney-function tests where clinically indicated.
• Urine-flow testing and measurement of urine left in the bladder after voiding.
• Ultrasound assessment of prostate volume and anatomy.
• Cystoscopy when bleeding, narrowing or bladder disease is suspected.
• Urodynamic testing in selected cases when bladder-muscle function is uncertain.

Removing prostate tissue may not resolve every symptom in a patient who has used a catheter for a long time, has a neurological condition or retains a large amount of urine. Separate assessment of bladder function may therefore be recommended.

Does every enlarged prostate require surgery?

No. If symptoms are mild and there is no concerning effect on the kidneys, bladder or infection risk, monitoring and lifestyle measures may be considered. Carefully adjusting evening fluids, reducing excess caffeine and alcohol, preventing constipation, supporting a healthy weight and reviewing medicines that may worsen symptoms can help some patients. Excessive fluid restriction is not advisable because it can contribute to dehydration and infection.

For moderate or severe symptoms, a clinician may discuss alpha-blockers, medicines intended to reduce prostate growth over time or treatments for bladder-storage symptoms. Blood pressure, possible sexual side effects, prostate size, other illnesses and existing medicines should inform the choice. Starting or stopping these medicines without medical advice is not recommended.

When might a procedure be considered?

Interventional treatment may be discussed when symptoms continue to disrupt quality of life despite medication, or when there is recurrent or persistent urinary retention, repeated infection, bladder stones, treatment-resistant bleeding from the prostate, or an effect on the kidneys and upper urinary tract. A procedure should not be recommended simply because an imaging report says the prostate is enlarged.

What is HoLEP?

Holmium laser enucleation of the prostate, or HoLEP, is an endoscopic operation. A holmium laser is used to separate obstructing prostate tissue from the surgical capsule. The tissue is moved into the bladder, divided into smaller pieces and removed. There is no skin incision, and the removed tissue can usually be sent for laboratory examination.

HoLEP may be considered across a wide range of prostate sizes. Its quality depends on more than the availability of a laser platform: procedure-specific surgeon experience is particularly important. Patients may wish to ask about the surgeon’s direct HoLEP volume, experience with prostates similar to theirs, management of bleeding and temporary leakage, and access to support if an unexpected problem occurs.

What is TURP?

Transurethral resection of the prostate, or TURP, removes obstructing tissue in small pieces using an instrument passed through the urethra. It is a well-established endoscopic operation. Monopolar and bipolar techniques may be available. Prostate size, anatomy, equipment, surgeon experience and the patient’s health influence whether it is appropriate.

Tissue removed during TURP can usually be examined by a pathologist. The operation does not remove the whole prostate and is not the same as a radical prostatectomy performed for prostate cancer.

HoLEP versus TURP: what are the main differences?

It is not advisable to assume that laser surgery is always better or that TURP is sufficient for everyone. Prostate size, anatomy, bleeding risk, pathology needs, available equipment, surgeon experience and personal priorities should be considered together.

Which other treatments may be discussed?

Depending on the assessment, alternatives may include:

• TUIP: incisions can widen the bladder outlet in selected men with a small prostate and suitable anatomy.
• Laser vaporisation: prostate tissue is vaporised; its bleeding profile may be useful in selected situations, although less tissue may be available for pathology.
• ThuLEP or bipolar enucleation: the same broad anatomical principle as HoLEP may be performed with other energy systems.
• Prostatic urethral lift or water-vapour therapy: minimally invasive options for selected anatomy; possible preservation of ejaculation should be balanced against the degree of symptom relief and the chance of future retreatment.
• Aquablation or other water-jet techniques: suitability may depend on prostate anatomy, evidence, local availability and team experience.
• Prostatic artery embolisation: an interventional radiology option for selected patients; it should not be assumed to produce the same result as tissue-removing surgery.
• Simple prostatectomy: an open, laparoscopic or robot-assisted approach may be considered for a very large prostate and should be compared with endoscopic enucleation where available.

A treatment being newer or described as minimally invasive does not automatically make it safer, more durable or suitable for every patient. Anatomy, evidence, expected symptom relief, sexual priorities, retreatment risk and the centre’s experience all matter.

What should patients know about sex and fertility?

After HoLEP or TURP, semen may pass backwards into the bladder instead of leaving through the penis. This is called retrograde ejaculation. Orgasm may still be felt, but little or no semen outside the body can affect natural fertility. Patients who may want children in the future are advised to discuss fertility preservation, including possible semen storage, before treatment.

Changes in erectile function, continence and the experience of orgasm vary. Claims that sexual function will definitely remain unchanged—or will definitely deteriorate—are not reliable. Baseline sexual health, medicines, age, vascular health and the selected procedure should be discussed individually.

What are the possible risks?

The risk profile differs between procedures and patients. Possible issues after HoLEP or TURP include:

• Blood in the urine, clots and, less commonly, a need for further intervention or blood support.
• Urinary infection.
• Temporary inability to pass urine after catheter removal.
• Burning, urgency, frequency or temporary leakage.
• Less commonly, persistent incontinence.
• Urethral stricture or narrowing at the bladder neck.
• Retrograde ejaculation and an effect on fertility.
• Incomplete symptom relief or a future need for another treatment.
• General anaesthetic, cardiovascular and clotting risks associated with surgery.

Personal risk may change with prostate volume, existing infection, catheter use, blood-thinning treatment, diabetes, heart or lung disease and the surgeon’s experience with the chosen method.

What if the patient uses blood thinners?

Anticoagulants or antiplatelet medicines should not be stopped without a medical plan. The reason for the medicine, the danger of a clot, kidney function and the proposed procedure should be reviewed by the urologist, anaesthetic team and, where needed, the relevant cardiology or medical team. A laser approach may offer a favourable bleeding profile for some patients, but blood-thinner use does not automatically make HoLEP suitable.

What may recovery involve?

A temporary urinary catheter and bladder irrigation may be needed. After catheter removal, burning, urgency, frequency and some blood in the urine can occur. These symptoms may improve gradually; the pace depends on the procedure, prostate size, bladder health and general condition.

Before discharge, the team should assess urination, bleeding, pain, temperature and general wellbeing. Unless the treating team advises otherwise, adequate hydration, avoiding constipation and straining, and following individual instructions on lifting, strenuous exercise, cycling and sexual activity are recommended.

Which symptoms may require emergency care after discharge?

Urgent assessment is advisable for an inability to pass urine, increasing bleeding with large clots, high temperature or shaking chills, worsening pain, fainting, chest pain, sudden breathlessness or painful swelling in one leg. In Türkiye, emergency services can be reached on 112; after returning home, patients should use the emergency system in their country.

How long should a patient stay in Türkiye, and when might flying be advised?

There is no single safe timetable for everyone. Catheter duration, bleeding, ability to empty the bladder, the pathology plan, other health conditions and flight length should all be considered. A return ticket should not be based only on the shortest package stay.

Before flying, it is sensible to confirm:

• Whether the catheter has been removed, or whether there is a written plan for travelling with it.
• Whether voiding and residual urine have been assessed.
• Whether bleeding is controlled.
• Whether there are signs of infection, urinary retention or a clot.
• Whether a medicine list and urgent contact details have been supplied.
• Whether mobility, hydration and clot-prevention advice for the journey has been personalised.

What may affect the cost of HoLEP or TURP in Türkiye?

One fixed price is not reliable for every patient. A quotation may be affected by:

• Consultation, laboratory work, imaging, cystoscopy or other tests.
• The chosen procedure and technology.
• The surgeon’s procedure-specific experience and the level of the hospital.
• Anaesthesia, operating theatre, admission and catheter management.
• Pathology and the appointment to explain the result.
• Extra nights, unplanned treatment or complication care.
• Interpreting, transfers, accommodation and companion arrangements.
• Remote and local follow-up after returning to Europe.

Patients are advised to obtain a written explanation of inclusions, exclusions, cancellation or plan-change rules, and financial responsibility if a complication occurs.

Questions to ask the surgeon and healthcare provider

1. How was it confirmed that my symptoms are caused by prostate obstruction?
2. How do my prostate volume and middle-lobe anatomy affect the choice?
3. Why is medication, monitoring or a less invasive procedure suitable or unsuitable for me?
4. How many procedures of the recommended type have you personally performed?
5. What are the separate benefits and risks of HoLEP, TURP and other reasonable alternatives in my case?
6. How do you assess retrograde ejaculation, erections, leakage and retreatment risk for me?
7. Will tissue be sent for pathology, and who will explain the result?
8. When might the catheter be removed, and what is the plan if I cannot urinate?
9. How long am I advised to remain in Türkiye and when may I fly?
10. Who is my first contact after I return to Europe?
11. Which tests, medicines, admission costs and possible extra care are included in the quotation?
12. How are responsibility and cost managed if an urgent problem or revision is needed?

How may Clinicly support the treatment journey?

As an international health-tourism intermediary, Clinicly may support secure record transfer to a suitable urology team, appointment coordination, comparison of written proposals, interpreting, transfers, accommodation and follow-up communication. The Clinicly guide to urology treatments in Türkiye provides a broader overview. Patients may also review the available urology treatment category and the guide to planning treatment in Türkiye with Clinicly.

Clinicly does not diagnose, prescribe medicines, select an operation or guarantee an outcome. Medical suitability, treatment decisions, informed consent and clinical follow-up remain the responsibility of the authorised healthcare provider and clinicians who assess the patient.

Frequently asked questions

Is HoLEP definitely better than TURP?

No. HoLEP may be an effective option across different prostate sizes and may offer perioperative advantages for some patients. TURP is a well-established and widely available standard. The appropriate option depends on anatomy, bleeding risk, surgeon experience and personal priorities.

Is HoLEP the only option for a very large prostate?

HoLEP may be considered, but bipolar or thulium enucleation, simple prostatectomy and selected other approaches may also be relevant. The patient’s condition and the centre’s genuine experience should be compared.

Do HoLEP or TURP treat prostate cancer?

These operations are generally used to relieve benign obstruction and do not remove the whole prostate. Unexpected cancer can occasionally be identified in the tissue, in which case further assessment may be needed. Suspected cancer requires its own diagnostic and treatment pathway.

Is a catheter always required?

A temporary catheter is commonly used after endoscopic prostate surgery. Its duration varies with the procedure, bleeding, bladder function and the patient’s ability to urinate.

Can retrograde ejaculation be permanent?

Yes, it may be common and persistent after HoLEP or TURP. Anyone with future fertility plans is advised to discuss this before treatment.

Will erectile function necessarily worsen?

No. However, baseline sexual health, vascular disease, medicines and the surgical course may influence the outcome. Individual discussion with the urologist is recommended.

How long does urinary leakage last?

Temporary urgency or leakage may occur and can improve with time. Duration varies. Ongoing or severe leakage may require urological review and appropriate rehabilitation.

Can prostate tissue grow again?

New symptoms can develop in later years. Regrowth is one possible explanation, but bladder dysfunction, narrowing or another condition may be responsible. Recurrent symptoms should be reassessed rather than presumed to have one cause.

Which documents should be collected before leaving Türkiye?

Patients are advised to obtain a discharge summary, operative and anaesthetic reports, details of the technique used, medicine list, catheter instructions, pathology plan, urgent contact information and a written follow-up schedule.

Is a local urologist needed after returning to Europe?

Arranging follow-up with a local urologist or primary-care doctor may improve continuity. Responsibility for reviewing pathology, urine flow, residual urine, infection and ongoing symptoms should preferably be agreed before travel.

Conclusion

HoLEP, TURP and other options may be available in Türkiye for benign prostate enlargement, but the decision should not be based on a technology name or package price alone. The cause and degree of obstruction should first be confirmed, and the prostate and bladder assessed together. Sexual function, fertility, bleeding, retreatment, surgeon experience, pathology and follow-up in Europe deserve a clear discussion. Clinicly may support organisation and communication; personalised medical advice and the final treatment decision should come from the authorised urology team.