HoLEP in Turkey: What International Patients Should Know

The prostate can be pictured as an orange: an outer peel and an inner pulp. In benign enlargement it is the pulp that grows and compresses the urinary channel.

A traditional TURP shaves tissue away from the inside of that pulp. HoLEP instead separates the whole pulp from the peel using a holmium laser, pushes it into the bladder, and then breaks it up there for removal. The outer capsule stays in place.

Because the obstructing tissue is removed completely rather than partially, the improvement in urinary flow tends to be more durable and the likelihood of needing a repeat procedure years later is lower. For a patient who has travelled a long distance, that durability is a significant part of the argument.

With TURP, the larger the prostate, the longer the operation and the more fluid is absorbed, which eventually sets a practical ceiling. Beyond that ceiling, open surgery used to be the only option.

HoLEP does not have the same ceiling. A very large prostate can be treated with the same technique as a moderate one. This is why men with large glands, who in the past would have been offered an open operation, are now frequently treated endoscopically.

If your prostate is large, the real decision is between enucleation and open surgery — not between brands of laser.

Bleeding tends to be well controlled during enucleation because vessels are sealed as the tissue plane is developed. This is relevant for men taking anticoagulants, and it is relevant for anyone planning a flight home.

Blood thinners still need to be managed individually before surgery. Do not stop any medication on your own; send your full medication list when you make your enquiry so that the plan can be made before you travel.

After the obstructing tissue is removed, continence depends entirely on the external sphincter, which previously had help from the prostatic mechanism. That muscle needs time to adapt, and in the meantime some leakage is common.

In most men this settles over weeks. Pelvic floor exercises help, and they are easier to learn before the operation than after it.

This should be discussed openly before you book a flight. It is manageable and usually temporary, but discovering it on the plane home is a poor way to find out.

After the prostate tissue is removed, semen commonly passes backwards into the bladder instead of outwards. It is harmless and does not affect erections or sexual desire, but it does affect fertility and some men find it unwelcome.

If you still wish to father children, say so clearly at the consultation stage. It changes which options should be considered.

A realistic plan allows for arrival and pre-operative tests, the procedure, a short hospital stay, a period with the catheter, catheter removal, and a review appointment before flying.

The catheter is usually removed before you leave, so that any problem passing urine is dealt with here rather than at home. Do not plan a flight for the day after catheter removal; leave room for a check.

Build in a margin. A plan with no spare days turns a minor delay into a crisis, and pushes patients towards flying before they should.

A recent PSA result, an ultrasound or other imaging giving prostate volume, a uroflowmetry result and post-void residual measurement if available, your full medication list including anticoagulants, and a summary of other medical conditions.

With these, you can be told before you buy a ticket whether HoLEP is the appropriate procedure for you — or whether something else fits your situation better. An honest answer at that stage is worth more than a quick booking.

This article is general information and does not replace medical advice.