ThuLEP (Thulium Laser Enucleation of the Prostate)
An endoscopic method in which the obstructing tissue of an enlarged prostate is enucleated whole with a thulium laser.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 60–120 minutes
- Anesthesia
- General or spinal anesthesia
- Hospital stay
- 1 night
- Stay in Türkiye
- 5–7 days
- Catheter duration
- 1–2 days
- Return to work
- 2–3 weeks
- Flight clearance
- From day 7
About the condition
Benign prostatic enlargement (BPH) is the age-related growth of prostate tissue that compresses the urinary channel from outside. The most common complaints are a weak stream, difficulty starting, waking several times at night and a feeling that the bladder does not empty fully. In advanced cases, inability to pass urine (retention), recurrent urinary tract infection or bladder stones may develop.
ThuLEP is an endoscopic operation in which the obstructing prostate tissue is separated from its capsule with a thulium laser and removed AS A WHOLE. No incision is made in the body; the entire procedure is performed through the urinary channel. Whereas classic TURP shaves the tissue away in small chips, enucleation peels the obstructing tissue off in one piece — applying the logic of open prostate surgery through a closed approach.
The thulium laser emits a continuous wave; it cuts tissue while sealing small vessels at the same time. Because this makes bleeding easier to control, the method can be preferred in large-volume prostates and in selected patients who require caution because of blood-thinning medication.
The enucleated tissue is reduced inside the bladder with a device called a morcellator, removed, and sent for PATHOLOGICAL EXAMINATION. This is an important difference from methods that vaporise the tissue: if an unexpected focus of cancer is present, the diagnosis is not missed.
ThuLEP and HoLEP are not different operations; both perform the same task, separating the obstructing inner portion of the prostate from its capsule as a whole and removing it (enucleation). The difference lies in the type of laser used. Their results are comparable, and which system a surgeon works with most is more telling than the make of the laser.
The situation in which this method comes to the fore is a large prostate: in conventional techniques a practical ceiling appears as the gland grows, whereas enucleation has no such ceiling because the gland can be removed completely. The removed tissue can also be examined pathologically, which allows an unsuspected cancer to be identified.
Our surgeon’s own publication in this field
ThuLEP is an area our clinic works in. The peer-reviewed paper below evaluates intraoperative and postoperative complications in a series of 42 consecutive cases. It is cited here for reference only; no outcome or success rate is presented as a promotional claim.
Ergün M, Sağır S, Hacıbey İ. ThuLEP technique for managing benign prostatic hyperplasia: Intraoperative and postoperative complications in a series of 42 consecutive cases. Journal of Surgery and Medicine, 2025.
Who is it suitable for?
May be suitable
- Patients with a medium or large prostate who do not benefit sufficiently from medication
- Patients who cannot continue medication because of side effects
- Patients with recurrent urinary retention or who have become catheter-dependent
- Patients who develop recurrent urinary tract infection or bladder stones due to prostate enlargement
- Selected patients requiring caution over bleeding control, where the surgeon judges the method suitable
May not be suitable
- Patients with an active urinary tract infection — the infection is treated first and surgery is postponed
- Patients in whom suspicion of prostate cancer has not yet been resolved — diagnostic work-up is completed first
- Patients whose symptoms arise from loss of bladder muscle function rather than obstruction may gain limited benefit
- Patients at high anesthetic risk because of comorbidities
- Patients planning to father children — retrograde ejaculation is possible and must be discussed before surgery
Technology used
- Quanta thulium laser platform
- Continuous-wave thulium: cutting and bleeding control at the same time
- Safe removal of tissue from the bladder with a morcellator
- All removed tissue sent for pathological examination
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remote
Pre-assessment
Your urinary flow test (uroflowmetry), IPSS symptom score, PSA value, prostate volume and post-void residual volume are reviewed, and the suitability of the method is assessed.
- Day 1
Arrival and tests
In-person examination, completion of any missing tests and anesthesia assessment.
- Day 2
Procedure
ThuLEP is performed under general or spinal anesthesia; it usually takes 60–120 minutes and requires no incision.
- Day 3
Catheter removal and discharge
The catheter is removed once the urine is clear; discharge is planned after you are seen to pass urine on your own.
- Day 7–10
Review and pathology
A follow-up examination is carried out, the pathology result is reviewed and clearance is given for the return flight.
Method comparison
| Criterion | ThuLEP | HoLEP | TURP | Rezūm |
|---|---|---|---|---|
| Suitable prostate volume | Any volume, especially large | Any volume, especially large | Small–medium | Small–medium |
| Tissue sent for pathology | Yes | Yes | Yes | No |
| Average catheter time | 1–2 days | 1–2 days | 2–3 days | Variable |
| Hospital stay | 1 night | 1 night | 1–2 nights | May be day-case |
| Effect on sexual function | Retrograde ejaculation common | Retrograde ejaculation common | Retrograde ejaculation common | Ejaculation less affected |
This table is for general information. The method is chosen individually after assessing prostate volume, comorbidities and the patient’s priorities.
Risks
- Temporary burning and sudden urgency when passing urine
- Temporary stress-type urinary leakage — in most patients it settles within weeks, and pelvic floor exercises support this
- Retrograde ejaculation: semen passing into the bladder rather than outward; it is common and affects fertility
- Urinary tract infection
- Urethral stricture or bladder neck contracture (less common; may require an additional procedure)
- Bleeding and general surgical risks related to anesthesia
Alternatives
- Medication (alpha blockers, 5-alpha reductase inhibitors)
- HoLEP — enucleation with a holmium laser
- TURP — classic endoscopic resection
- Rezūm — volume reduction with water vapour (in smaller prostates)
- Open (simple) prostatectomy — in very large prostates, increasingly rare
Recovery
First 48 hours
The catheter is in place. Plenty of fluids are advised; a slight pink tinge and sediment in the urine may be seen and is expected.
Week 1
The catheter has been removed. Burning and urgency on passing urine gradually decrease. Short walks are advised; heavy lifting and long car journeys are avoided.
Weeks 2–3
Improvement in urinary flow becomes clear. Returning to desk work is usually possible in this period. Pelvic floor (Kegel) exercises are continued.
Weeks 4–6
Any urinary leakage largely settles. Heavy physical activity and sexual intercourse await your surgeon’s approval.
Month 3
Results stabilise. At follow-up the IPSS score and uroflowmetry are repeated so the improvement is measured objectively.
Frequently asked questions
What is the difference between ThuLEP and HoLEP?
Both are enucleation methods that remove the obstructing prostate tissue as a whole; the difference is the laser used. HoLEP uses a holmium laser, ThuLEP a thulium laser. Because thulium emits a continuous wave, bleeding control during cutting is easier. From the patient’s point of view the process, recovery and expected outcomes are largely similar; the choice depends on the surgeon’s experience and the available equipment.
My prostate is very large — can a closed method still be used?
Yes. The main advantage of enucleation methods is that they can be used in large-volume prostates as well. Prostates of a size that once required open surgery can be treated with ThuLEP without an incision.
Will my sexual function be affected?
Erectile function is usually preserved. Retrograde ejaculation — semen passing into the bladder rather than outward — is, however, a common change. It is not harmful to health but it does affect fertility. If you plan to have children, we must discuss this before surgery.
How long does the catheter stay in?
Usually 1–2 days. The catheter is removed once the urine is clear, and you are discharged after you are seen to pass urine on your own. This period is occasionally longer.
I take blood thinners — can I have this operation?
Because the thulium laser makes bleeding control easier, ThuLEP can be considered in these patients. However, whether and how your medication is adjusted is decided together with the physician who follows you. Do not stop your medication on your own.
Is the removed tissue examined, and what if cancer is found?
Yes. In enucleation all removed tissue is sent for pathology. If an unexpected focus of cancer is found, a plan for further treatment or surveillance is prepared according to its stage and explained to you in detail.
Will the procedure need to be repeated?
Because enucleation removes the obstructing tissue as a whole, it aims for a durable result. Even so, no method can guarantee that repeat treatment will never be needed; regular follow-up is advised.
Will urinary leakage be permanent?
Leakage that may occur in the first weeks after surgery is temporary in most patients and improves gradually. Pelvic floor exercises support this. Permanent leakage is uncommon; the risk is discussed with you separately during pre-operative assessment.
When can I fly after the operation?
Clearance to fly is usually given after the follow-up examination, generally 7 days after the procedure. On long flights, movement and fluid intake are advised to reduce the risk of clots.
How many nights will I spend in hospital?
Usually one is enough. What determines your total stay in Turkey, however, is not the hospital admission but catheter removal and the review that follows. Plan your stay around the catheter rather than the ward, and leave a few days of margin.
Should I stop my blood thinner before surgery?
Never stop it on your own. When and how these medicines are managed is planned together with the doctor who prescribed them; in some patients stopping carries more risk than continuing. Send your complete medication list with your enquiry so that this plan is made before you travel.
Is the removed tissue examined?
Yes, and this is an important detail. Where tissue is removed it is examined pathologically, which can reveal an unsuspected cancer. Methods that do not remove tissue offer no such examination.
Articles on this topic
Scientific sources
- EAU Guidelines on Management of Non-Neurogenic Male LUTS — European Association of Urology
- Ergün M, Sağır S, Hacıbey İ. ThuLEP technique for managing benign prostatic hyperplasia: Intraoperative and postoperative complications in a series of 42 consecutive cases. Journal of Surgery and Medicine, 2025.
This page is for general information only and is not a substitute for medical advice.
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