Last updated: March 2026
It is a fair and necessary question. You have every right to know how much your surgery will cost before making a decision. And you have every right to understand what you are paying for and why prices vary so much from one centre to another.
I will be as transparent as possible about the factors that influence the cost of HoLEP surgery, what a serious quote should include, and why the lowest price is not always the most economical option in the long run.
Why does the price of HoLEP vary so much?
If you have been requesting quotes, you have probably encountered very significant differences between centres. This is because the cost of a HoLEP depends on multiple factors, and not every centre includes the same items in their quote.
Prostate size
A 40-gram prostate is not the same operation as a 180-gram one. With large prostates, surgical time is longer, more operating theatre time is needed, more anaesthesia time, and occasionally an extra night in hospital. Prostate size is the single factor that most influences the duration of the procedure and, therefore, the associated costs.
Type of anaesthesia
HoLEP can be performed under general anaesthesia or spinal anaesthesia. Spinal anaesthesia, when feasible, is safer in older patients, allows faster recovery, and slightly reduces costs. In our practice, most patients are operated under spinal anaesthesia.
Length of hospital stay
At ICUA, most patients stay one night in hospital and go home the day after surgery with their urinary catheter, which is removed at a follow-up visit a few days later. Some centres keep patients in hospital until catheter removal — this increases hospital costs without proven clinical benefit.
Surgeon experience
Let me be direct about this. The fees of a surgeon who has performed 10,000 procedures are not the same as those of one who has performed 50. And they should not be. Surgeon experience is the single factor that most influences HoLEP outcomes — complication rates, speed of recovery, likelihood of requiring retreatment, and continence preservation.
When comparing quotes, do not compare numbers alone. Compare what those numbers represent.
Equipment and technology
The holmium laser is a sophisticated piece of equipment that requires constant maintenance and disposable laser fibres of significant cost. A morcellator is also needed to fragment the tissue, along with an operating theatre equipped with a high-definition endoscopic tower. Centres with their own up-to-date equipment can offer greater efficiency than those that hire equipment on a per-procedure basis.
What should a HoLEP quote include?
A complete, honest quote must include all components with no hidden extras. At ICUA, we provide a fixed, itemised quote that includes:
- Surgical team fees: surgeon, assistant, anaesthetist.
- Operating theatre time: full surgical duration.
- Disposable materials: laser fibre, morcellator, catheter, irrigation supplies.
- Hospital stay: private room, medication, nursing care.
- Histopathological analysis: examination of the removed tissue — essential to rule out incidental prostate cancer.
- Postoperative follow-up: follow-up appointments, catheter removal, control flowmetry.
Insurance and HoLEP
Private insurance in Spain
Most private insurers in Spain cover surgery for benign prostatic hyperplasia, including HoLEP, when there is a medical indication. However, conditions vary between companies and between policies. Some points to consider:
- Some insurers require prior authorisation and may insist that medical treatment has been tried before approving surgery.
- Reimbursement may be partial if the surgeon or facility is not within the insurer's approved network.
- Co-payment policies may cover a variable percentage of the total cost.
At ICUA, we treat patients from all major Spanish insurers and manage the necessary authorisations. We recommend checking with your insurer before your first visit to understand the specific conditions of your policy.
International patients
We receive patients from all over the world — Europe, the Middle East, Latin America, Asia. For international patients, we provide a detailed medical invoice and a comprehensive clinical report that facilitates reimbursement from your insurer or healthcare system in your home country. The cost of HoLEP in Spain is significantly lower than in countries such as the United States, the United Kingdom, or Switzerland, with outcomes comparable to or better than the leading international centres.
The hidden cost: the surgery that needs repeating
This is the most important consideration in this article, and one that rarely appears when prices are being compared.
Transurethral resection (TURP) — the classic technique — has a retreatment rate of 10–15% at 8–10 years. This means that roughly one in seven or eight patients will need to be operated on again. That second operation is more complex, carries more risk, and naturally comes with an additional cost.
HoLEP, by removing the entire adenoma, has a retreatment rate below 2%. In our series of 754 patients with long-term follow-up, the likelihood of requiring reoperation due to regrowth is exceptional.
If a HoLEP costs somewhat more than a TURP but virtually eliminates the possibility of a second operation, which is truly the more expensive option? And that is without factoring in the cost to quality of life — going through surgery again, another period off work, another recovery.
Why Spain? A note for patients travelling for surgery
Spain has become one of the leading destinations in Europe for prostate surgery, and for good reason. The combination of highly experienced surgeons, modern private hospital infrastructure, competitive pricing, and a pleasant climate for recovery makes it an attractive option for patients from countries where either the wait is too long, the cost is prohibitive, or the expertise in HoLEP is limited.
At ICUA, we have developed a streamlined pathway for international patients: remote consultation with review of imaging and blood tests, a fixed all-inclusive quote before you travel, surgery within days of arrival, and a detailed discharge report in your language for continuity of care back home, although we remain available for continued online follow-up.
How to request a personalised quote
Every case is different. Prostate size, the patient's medical conditions, and their insurance situation mean it is not possible to provide a single price for everyone.
What we can do is give you a fixed, detailed quote with no hidden extras after the first consultation, once we have the ultrasound and know your case. If you are coming from outside Madrid or from abroad, we can carry out an initial assessment by video consultation using the tests you already have, and provide an indicative quote before you travel.
Request a consultation or video consultation. We will provide a fixed, personalised quote with no obligation.
📞 +34 91 435 28 44 · ✉ icua@icua.es
Scientific references
- Iscaife A, Rodríguez Socarrás M, Talizin TB, et al. Contemporary results of En Bloc HoLEP for large prostates. World J Urol. 2025;43:401. PubMed
- Gauhar V, Gómez Sancha F, Enikeev D, et al. Results from a global multicenter registry of 6193 patients (REAP). World J Urol. 2023;41:3033-3040. PubMed
- Rücker F, Lehrich P, Gilfrich C, et al. HoLEP in three different techniques: a comparison of 600 patients. World J Urol. 2021;39:4063-4069. DOI
- Tricard T, Xia M, Trambert C, et al. Open prostatectomy is dead — long live endoscopic enucleation of the prostate! World J Urol. 2023;41:1457-1463. DOI
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