Holmium Laser Enucleation of the Prostate (HoLEP) is a well-proven minimally invasive surgical method that can effectively manage benign prostatic hyperplasia (BPH) regardless of prostate size. The present study aims to evaluate the efficacy and safety of HoLEP in patients with prostate volume over 100 cc.

The data of 87 patients who had prostates exceeding 100 cc and undergone HoLEP at our institution from January 2018 to January 2021 were retrospectively reviewed. Patient characteristics and intra/peri/postoperative data were collected by reviewing medical records. International prostate symptom score (IPSS) and quality of life (QoL) obtained preoperatively and 3 months postoperatively were compared. Also, the changing tendency of peak urinary flow rate (Qmax) and postvoid residual (PVR) during the follow-up period was analyzed.

The mean age and prostate volume of the patients were 72.76 ± 6.98 years and 131.09 ± 34.54 g, respectively. The mean enucleation and morcellation time were 57.10 ± 21.07 and 24.89 ± 18.33 minutes, respectively, and the mean resected adenoma weight was 69.13 ± 27.30 g. Postoperative Hb drop and WBC count raise were not statistically significant (p = 0.058 and p = 0.204, respectively). Other pre/perioperative findings are shown in Table 1. At postoperative follow up, the mean IPSS and QoL was significantly improved from 24.3 ± 8.0 to 9.9 ± 5.5 (p <0.001, Figure 1a) and from 5.0 ± 1.0 to 2.4 ± 1.6 (p <0.001, Figure 1b), respectively. Significant increasing and the decreasing tendency was observed regarding mean Qmax and PVR, respectively, from baseline to postoperative 6 months (p <0.001 in both; Figure 1c and 1d, respectively). Persistent urinary incontinence at 3 postoperative months and malignancy according to pathologic report was observed in 4 and 8 patients, respectively. Major complications were not encountered in all patients.

In addition to its efficacy in improving IPSS and QoL scores, HoLEP has demonstrated a significant increase in Qmax and a reduction in PVR among patients with prostates exceeding 100 cc. The absence of significant postoperative bleeding or infection, coupled with the absence of major complications in any of the patients, underscores the safety profile of HoLEP as a surgical intervention for BPH in this particular subset of patients. These findings highlight HoLEP's potential to not only effectively alleviate BPH symptoms but also provide a safe alternative to traditional surgical approaches for individuals with larger prostates. Consequently, HoLEP emerges as a promising option for patients seeking durable relief from BPH-related urinary symptoms while minimizing the risks associated with surgical interventions.

HoLEP is an effective and safe surgical treatment for huge prostates exceeding 100 cc.