Benign prostatic hyperplasia (BPH) is a condition in which a man's prostate gland abnormally enlarges with age. While the typical prostate size is around 20g, it can sometimes exceed 100g when hypertrophied. In severe cases, it can even develop into a gigantic prostate weighing up to 200g. Such an enlarged prostate compresses the urethra, making urination difficult and causing various voiding dysfunctions such as a sensation of incomplete bladder emptying (residual urine), frequent urination (pollakiuria), and nocturia. Delaying treatment can lead to urinary tract infections, decreased bladder function, and kidney function abnormalities, thus necessitating early diagnosis and treatment.
According to statistics from the Health Insurance Review and Assessment Service (HIRA), the number of patients with benign prostatic hyperplasia exceeded approximately 1.53 million in 2023. It primarily affects middle-aged and elderly individuals aged 50 and above, and it has been observed that there are more patients in autumn and winter than in spring and summer.
Treatment for benign prostatic hyperplasia varies depending on the severity of symptoms and the size of the prostate. In the initial stages, symptoms are managed with medication, but if there is no improvement or if side effects occur, surgical treatment should be considered. One of the latest surgical methods for treating BPH is Holmium Laser Enucleation of the Prostate (HoLEP).
HoLEP surgery effectively resects enlarged prostate tissue using a holmium laser, and it is particularly characterized by its ability to treat even gigantic prostates exceeding 100g. As a minimally invasive procedure performed endoscopically, it can safely remove even super-large prostates weighing up to 200g without the need for open surgery. Furthermore, due to the nature of the holmium laser, hemostasis occurs simultaneously with resection, resulting in less bleeding and faster recovery.
Moreover, HoLEP surgery is effective for patients with moderate to severe benign prostatic hyperplasia who have not responded to medication. This is because if residual urine accumulates to 300mL or more, or if voiding difficulty persists despite long-term medication use, there is a significant risk of leading to decreased bladder function. Indeed, cases have been reported where patients who did not respond to drug therapy experienced a recovery in urinary flow rate up to 23.8 mL/sec and a significant improvement in voiding discomfort after HoLEP surgery.
HoLEP surgery is also useful for patients with gigantic prostates accompanied by acute urinary retention. Even if the prostate protrudes into the bladder, making urine discharge impossible, precise resection of the prostate tissue using a laser can enable rapid recovery of urination. Particularly in situations requiring the removal of a large volume of prostate tissue, it results in minimal bleeding, less burden on the patient, and a shorter recovery period compared to traditional open surgery.
HoLEP surgery can effectively remove even super-large prostates weighing up to 200g. Unlike the conventional transurethral resection of the prostate (TURP), HoLEP can be applied even in cases of gigantic prostates. Furthermore, the precise resection using a laser results in minimal damage to surrounding tissues and significantly less bleeding, making it suitable for elderly patients. The incidence of complications is also low, with the rate of urinary incontinence being less than 1%. In terms of cost, it is covered by national health insurance, thus reducing the financial burden.
Dr. Na Jun-chae of Goldman Urology Jamsil Branch stated, "For patients with gigantic benign prostatic hyperplasia, as symptoms worsen, their quality of life significantly deteriorates, and the risk of complications such as decreased bladder or kidney function also increases. Therefore, it is crucial to receive appropriate treatment at the right time." He added, "If you experience difficulty urinating or any voiding-related discomfort, I recommend visiting a urology department for an accurate diagnosis and proper treatment."