Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland becomes abnormally enlarged as men age. The normal prostate size is around 20 grams, but in cases of enlargement it can exceed 100 grams, and in severe cases it may grow to as large as 200 grams. When the prostate enlarges to this extent, it compresses the urethra and makes urination difficult, causing various urinary symptoms such as a weak stream, a sensation of incomplete bladder emptying, frequent urination, and nocturia. If treatment is delayed, complications such as urinary tract infections, bladder dysfunction, and kidney problems may develop, making early diagnosis and treatment important.
According to statistics from the Health Insurance Review and Assessment Service in Korea, more than 1.53 million patients were diagnosed with BPH in 2023. The condition mainly affects middle-aged and older men over the age of 50, and the number of patients tends to increase during autumn and winter compared to spring and summer.
Treatment for BPH varies depending on symptom severity and prostate size. In the early stages, medications are commonly used to control symptoms. However, if symptoms do not improve or if side effects occur, surgical treatment may need to be considered. One of the latest surgical options for treating BPH is holmium laser enucleation of the prostate (HoLEP).
HoLEP uses a holmium laser to remove enlarged prostate tissue effectively. One of its key advantages is that it can treat very large prostates, including those exceeding 100 grams. The procedure is performed endoscopically and is minimally invasive, allowing even extremely large prostates approaching 200 grams to be removed safely without open surgery. In addition, the laser simultaneously cuts and cauterizes tissue, resulting in minimal bleeding and faster recovery.
HoLEP is also effective for patients with moderate to severe BPH who do not respond well to medication. In some cases, patients who have taken medication for a long time still develop significant residual urine, sometimes exceeding 300 mL, and persistent urinary obstruction. If untreated, this can lead to bladder dysfunction. Clinical cases have shown that patients who did not respond to medication experienced significant improvement after HoLEP, with peak urinary flow rates recovering to around 23.8 mL per second and urinary symptoms markedly reduced.
The procedure is also useful for patients with large prostates accompanied by acute urinary retention. Even when the enlarged prostate protrudes into the bladder and blocks urine flow, precise removal of the obstructing tissue with a laser can restore urination quickly. Compared with traditional open surgery, HoLEP allows the removal of large amounts of prostate tissue with minimal bleeding and a shorter recovery period.
Unlike conventional transurethral resection of the prostate (TURP), which may have limitations in treating very large prostates, HoLEP can effectively remove prostates weighing up to 200 grams. Because the laser allows precise tissue removal while minimizing damage to surrounding structures, the amount of bleeding is significantly reduced and the procedure can be safely performed even in elderly patients. The rate of complications is also low, with urinary incontinence occurring in less than 1% of cases. In addition, the procedure is covered by national health insurance in Korea, which helps reduce the financial burden on patients.
Dr. Na Jun-chae of Goldman Urology Clinic’s Jamsil branch explained that patients with large prostate enlargement often experience a significant decline in quality of life as symptoms worsen, along with an increased risk of complications such as bladder or kidney dysfunction. He emphasized that receiving appropriate treatment at the right time is crucial, and recommended that anyone experiencing difficulty urinating or other urinary discomfort visit a urology clinic for accurate diagnosis and proper treatment.