Benign prostatic hyperplasia (BPH) is a condition in which the prostate enlarges abnormally with age. While a normal prostate typically weighs around 20 grams, it can grow beyond 100 grams, and in severe cases, reach over 200 grams. As the prostate enlarges, it compresses the urethra, leading to difficulty urinating and symptoms such as incomplete emptying, frequent urination, and nocturia.
Holmium laser enucleation of the prostate (HoLEP) is one of the most advanced surgical treatments for BPH. It uses a holmium laser to precisely remove enlarged prostate tissue and is particularly effective for large prostates, including those exceeding 100 grams. As a minimally invasive endoscopic procedure, HoLEP can safely treat even extremely large prostates—up to 200 grams—without the need for open surgery. The laser simultaneously cuts and coagulates tissue, resulting in minimal bleeding and faster recovery.
Consider the following clinical cases involving large prostates.
The first case involves a patient with a massive prostate weighing over 200 grams. A 68-year-old man presented with severe, long-standing urinary symptoms. Imaging revealed a prostate size of 210 grams, and his maximum urinary flow rate (Qmax) was only 4.3 mL/s. In the past, such cases required open surgery. However, HoLEP allowed for safe and complete removal of the enlarged tissue. After surgery, his Qmax improved significantly to 25.7 mL/s, and post-void residual urine was nearly eliminated.
The second case involves a patient who did not respond to medical therapy. A 73-year-old man with a 180-gram prostate had been on medication for five years, but his symptoms progressively worsened. His residual urine volume exceeded 300 mL, raising concerns about bladder and kidney function. Following HoLEP, his Qmax improved to 23.8 mL/s, and he reported a high level of satisfaction with the outcome.
The third case involves acute urinary retention. A 65-year-old man with a 190-gram prostate presented to the emergency department with sudden inability to urinate. After catheterization and stabilization, further evaluation revealed that the enlarged prostate was protruding into the bladder. HoLEP was performed successfully, restoring normal urination. Notably, even in such large prostates, the procedure carries a lower risk of bleeding compared to traditional open surgery.
These cases demonstrate that HoLEP is highly effective even for extremely large prostates approaching 200 grams. Unlike traditional transurethral resection of the prostate (TURP), which has limitations in large glands, HoLEP can be applied regardless of prostate size. Its precise laser-based technique minimizes damage to surrounding tissue and significantly reduces bleeding, making it suitable even for elderly patients. The complication rate is low, with postoperative urinary incontinence occurring in less than 1% of cases. Additionally, because the procedure is often covered by national health insurance, it is relatively cost-effective.
Patients with large BPH often experience a substantial decline in quality of life, along with an increased risk of complications such as bladder dysfunction and kidney impairment. Timely and appropriate treatment is therefore essential. With extensive surgical experience and a personalized approach, optimal outcomes can be achieved for each patient. If you are experiencing difficulty urinating or other urinary symptoms, it is important to seek evaluation from a urology specialist for accurate diagnosis and appropriate treatment.