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Related Experiment Video

Updated: Nov 6, 2025

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
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A call for HoLEP: AEEP for mega-prostates (≥ 200 cc).

Nicholas E Boxall1, Fanourios Georgiades1, Saiful Miah1

  • 1Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.

World Journal of Urology
|May 12, 2021
PubMed
Summary

Holmium laser enucleation of the prostate (HoLEP) is effective for large prostates (≥200 cc), though it may require longer hospital stays and cause greater hemoglobin reduction. Functional outcomes remain comparable to smaller prostates.

Keywords:
AEEPBPHHoLEPSupersize prostate> 200 cc prostate

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Area of Science:

  • Urology
  • Surgical Technology
  • Prostate Health

Background:

  • Benign prostatic hyperplasia (BPH) is a common condition affecting aging men.
  • Holmium laser enucleation of the prostate (HoLEP) is an effective treatment for BPH.
  • Evaluating HoLEP outcomes in very large prostates is crucial for surgical planning.

Purpose of the Study:

  • To assess the efficiency and efficacy of HoLEP in patients with prostate volumes (PV) ≥200 cc.
  • To compare HoLEP outcomes in large prostates (Group 1: PV ≥200 cc) versus smaller prostates (Group 2: PV 80-199 cc).
  • To analyze tissue retrieval methods and their impact on HoLEP outcomes in different prostate size groups.

Main Methods:

  • Retrospective review of HoLEP cases performed by two surgeons at a tertiary HoLEP center.
  • Comparison of 157 patients with PV ≥200 cc to 157 consecutive cases with PV 80-199 cc.
  • Analysis of enucleation and morcellation efficiency, tissue retrieval methods, hemoglobin decrease, transfusion rates, and length of stay.

Main Results:

  • HoLEP demonstrated greater enucleation efficiency in larger prostates (Group 1) compared to smaller ones (Group 2).
  • Cystotomy for tissue retrieval was more frequent in Group 1 (5.7%).
  • Group 1 experienced a greater decrease in hemoglobin and a longer length of stay, though functional outcomes (IPSS, Qmax, PVR, catheter-free rates) were similar between groups.

Conclusions:

  • HoLEP outcomes are largely independent of prostate volume, even for prostates ≥200 cc.
  • Increased length of stay and hemoglobin reduction are observed in patients with larger prostates undergoing HoLEP.
  • Alternative tissue retrieval methods like cystotomy may be necessary for very large prostates (≥200 cc).