A minimally invasive technique called holmium laser enucleation of the prostate (HoLEP) may be effective alternative to open prostatectomy in men with large prostate glands, according to a case report by researchers at Casey Hospital, Monash Health, in Australia.

The study, “Holmium Laser Enucleation of the Prostate in a 400 cc Prostate: Case Report,” was published in the Journal of Endourology Case Reports, and highlights the feasibility of HoLEP in large prostates.

Open prostatectomy is commonly used in the surgical management of benign prostatic hyperplasia in patients with very large prostates. The technique involves the removal of the prostate gland, and it is performed under a general or spinal anesthetic. But the number of less invasive endoscopic treatment approaches has increased in recent years, offering alternatives to open prostatectomy.

One such method is HoLEP, a minimally invasive treatment for an enlarged prostate, which uses a laser to remove prostate tissue that is blocking urine flow. Another instrument is then used to cut the tissue into easily removable pieces. The outcome of HoLEP is similar to open prostate surgery, but requires no incisions.

The case involved a 71-year-old with a symptomatic large prostate (over 400cc; normal prostate size for an adult is 15cc to 30cc) removed usingHoLEP. The patient had had severe hematuria — the presence of blood in the urine — 12 months before, requiring transfusion with seven units of blood before the condition was resolved using conservative measures. He alo had undergone transurethral resection of the prostate (TURP) eight and 15 years earlier, and was not taking any medication (besides fish oil).

Researchers used cystoscopy analysis, a procedure that allows the doctor to examine the lining of the bladder and the tube that carries urine out of the body (urethra), which revealed a massive regrowth of prostatic tissue. The analysis also confirmed a markedly enlarged prostate, measuring 10 × 9 × 11 cm, and prostatic volume was estimated at 436 cc by ultrasonography of the prostate.

The patient underwent HoLEP, with the total operating time of 225 minutes, and with successful resection of the prostate tissue (it weighted 314 g). There were no perioperative complications and blood transfusion was not necessary.

At outpatient follow-up two months later, the patient reported good urinary flow and no further episodes of hematuria.

“With greater experience in HoLEP and declining experience in open prostatectomy, there may be a shift toward HoLEP as the preferred treatment choice for large prostate glands,” the researchers wrote.