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Holep for patients with large prostate

HOLEP – Holmium laser enucleation of the prostate for patients with large prostate: 352gms

T Manohar, SK Nandakishore , UB joshi

Centre for advanced urology and minimal invasive surgery

Columbia Asia Hospitals, Bengaluru.

Centre for advanced urology and minimally invasive surgery, Bengaluru

Introduction and objective:

Holep as a surgical procedure is fast becoming the gold standard of choice for BPH with large prostates world wide, in spite of its high learning curve. This video demonstrates the enucleation of 352 gms prostate in a trilobar technique using high power Holmium Laser

Material and methods:

72 year old gentleman with no comorbidity presented with CKD ( ; 1.86) with bilateral gross hydronephrosis with chronic retention of urine with backpressure changes. Ultrasound examination showed large prostate measuring 352gms with post void residue of 750 cc. Serum PSA was 3.2 ng/dl


HOLEP using trilobar technique was used as the median lobe was large protruding almost into the bladder dome with >Grade 5 enlargement. Ureteric orifices could not be visualized. Total duration of surgery was 2hours 48 minutes with no blood loss. Enucleation time was 1hour 32 minutes and marcellation time was 76 minutes. Catheter removed on 5th POD.


Large size prostates can be tackled with minimum blood loss and early recovery. With experience and after having achieved certain level of learning curve larger prostate size seems to have no effect on the outcome in the management of BPH