To assess outcomes following Holmium Laser Enucleation of Prostate (HoLEP) in men with prostate volumes ≥150cc and compare this to men with prostate volumes ≤150cc.
We analysed our prospective database of consecutive patients undergoing HoLEP in a single tertiary public hospital between October2016 and January2019. We excluded patients with clinically significant prostate cancer or neurogenic bladders. Preoperative prostate volume was measured on MRI or ultrasonography. Perioperative variables and functional outcomes were recorded.
Of 304 HoLEPs performed, we included 97 patients with prostate volume of ≥150cc and 186 patients with prostate volume <150cc. Comparing both cohorts (≥150cc vs <150cc): mean age was 71.5 vs 68.3 years, prostate volume 195cc vs 93cc, pre-operative Qmax 9.6ml/s vs 10ml/s, American Urology Association Symptom Score (IPSS) 21 points vs 20.5 points; mean PSA 13.2µg/L vs 8.8µg/L; laser duration 86 vs 59 minutes; morcellation duration 29 vs 14 minutes; enucleated weight was 124g vs 60g. One patient (1%) from the ≥150cc cohort required a surgical procedure for stress urinary incontinence, and none from the <150cc cohort, but this did not achieve statistical significance (p=0.12). There were no statistically significant differences in postoperative Qmax (32.3 vs 26.4 ml/s; p=0.12), IPSS (5.9 points vs 7.3points; p=0.23), mean PSA (3.9µg/L vs 2.2µg/L; p=0.60), stricture incidence (1% vs 2.7%; p=0.63), or significant stress urinary incontinence (4.1% vs 0.5%; p=0.08).
Our large series demonstrates that HoLEP is safe and effective in patients with massive prostates (≥150cc), with similar outcomes compared to patients with prostates <150cc.

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