Holmium laser enucleation of the prostate (HoLEP) is safe and effective for treating symptomatic BPH independent of prostate size, according to a report in BJU International (2008;101:1536-1541).


In addition, the efficiency of the procedure increases with increasing prostate size.

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Hemendra N. Shah, MD, and colleagues at R.G. Stone Urological Research Institute in Mumbai, India, reviewed data on 354 patients who underwent HoLEP. In 235 patients, the prostate weighed less than 60 grams (group 1); in 77 patients, it weighed 60-100 grams (group 2); and in 42 patients, it weighed more than 100 grams. The mean prostate size was 38.1, 76.4, and 133.5 grams for groups 1, 2, and 3, respectively, according to the investigators.


The mean procedure efficacy rose from 0.36 g/min in group 1 to 0.49 g/min in group 2 to 0.58 g/min in group 3, the researchers reported. Overall, the procedure resulted in a 75% reduction in American Urological Association symptom score, a 225% increase in peak urinary flow rate, and an 86% decrease in post-void residual volume at one year follow-up. These improvements were comparable among the three groups.