绿激光前列腺汽化剜除术治疗大体积高危前列腺增生症

目的 探讨绿激光前列腺汽化剜除术治疗大体积高危良性前列腺增生症(BPH)的疗效.方法 自2009年4月至2010年4月,对50例被确诊的大体积高危BPH患者采用80W绿激光前列腺汽化术(PVP)治疗;自2010年5月至2011年5月,对50例被确诊的大体积高危BPH患者采用120W高性能系统激光前列腺汽化剜除术治疗,分析所有患者的临床资料、比较两种术式的操作特点及术后疗效.结果 术前两组患者平均年龄、平均前列腺体积相似,但在120W绿激光前列腺汽化剜除术组,手术时间明显缩短,对增生腺体的汽化更彻底,术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)等较80W绿激光前列腺汽化术组有很显著的改善.结论 120W绿激光前列腺汽化剜除术是治疗BPH的一种安全有效的新手术方法,效果优于80W绿激光汽化术,尤其适用于大体积高危BPH患者.     

经尿道等离子双极电切加绿激光汽化治疗大体积良性前列腺增生症

目的分析等离子体经尿道前列腺电切术(PKRP) 绿激光前列腺汽化术(PVP)治疗大体积前列腺增生症的有效性和安全性。方法总结05年6月~06年12月采用等离子体电切 绿激光治疗体积100ml以上的良性前列腺增生症81例(100~279)ml,平均(136.1±31.6)ml。手术方法为先行PKRP术,随后再行PVP术;对前列腺表面血管扩张明显者,先用激光对前列腺进行汽化,随后行电切,最后再行PVP术。结果本组手术时间90~180min,平均135min,切除前列腺54~180g,平均(82.0±32.0)g,术中出现较明显出血并需要输血4例,均为术前服用抗凝药物者。术后留置导尿管1~4d。出院时平均最大尿流率:术前留置导尿管者13.4ml/s,未留置导管者16.8ml/s。结论PKRP PVP术对大体积前列腺增生症患者是一种安全、有效的微侵袭性方法;术前尿潴留者在术后短期内疗效不及无尿潴留者。     

经尿道80W绿激光汽化术联合等离子电切治疗大体积前列腺增生症

目的 探讨经尿道80 W绿激光前列腺汽化术(PVP)联合等离子电切术(PKRP)治疗大体积(＞100毫升)的良性前列腺增生(BPH)的临床疗效及安全性.方法 2006年1月至2008年12月采用PVP联合PKRP治疗体积100毫升以上的前列腺增生症共计87例,方法为先行PKRP术,切除大部分增生的腺体,再以PVP对...     

经尿道选择性绿激光汽化术治疗大体积前列腺增生患者120例临床分析

目的 探讨临床应用选择性绿激光汽化术(PVP)治疗腺体体积大于80ml的前列腺增生患者的安全性及有效性.方法 PVP手术治疗120例腺体体积大于80ml的前列腺增生患者,进行术前术后对比分析.结果 120例患者平均前列腺体积138.6(86.5～234)ml,均顺利完成手术,未输血,未出现电切综合征(TURS).术后1个月随访,最大尿流率、国际前列腺症状评分(IPSS)、生活质量评分(QOL)均较术前有显著性改善(P<0.01).结论 PVP治疗大体积前列腺增生是安全有效的微创手术方法.     

高功率绿激光前列腺汽化术的5年临床经验总结

绿激光前列腺汽化术(PVP)使用的是磷酸钛氧钾晶体(KTP)激光,波长为532nm.由于它被血红蛋白选择性吸收,故只有800μm的穿透深度,因而热量被限制在前列腺浅表组织很小的体积内,使前列腺组织由于细胞中水分汽化而被迅速去除,只留下1～2mm的凝固层.     

KTP绿激光选择性前列腺汽化术:240例患者的长期随访结果

总结KTP绿激光选择性前列腺汽化术（PVP）治疗BPH的症状和梗阻的1年期疗效和安全性。从2004年1月-2005年3月采用KTP532nm绿激光选择性前列腺汽化术（PVP）治疗年龄在49～80岁（平均65．3岁）由BPH导致的下尿路症状和梗阻患者240例,激光功率80W。手术均汽化至包膜,所有患者接受IPSS、最大尿流率、超声波前列腺体积检查、剩余尿量、前列腺特异抗原和直肠指检等检查。术前前列腺体积平均52．1CC（28～120cc）。     

经尿道绿激光前列腺汽化切除术治疗良性前列腺增生临床价值研究

目的 探讨经尿道绿激光前列腺汽化切除术(PVP)治疗良性前列腺增生(BPH)的临床价值.方法 回顾性分析2017-07—2020-04郑州第九人民医院泌尿外科行手术治疗的86例BPH患者的临床资料.按手术方式分为经尿道绿激光前列腺汽化切除术组(PVP组,44例)和经尿道前列腺电切术组(TURP组,42例).比较2组患者...     

经尿道选择性绿激光前列腺汽化术与前列腺电切术治疗重度良性前列腺增生的对比研究

目的 比较经尿道选择性绿激光前列腺汽化术与前列腺电切术治疗重度良性前列腺增生症的临床疗效.方法 将63例重度良性前列腺增生症患者随机分为经尿道选择性绿激光前列腺汽化术(PVP)组32例和前列腺电切术(TURP)组31例,分别行PVP术与TURP术.观察两组患者手术时间、住院时间、保留导尿管时间、手术出血量、IPSS评分、最大尿流率、前列腺体积的变化及并发症.结果 所有手术均成功,无严重手术并发症发生.TURP组电切综合征、输血病例各2例,PVP组无该并发症.PVP组手术出血量、输血率、住院时间及留置导尿管时间明显少于TURP组(P>0.05),然而,PVP组的手术时间、术后感染控制时间、早期急性尿潴留发生率及残留腺体体积明显大于TURP组.两组术后IPSS评分下降率、最大尿流率差异、感染发生率及逆行射精发生率差别均无显著性(P>0.05).结论 治疗重度良性前列腺增生时,PVP手术具有一定的局限性,可作为TURP的一种补充手术方法应用于高危患者的治疗,而不作重度良性前列腺增牛的首选治疗方法.     

80W和120W绿激光汽化治疗高危良性前列腺增生的疗效及安全性分析

目的:探讨和比较80 W和120 W绿激光汽化治疗高危良性前列腺增生(BPH)的疗效和安全性。方法:将290例确诊为BPH的患者按就诊时间顺序分为两组,220例接受80 W绿激光治疗,70例接受120 W绿激光治疗。记录比较两组患者术前、术后相关临床指标、手术时间及激光激发时间。结果:所有患者手术均获得成功,两组患者的前列腺体积、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)及残余尿(PVR),术前、术后相比有统计学差异(P<0.01),但两组间比较无明显差异(P>0.05)。两组的手术时间分别为(56.5±22.6)min和(45.1±20.4)min,激光激发时间分别为(31.2±10.3)min和(24.6±8.3)min,激光消耗能量分别为(159.8±29.0)kJ和(134.2±23.3)kJ,两组间比较均有统计学差异(P<0.01)。结论:绿激光前列腺光汽化术操作简单、疗效满意、出血少、并发症少、手术安全。新一代的高功率绿激光操作更为简单、手术时间短,是治疗高龄高危BPH患者理想的微创手术方法。     

120W与80 W绿激光前列腺汽化术操作技术及术后近期并发症的比较

目的：比较120 W（HPS）和80 W（KTP）绿激光前列腺汽化（PVP）术的操作技术及近期术后并发症.方法：2008年至今,我院采用PVP手术治疗BPH患者共136例,其中76例接受80 W（KTP）PVP手术治疗,60例接受120 W高性能系统（HPS）PVP手术治疗,比较两种术式的操作特点及术后6个月内的并发症.采用Wilcoxon秩和检验进行统计学分析.结果：两组患者术前平均前列腺体积相似[KTP组（50.3±18.3）g vs.HPS组（55.6±15.2）g,P＞0.05];HPS组手术时间明显短于KTP组[KTP组（85.3±18.5）min vs.HPS组（74.2±12.6）min,P＜0.053;两组激光能量消耗无明显差别[KTP组（265±53.4）kJ vs.HPS组（276±48.3）kJ,P＞0.05].术后KTP组出现延迟性血尿4例,尿路感染4例,拔管后尿潴留2例,短期急迫性尿失禁1例;HPS组出现术中包膜穿孔1例,术后延迟性出血1例.结论：120 W HPS较80 W KTP具有更高的汽化效率.两者手术操作各具特点,但120 W HPS相对操作技术要求更高,并发症更少,是值得推荐的手术方式.     

保留前列腺尖部对绿激光前列腺汽化术后患者疗效的影响

目的探讨保留前列腺尖部对绿激光前列腺汽化术后患者疗效的影响。方法98例入组患者随机分成A组和B组,A组行绿激光治疗,保留超过精阜的前列腺尖部;B组在A组基础上继续行等离子电切除尖部前列腺组织,比较两组患者手术情况、疗效和并发症。结果B组手术时间、出血量高于A组(P<0.05),留置尿管和住院时间长于A组(P<0.05),而两组在术后8周国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)和残余尿(PVR)差异没有统计学意义(P>0.05)。结论在行经尿道前列腺绿激光汽化术时可以以精阜水平为界,超过精阜水平的远端腺体组织保留,而不影响术后早期排尿改善情况及生活质量。     

Photoselective vaporization of the prostate: a volume reduction analysis in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia and carcinoma of the prostate

PURPOSE: In this study preoperative and postoperative transrectal ultrasound prostate volume was evaluated in patients undergoing photoselective vaporization of prostate using an 80 W potassium-titanyl-phosphate (KTP) laser (Greenlight PV Laser System, Laserscope, San Jose, California) for obstructive uropathy secondary to benign prostatic hyperplasia or carcinoma of the prostate. MATERIALS AND METHODS: A total of 18 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (8) and carcinoma of the prostate (10) were treated with an 80 W quasicontinuous KTP laser. Preoperative and immediate postoperative treatment prostate volume measurements were recorded by transrectal ultrasound. The end point of treatment was complete vaporization of the obstructive adenoma to the level of the capsular fibers and the creation of an adequate transurethral resection-like prostatic cavity. KTP/532 laser energy was delivered by a side firing glass fiber through a 27Fr continuous flow resectoscope. Photoselective vaporization of the prostate using sterile water irrigation was performed with all patients under spinal anesthesia. Mean lasting time +/- SEM was 33.5 +/- 12 minutes (range 11 to 53). RESULTS: Mean preoperative prostate volume +/- SEM was 53.2 +/- 24.7 ml (range 23.6 to 110), while mean postoperative prostate volume was decreased to 26.2 +/- 14.8 ml (range 8 to 58) during a mean followup of 2.8 +/- 2.3 months (range 1 to 10), resulting in a 51% mean decrease in prostate volume, as measured by transrectal ultrasound. There was no significant intraoperative bleeding and no change in serum sodium postoperatively. One patient sustained a small capsular perforation with persistent venous bleeding, which could not be controlled with KTP laser. Because of poor vision, the procedure was completed with electroresection. Complications included mild dysuria in 2 patients (11%) and mild hematuria longer than 2 weeks in duration in 4 (22%). CONCLUSIONS: Photoselective prostate vaporization can effectively vaporize obstructive benign and malignant prostatic tissue, leading to a significant decrease in the total volume of the treated prostate (p = 0.000).     

Holmium laser enucleation versus transurethral resection of the prostate. Are histological findings comparable?

PURPOSE: We investigated if an adequate histological diagnosis can be made from tissue after holmium laser enucleation of the prostate (HoLEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: We analyzed 40 HoLEP and 40 age matched TURP tissue specimens from patients who underwent 1 of the 2 procedures between January 2001 and August 2002. Each histological specimen was reviewed by a single pathologist. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. RESULTS: Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Tissue remaining following the procedure was estimated to be 36.3% of preoperative ultrasound volume after HoLEP and 52.8% after TURP (p <0.001). Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups. Tissue thermal artifacts induced by the laser were mostly due to coagulation. Thus, the alterations were similar to those after TURP. CONCLUSIONS: Tissue quality is altered after HoLEP and TURP. General prostatic architecture was maintained in the majority of HoLEP histological specimens. A moderately higher percent of prostatic tissue obtained by the Ho laser is lost by vaporization and coagulation. Nevertheless, these differences do not seem to alter pathologist ability to detect incidental prostate cancer and PIN.     

绿激光各术式治疗前列腺增生的差异研究

目的比较绿激光各种术式治疗前列腺增生的安全性及有效性。方法回顾性对比分析本院自2016年5月至2018年5月2年内绿激光各种术式,包括绿激光前列腺汽化术(GL-PVP)、绿激光前列腺汽化切割术(GL-PVRP)、绿激光前列腺剜除术(GEL-EP)治疗前列腺的手术时间、出血量、膀胱冲洗时间、术后导尿管留置时间等近期临床指标。对于术后3个月随访的尿流动力学数据、术后国际前列腺症状评分(IPSS)评分改变值、术后生活质量评分(QOL)评分改变值、国际勃起功能指数问卷调查表评分(IIEF评分)差值、术后并发症等远期临床指标进行组间分析。结果GL-PVP组、GL-PVRP组、GEL-EP组患者的术前一般数据[年龄、术前前列腺体积、术前前列腺特异性抗原(PSA)、术前IPSS评分、术前QOL评分、术前最大尿流率(Qmax)、术前膀胱残余尿(PUR)、IIEF之间]差异无统计学意义(P>0.05)。相比术前,患者在术后最大尿流率(Qmax)、术后膀胱残余尿(PUR)、术后IPSS评分、术后QOL评分改善较术前差异均有统计学意义(P<0.01)。组间比较中,PVP、PVRP、EP三种术式治疗BPH的平均手术时间、术中平均出血量、持续膀胱冲洗时间、留置导尿管时间比较,差异有统计学意义(P<0.05)。而在术后IPSS改变值、术后QOL改变值、尿流率改变值、膀胱残余尿改变值、国际勃起功能指数问卷调查表评分差值、术后并发症发生率等方面差异无统计学意义(P>0.05)。结论绿激光可以有效地、安全地治疗前列腺增生,相比PVRP及GL-EP术,PVP术手术时间更短,术中出血量更少,术后膀胱冲洗时间更短,留置尿管时间更短。     

Update on photoselective vaporization of the prostate

Photoselective vaporization of the prostate (PVP) with a potassium titanyl phosphate (KTP) laser may be the most promising new technology applied to the treatment of benign prostatic hyperplasia (BPH). The specific laser light characteristics and the ideal interactions between KTP lasers and prostatic tissue result in an even and efficient vaporization of the prostate and the formation of a clearly deobstructed prostate cavity. PVP can be a day-care procedure, with few hours of catheterization and minimal postoperative discomfort, offering outcomes at least equivalent to the reference standard transurethral resection of the prostate. Although larger studies are necessary to further define where PVP stands in the management of BPH, this review focuses on contemporary treatment techniques and their limitations, and comments on the outcomes of its current use.     

Photoselective vaporization of the prostate (PVP) using 80 watt high power potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia: the first fifty-seven patients in Japan

OBJECTIVE: To assess the safety and efficacy of photoselective vaporization of the prostate (PVP) using 80 watt high power potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia (BPH). METHODS: Fifty-seven patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia underwent 80 W KTP laser vaporization of the prostate. According to their International Prostate Symptom Score Index (IPSS) and Quality of life (QOL) score as well as measurements of their peak flow rate and postvoiding residual urine volume (RUV), they fulfilled the diagnostic criteria of BPH. Vaporization was performed with the GreenLight PV ADDStat fiber, which was inserted through a 22.5Fr. continuous flow laser cystoscope, and a saline solution was used for irrigation. KTP laser energy was generated by a GreenLight PV (Minnetonka, Minnesota) generator. The end point of the procedure was to create a cavity like in TURP. Once vaporization was completed, an18Fr Foley catheter was inserted and was removed the next morning, as a rule. Patients were evaluated preoperatively, and at 2 weeks and 1, 3 and 6 months postoperatively. RESULTS: The procedure could be performed without any intraoperative complication. None of the patients required continuous bladder irrigation or blood transfusion postoperatively. The mean age was 71.0 +/- 8.3 years (range 52 to 86). The preoperative prostate volume was 41.0 +/- 24.9 (mean +/- SD, range 6.7 to 107.2) and the preoperative serum PSA was 4.5 +/- 4.1 ng/ml. Preoperative and immediate postoperative serum sodium concentration was 141.9 +/- 1.8 mEq/L and 142.2 +/- 1.8 mEq/L, respectively (p = 0.23). The hemoglobin value changed from 14.0 +/- 1.4 mg/dl preoperatively to 13.4 +/- 1.4 mg/dl postoperatively. The operating time was 68.3 +/- 35.0 minutes (range 21 to 170) and total laser energy was 171.1 +/- 80.3 kJ (range 18.1 to 484.8). The catheter indwelling time was 18.6 +/- 3.3 hrs (range 15 to 48). At 2 weeks and 1, 3 and 6 months the International Prostate Symptom Score decreased from 20.2 +/- 8.9 to 11.4 +/- 7.8, 9.3 +/- 6.0, 6.6 +/- 5.0 and 6.1 +/- 5.0, respectively. The maximum urinary flow increased from 7.2 +/- 2.9 mL/s to 13.6 +/- 7.6, 12.2 +/- 6.1, 15.3 +/- 7.4, and 15.3 +/- 7.5 mL/s, respectively. CONCLUSIONS: Photoselective vaporization of the prostate (PVP) using the high power (80 W) potassium-titanyl-phosphate laser for benign prostatic hyperplasia (BPH) proved to be an effective and safe procedure for our patients.     

Impact of preoperative haemoglobin concentrations on the efficiency of KTP-laser vaporization of the prostate

Purpose  The potassium-titanyl-phoshate laser (KTP laser) device produces light (wavelength of 532 nm) that is absorbed by haemoglobin, thus releasing thermal energy. This reaction causes vaporization of the tissue. We tested whether preoperative haemoglobin concentrations (Hb) affect the efficiency of the 80 W KTP laser, thus affecting the energy applied. Methods  We assessed 164 patients undergoing KTP-laser vaporization for benign prostate hyperplasia from January 2005 to July 2006 at Heidelberg University Hospital. We prospectively collected data on patients’ demographics, urodynamics, Hb, prostate volume, and energy applied. We calculated the correlation between preoperative Hb and surgery energy applied and we adjusted it for prostate volume. We further compared the postoperative urinary flow and residual volume results in non-low-Hb and in low-Hb patients. Results  The mean age was 68.8 (±8.8 years), the median prostate volume 50.0 mL (interquartile range 40–80), the median preoperative urinary flow 10.1 mL/s (interquartile range 7.1–14.0), the median surgery duration 70.0 min (interquartile range 50–92.75), the median preoperative Hb 144.5 g/L (interquartile range 132–151), and the median applied energy 209.5 kJ (interquartile range 156.5–272.75). The unadjusted correlation between preoperative Hb and applied energy was −0.089 (P < 0.05). After adjustment for prostate volume this correlation was not significant (Pearson r = −0.180, P > 0.05). Functional results did not differ between low-Hb and non-low-Hb patients (P > 0.05 for urinary flow and postvoid volume). Conclusions  Haemoglobin concentrations, in the range of clinically encountered values, do not affect the efficiency of 80 W KTP-laser vaporization of the prostate. This laser technique is thus applicable in patients with low haemoglobin concentrations without concerns about efficiency.     

Laser bladder perforation from photoselective vaporization of prostate resulting in rhabdomyolysis induced acute renal failure

Hyponatremia and its related comorbidities remain a concern after traditional transurethral resection of the prostrate (TURP). Photoselective vaporization of the prostate (PVP) laser coagulation therapy is a new, relatively bloodless procedure for treatment of benign prostatic hyperplasia (BPH). Perceived benefits with PVP laser TURP include excellent visualization of the operative field during urethral prostatic tissue vaporization and the reduced incidence of laser penetration through the prostatic capsular fibers once the capsule is reached. Theoretically, this would provide a low risk method of perforation during laser TURP. After literature review, we report this as the first case of laser bladder perforation as a complication arising from PVP therapy. This case report discusses the management of acute hyponatremic induced rhabdomyolysis with acute renal failure (ARF) and the recommendation to use sodium chloride vs. sterile water for bladder irrigation during PVP TURP procedures.     

Impact of prostate-specific antigen level and prostate volume as predictors of efficacy in photoselective vaporization prostatectomy: analysis and results of an ongoing prospective multicentre study at 3 years

In a multicentre study from the USA, 3-year results of the high-power KTP laser prostatectomy are presented. The authors used preoperative PSA level as a marker of prostate volume and assessed its potential predictive value on the level of clinical efficacy for treating symptomatic BPH. They found that the overall results from the technique were positive and durable, and suggested that there was a significant difference in efficacy between patients presenting with a total PSA of <6 or >6 ng/mL. Many patients who have had a radical prostatectomy are followed for a prolonged period and several observations are presented from an Italian study of urinary incontinence. The authors present their detailed results, finding a considerable trend in incontinence and anastomotic stricture, which decreased over time. OBJECTIVE: To report the 3-year results and analyse whether total prostate-specific antigen (tPSA) levels and prostate volume before treatment can predict the level of clinical efficacy of photoselective vaporization prostatectomy (PVP) for treating obstructive benign prostatic disease, as high-power potassium-titanyl-phosphate (KTP) laser prostatectomy was previously shown to be safe and to efficiently vaporize prostatic adenoma secondary to benign prostatic hyperplasia (BPH), with minimal bleeding and morbidity. PATIENTS AND METHODS: From October 2001 to January 2003, 139 men (mean age 67.7 years, sd 8.7) diagnosed with obstructive lower urinary tract symptoms secondary to BPH, had PVP with an average 80 W of KTP laser energy, at six investigational centres. A subanalysis evaluating each patient for tPSA and prostate volume before PVP was conducted, with a long-term assessment of the primary efficacy outcomes at 3 years after PVP. Each patient was assigned to one of two subgroups according to the tPSA level (group 1, < or = 6.0 ng/mL; group 2 > or = 6.1 ng/mL) and evaluated separately. Each subgroup was assessed for changes from baseline in American Urological Symptom Index (AUA SI) score, quality of life (QoL) score, peak urinary flow rate (Q(max)), prostate volume, and postvoid residual urine volume (PVR) at 1, 2 and 3 years after PVP. RESULTS: All tPSA subgroups had a sustained improvement in all efficacy outcomes maintained through the 3 years. There was a statistically significant difference in the level of improvement between groups 1 and 2 (P < 0.05) in AUA SI and Q(max) at 1, 2 and 3 years. The mean (sd) prostate volume for group 1 was 48.3 (16.7) mL (87 men), and was 83.1 (30.6) mL (52 men) in group 2. The mean percentage improvement in the AUA SI at 1, 2 and 3 years in group 1 and 2, respectively, was 86%, 92% and 85%, and 69%, 74% and 76%; the corresponding percentage improvement in Q(max) was 194%, 185% and 179%, and 124%, 145% and 139%, respectively. Overall treatment efficacy in all patients evaluated showed a mean 83%, 79%, 71% and 165% improvement in AUA SI, QoL, PVR and Q(max), respectively. Adverse events were minimal and the re-treatment rate was 4.3%. CONCLUSIONS: These results suggest that there is a significant difference in efficacy in patients with a tPSA of < or = 6.0 ng/mL or > or = 6.1 ng/mL before PVP. However, the overall results achieved with PVP were very positive and durable to 3 years, irrespective of tPSA level and prostate volume.     

Holmium laser enucleation for large (greater than 100 mL) prostate glands

BACKGROUND: To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands > 100 mL. METHODS: Eighteen patients with preoperative prostate volumes > 100 mL underwent the HoLEP procedure. The criteria for surgery were determined by a preoperative International Prostate Symptom Score (IPSS), a prior failure of medical therapy, and urinary retention. RESULTS: The mean preoperative IPSS and prostate gland size were 13.8 and 142.3 mL, respectively. The total energy used by the laser was 288.4 kJ. The mean catheter time was 23.8 h and, perioperatively, no patients had electrolyte abnormalities or required blood transfusions. The 3-week postoperative IPSS was 2.8, with minimum long-term complications. CONCLUSIONS: Holmium laser enucleation of the prostate with TUSTM is a safe and effective alternative to open prostatic surgery for glands > 100 mL.