A 65-year-old man presents with lower urinary tract symptoms and AUA/IPSS score of 22. Flow rate is 8 mL/s and post-void residual is 250 mL. Medical therapy with alpha-blockers and 5-alpha reductase inhibitors failed. Which surgical option has the BEST evidence for long-term outcomes in BPH?

• A Urethral dilation — simple and repeatable
• B Clean intermittent self-catheterisation indefinitely
• C Prostate artery embolisation as first-line surgical approach
• D Holmium laser enucleation of the prostate (HoLEP) — size-independent efficacy with durable results ✓

Explanation

HoLEP (Holmium Laser Enucleation of the Prostate) has the best durability evidence for surgical treatment of BPH, regardless of prostate size. It replicates open prostatectomy results endoscopically — removing the entire adenoma — with lower blood loss, shorter catheterisation time, and shorter hospital stay than TURP for large glands. TURP remains standard for glands <80 mL. Prostate artery embolisation is an emerging but less durable option. Urethral dilation has no role in BPH management.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.