A 70-year-old man with a 45 g prostate and IPSS score of 22 (severe LUTS) fails medical therapy with alpha-blockers and 5-alpha reductase inhibitors. A urodynamic study confirms bladder outlet obstruction. Which surgical intervention has the best long-term efficacy with the highest retreatment rates avoided in this size prostate?
- A Transurethral resection of the prostate (TURP)
- B HoLEP (holmium laser enucleation of the prostate) ✓
- C Open simple prostatectomy (Millin's retropubic prostatectomy)
- D Prostatic urethral lift (UroLift)
Explanation
HoLEP (Holmium Laser Enucleation of the Prostate) is the gold standard endoscopic procedure regardless of prostate size, with superior long-term durability, lower retreatment rates, and equivalent functional outcomes to open prostatectomy. For a 45 g prostate, TURP remains effective but HoLEP demonstrates less blood loss, shorter catheterisation time, and no size limitation. Open prostatectomy is typically reserved for prostates >80–100 g. UroLift is indicated for smaller prostates (<70–80 mL) and does not address large median lobes; it has higher retreatment rates than TURP or HoLEP.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.