A 70-year-old male with benign prostatic hyperplasia (BPH) has refractory urinary retention despite medical management (alpha-blocker + 5-alpha reductase inhibitor). Urodynamics show poor detrusor contractility with maximum flow of 3 mL/s. Prostate volume is 55 mL. Which surgical option is MOST appropriate?
- A Transurethral needle ablation (TUNA)
- B Prostate artery embolization (PAE)
- C Holmium laser enucleation of the prostate (HoLEP) ✓
- D UroLift (prostatic urethral lift)
Explanation
HoLEP (Holmium Laser Enucleation of the Prostate) is the surgical treatment of choice for large prostates (>80 mL in most guidelines, but effective from 40 mL upwards) and is size-independent. It enucleates the entire adenoma along the surgical capsule plane, providing equivalent tissue removal to open prostatectomy with minimal blood loss, shorter catheterisation time, and shorter hospital stay. For a 55 mL prostate with refractory retention, HoLEP is the best option among those listed, as it allows complete tissue removal and histological analysis. UroLift is only approved for prostates <80 mL without obstructing median lobe. PAE has a slower onset and is used mainly in patients unfit for surgery. TUNA is largely obsolete.
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.