A 74-year-old man with International Prostate Symptom Score (IPSS) of 24 (severe LUTS), PSA of 2.8 ng/mL, and prostate volume of 80 mL on TRUS fails medical therapy with alpha-blocker and 5-alpha-reductase inhibitor combined for 12 months. He has no indications for absolute surgery. The minimally invasive surgical option with the best evidence for volume reduction in large prostates (> 80 mL) is:

• A Holmium laser enucleation of the prostate (HoLEP) ✓
• B Transurethral resection of the prostate (TURP)
• C Prostatic urethral lift (UroLift)
• D Thulium vapoenucleation

Explanation

HoLEP (holmium laser enucleation of the prostate) is the preferred surgical option for large-volume prostates (> 80 mL) and is volume-independent. It removes the entire adenoma and is superior to TURP in large glands for durability of symptom improvement, transfusion rate, and catheterisation time. TURP is limited by resection volume (tissue restriction risk > 60–80 mL), and UroLift is only approved for glands < 100 mL without median lobe, with lesser symptom score improvement.

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.