For large-volume BPH, which surgical option provides enucleation with complete tissue removal and is able to treat very large glands?

• A. Transurethral resection of the prostate (TURP)
• B. Open simple prostatectomy
• C. Holmium laser enucleation of the prostate (HoLEP)
• D. Photoselective vaporization of the prostate (PVP)

Answer: (C)

Enucleation with complete tissue removal in very large glands is best achieved with HoLEP. The holmium laser is used to dissect the entire adenoma away from the surrounding surgical capsule in its natural plane, allowing the whole glandular tissue to be enucleated. After enucleation, the tissue is morcellated and removed, so even glands well over 100 g can be treated in one procedure. This endoscopic approach combines the thoroughness of open surgery with the minimal invasiveness of a laser procedure, giving durable relief, less bleeding, and shorter catheterization and hospital stay. Compared with TURP, HoLEP handles large glands more effectively and efficiently; compared with PVP, it removes large tissue volumes rather than just vaporizing them; and while open simple prostatectomy can also treat large glands, it is more invasive with higher morbidity. Hence, HoLEP provides the complete removal of tissue needed for very large BPH.