Introduction: Patients presenting with very large prostates (> 200 ml of total volume) are a challenge to both patients and surgeons. Nowadays, although the efficacy and the less invasiveness of HoLEP compared to open techniques has been proven, still high level evidences for the best treatment of large prostates are limited. Aim of the study is to evaluate the short and long term outcomes of patients with very large prostates (>200 cc) in the largest series available so far. Methods: Clinical data were collected in a prospective maintained database, we performed 183 HoLEP procedures on prostates greater than 200 gr in 86 months. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Surgical technique: we used a Gilling modified technique with a three-lobe enucleation with a high power 120 W Holmium laser (Lumenis Pulse). Morcellation is conducted with a 7 gr/min morcellator (Lumenis VersaCut) together with basket for removal of the small prostate chips, in order to reduce operating time. Patients results were collected in a proper database Patients with limited follow-up and with data unavailable were excluded. Results: We collected retrospectivally data of consecutive male patients who underwent HoLEP from July 2015 to September 2022 (86 months). There were 183 patients with a mean preoperative gland size of 218.9 cc (200-366 cc). Mean operative (145 min) and enucleation time ( 83 min) .Enucleation efficiency was greater for glands = 300 cc (4.5 cc/min). Mean length of stay was 2.2 ± days and catheter duration was 2.8 ± days. Mean haemoglobin loss was (3,6 gr/dl, SD 0,1 - 6 gr/dl). 7 cases required blood transfusion (3,8%). 52 patients (28.4%) had indwelling catheter before surgery for urinary retention; this population experienced higher incidence of post-operative UTI and fever (42% vs 13%; p= 0.001) Mean variation of Qmax was +14 ml/s (p <0,05) and IPSS score -16 points (p <0,05) at long term follow-up, these results stayed stable for during time with a mean follow 24 months (range 2-86) 3 (7.1%) patient required retreatment of BPH at last follow-up. Conclusions: HoLEP for giant prostate is a minimally invasive option with low morbidity and good post-operative outcomes. These data support the feasibility of HoLEP regardless the size of the prostate and suggest that HoLEP could become the “gold standard” approach for prostate > 200 cc. SOURCE OF Funding: 1) World Journal of Urology https://doi.org/10.1007/s00345-020-03156-5
