Faculty:
Dr. Kapil Jain – Sr. Consultant, Urology

Presenting/Chief Complaints:
A 77-year-old male presented with complaints of obstructive voiding symptoms and recurrent episodes of urinary retention. The patient had a history of non-compliance with previously prescribed medical management.

Clinical Findings:

• Ultrasonography revealed chronic cystitis with a grossly enlarged prostate (~288 cc) and a prominent median lobe bulge.*
• Serum PSA: 19.62 ng/ml
• Multiparametric MRI prostate: PIRADS 3 lesion
• TRUS-guided prostate biopsy: Benign Prostatic Hyperplasia (BPH) with chronic prostatitis

Pre-operative Assessment:
The patient was evaluated and deemed fit for surgery. Comorbidities included hypothyroidism and arthritis, both well-controlled on medication. Pre-anaesthetic evaluation was unremarkable.

Procedure:

• The patient was counselled and planned for Mini-HOLEP (MiLEP).
• Intraoperative findings included a normal urethra, massively enlarged prostate, and a trabeculated bladder.*
• Using a 22 Fr endoscope and Holmium Laser complete enucleation of the prostatic adenoma was performed.
• Special attention was given to precise dissection at the apical region.
• Total laser time: ~70 minutes
• Blood loss: Minimal
• The procedure was completed uneventfully.

Post-operative Course:

• The patient had a stable recovery.
• The catheter was removed on post-operative day 2.
• The patient was discharged the same day, with a total hospital stay of 2 days.

On follow-up:

• Good urinary flow
• No urinary incontinence
• Post-void residual urine: 90 ml

Histopathology:
BPH with chronic prostatitis.

Key Highlights:

• Successful management of a very large prostate (~288 cc) using Mini-HOLEP, demonstrating the effectiveness of laser enucleation even in complex, high-volume cases.
• Dr. Kapil Jain’s surgical expertise enabled precise enucleation, particularly at the apical region, ensuring complete adenoma removal with preservation of continence.
• The procedure was performed with minimal blood loss and optimal operative time, reflecting advanced endoscopic skill and control.
• Patient benefited from rapid recovery, early catheter removal, and short hospital stay, with excellent functional outcomes.
• Highlights the advantage of modern small-calibre endoscopic techniques in reducing morbidity and improving overall patient comfort in large gland surgeries.