Mr. Nam suffered from prostate enlargement for 20 years, having undergone endoscopic surgery three times with recurrences. Recently, he experienced urinary retention, hematuria, and lower abdominal pain.

Ultrasound results at Tam Anh General Hospital, TP HCM, revealed Mr. Nam's prostate was enlarged to about 200 g, 10 times the normal size (15-25 g). Due to his advanced age, underlying high blood pressure, and anticoagulant use, many facilities suggested permanent percutaneous bladder catheterization. However, his family feared he might remove the catheter, leading to injury and difficult care, prompting them to seek definitive surgical treatment.

Dr. Pham Cao Thap, from the Department of Urology, Center for Urology - Nephrology - Andrology, and his team reviewed the cardiovascular and respiratory risks. They opted for holmium laser enucleation of the prostate (HoLEP). This minimally invasive technique suits large tumors and elderly patients who face a high bleeding risk from anticoagulant use. Compared to other methods like rezum, laser provides more thorough results for large tumors.

The team used laser energy to remove Mr. Nam's prostate tumor. *Photo: Tam Anh General Hospital*

Dr. Thap inserted an endoscope through the urethra into the prostate, requiring no skin incision. Guided by a high-resolution camera, he used a laser to separate the prostate tissue from its capsule. The laser simultaneously cut and immediately cauterized small blood vessels, minimizing blood loss. The team pushed the separated tissue into the bladder, minced it with a tissue morcellator, and suctioned it out.

After surgery, Mr. Nam's health stabilized; he had the catheter removed and urinated normally after three days.

Prostate enlargement is common in men over 50. Dr. Thap advised men with difficulty urinating, frequent nighttime urination, or weak urine flow to seek early hospital screening for effective treatment. Compared to traditional open surgery, HoLEP is less invasive, helping elderly patients with underlying health issues avoid significant blood loss, infection, and weakness. It also shortens hospital stays and prevents dangerous postoperative complications.

Bao Anh

*Patient's name has been changed*