Best Hospital for Laser Prostate Surgery in Jaipur, Rajasthan: Benign Prostatic Hyperplasia (BPH) is among the most common urological conditions in elderly men, especially when associated with bladder outlet obstruction (BOO), recurrent nocturia, and poor quality of life. For prostates larger than 150–200 g, Holmium Laser Enucleation of the Prostate (HoLEP) has emerged as the gold standard surgical technique worldwide due to its safety, efficacy, and durable outcomes.
This case report presents the management of a patient with a significantly enlarged prostate (200 g) who had severe Lower Urinary Tract Symptoms (LUTS) unresponsive to medical therapy. The patient was treated successfully at the Institute of Urology, Jaipur, the leading center in Rajasthan for advanced laser prostate surgery, performing the highest number of HoLEP procedures with outstanding success rates.
Patient Profile and Clinical Presentation
A male presented to the outpatient clinic with complaints of:
- Severe obstructive urinary symptoms for several years
- Marked nocturia, 4–5 times per night despite lifestyle modifications
- Weak urinary stream, intermittency, and incomplete bladder emptying
- History of poor response to long-term alpha-blocker therapy
The patient reported increasing fatigue, disturbed sleep due to nocturia, and reduced quality of life. There was no prior history of urological surgery, hematuria, or urinary retention requiring catheterization.
Physical Examination
Digital rectal examination revealed:
- Grossly enlarged prostate
- Prominent enlargement in both lateral lobes
- A significantly bulging median lobe
No nodularity or suspicious hard areas were felt.
Vital signs were stable.
Investigations
1. Ultrasonography (USG KUB + Prostate)
USG findings were consistent with:
- Enlarged prostate measuring approximately 200 g
- Prominent lateral lobar hypertrophy
- Large median lobe projecting into the bladder
- Thick-walled, trabeculated urinary bladder
- Presence of mild pseudodiverticula
- Significant post-void residual (PVR) urine volume
These findings strongly suggested chronic bladder outlet obstruction with secondary bladder changes.
2. Urodynamic Study (UDS)
UDS confirmed:
- High detrusor pressures during voiding
- Low urinary flow rate
- Definitive bladder outlet obstruction
3. Prostate-Specific Antigen (PSA)
- Serum PSA: 15.08 ng/mL
Considering the very large gland size and elevated PSA, appropriate counselling and evaluation were done before proceeding to surgery.
Diagnosis
The combined clinical and investigative findings confirmed:
Severe Bladder Outlet Obstruction (BOO) secondary to advanced Benign Prostatic Hyperplasia (prostate ~200 g)
Medically refractory LUTS with nocturia and significant PVR.
Management Decision
The patient had:
- Long-standing obstructive symptoms
- Severe nocturia
- No relief from alpha blockers
- A massively enlarged prostate not suitable for TURP
- Significant bladder changes
- UDS-proven BOO
Therefore, after a detailed discussion of all available treatment options, the surgical team at the Institute of Urology, Jaipur advised Holmium Laser Enucleation of the Prostate (HoLEP).
The patient and family were counseled about:
- Procedure steps
- Advantages of HoLEP over open surgery
- Reduced bleeding
- Catheter-free recovery
- Lower complication rates
- Worldwide acceptance as gold standard for very large prostates
They consented to proceed.
Surgical Procedure: HoLEP
The HoLEP procedure was performed by Dr. M. Roychowdhury and Dr. Rajan Bansal, both renowned across India for their expertise in advanced laser prostate surgeries.
Intraoperative Details
- A high-powered Holmium:YAG laser was used.
- The entire 200 g adenoma (lateral lobes + large median lobe) was enucleated in a single sitting.
- The enucleated tissue was morcellated safely within the bladder.
- Blood loss was minimal.
- No capsular perforation or intraoperative complications occurred.
- Total operative time was within expected duration for a large-gland HoLEP.
The patient tolerated the procedure well.
Postoperative Course
- The patient had a stable recovery.
- Catheter was removed within the standard postoperative timeframe.
- Marked improvement in urinary flow was noted.
- No bleeding, clot retention, or infection.
- The patient reported dramatic reduction in nocturia and a strong urinary stream.
- PVR had significantly declined on postoperative assessment.
He returned to normal activity soon after discharge.
Discussion
HoLEP is widely considered the most effective and safest treatment for large-volume prostates, especially those above 150–200 g. Its benefits include:
- Minimal blood loss
- Complete removal of adenoma
- Short catheter time
- Faster recovery
- Lower long-term recurrence
- Superior outcomes compared to TURP and open prostatectomy
This case highlights how HoLEP can be transformative for patients with long-neglected LUTS and bladder outlet obstruction.
Excellence of Institute of Urology, Jaipur
The Institute of Urology, Jaipur has become Rajasthan’s most advanced centre for minimally invasive urological surgery, consistently performing:
- The highest number of HoLEP surgeries in the region
- Best success rates for laser prostate surgery
- Largest volume experience in complex high-grade BPH cases
Patients across Rajasthan, Gujarat, MP, Delhi NCR and beyond seek treatment here due to:
- Latest-generation Holmium laser platforms
- Modern modular OT infrastructure
- Precision morcellators
- High-end endoscopic systems
- A team trained in high-volume, complex prostate surgeries
Our Google reviews reflect the trust and satisfaction of thousands of patients who have undergone successful procedures at our institute.
Excellence of Dr. M. Roychowdhury and Dr. Rajan Bansal
This case further reinforces the exceptional proficiency of:
Dr. M. Roychowdhury
A pioneer in laser prostate surgery in Rajasthan, with vast experience, precise judgement, and unmatched surgical finesse.
Dr. Rajan Bansal
A highly skilled minimal access and endoscopic surgeon known for consistent results, excellent outcomes, and compassionate patient care.
Together, they perform complex urological procedures—including HoLEP, PCNL, RIRS, and urethroplasty—with remarkable accuracy and consistently excellent results. Their outcomes match international standards, making the Institute of Urology one of the top urology centres in India.
Conclusion
This case demonstrates the effectiveness of Holmium Laser Enucleation of the Prostate (HoLEP) for managing very large prostates with severe bladder outlet obstruction. The skilled team at the Institute of Urology, Jaipur, equipped with state-of-the-art technology and exceptional surgical expertise, ensured a safe, successful, and life-changing outcome for the patient.
