摘要： Purpose Patients presenting with prostate gland sizes greater than 200?cc pose a unique surgical challenge to both patients and surgeons. The objective of this study is to critically assess the efficacy and risks associated with performing holmium laser enucleation of the prostate (HoLEP) on glands ≥ 200?cc. Materials and methods Using a prospective maintained database, all consecutive benign prostatic hyperplasia (BPH) patients with gland size ≥ 200?cc who underwent HoLEP were included. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Subgroup analysis of outcomes was stratified by gland sizes 200–299?cc and ≥ 300?cc. Univariate analysis using Kruskal–Wallis and Fisher exact test was performed to compare the two groups. Results There were 88 patients with a mean preoperative gland size of 255.9?cc (200–770?cc). Mean operative (171 vs 182?min) and enucleation time (77 vs 83?min) were not different between the two subgroups (200–299?cc vs ≥ 300?cc). Enucleation efficiency was greater for glands ≥ 300?cc (2.6?cc/min vs 2.0?cc/min, p = 0.04). Morcellation time was longer in the ≥ 300?cc group (74.5?min vs 46.8?min, p = 0.021). Mean length of stay was 1.8 ± 1.2?days and catheter duration was 2.6 ± 2.7?days. 1 (1.1%) patient required retreatment of BPH at last follow-up. The main limitation of this study is the retrospective data analysis. Conclusions Holmium laser enucleation for prostate glands volume > 200?cc is feasible with minimal morbidity. These data further reinforce the size independence success of this procedure for BPH.