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The management of lower urinary tract symptoms (LUTS) related to prostates over 80 cc is currently debated between proponents of laser enucleation, laser photovaporization and open simple prostatectomy especially for elderly men with comorbidities. Currently, there is a lack of long-term outcomes for laser surgery. Our goal was to evaluate the long-term functional outcomes and reoperation rate of laser photovaporization in this population.METHODS: We included consecutively all men treated for benign prostatic hypertrophy >80cc by Greenlight laser between January 2007 and December 2013 in an expert single-center. The functionnal outcomes were assessed on: Post-void residual volume (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), and Urinary Quality of Life score (Qol). All this outcomes were evaluated pre and postoperatively and every year thereafter. Data were analyzed at the date of the latest news for patients who were followed for 5 years at least. For these men we assessed the need for any reoperation or any drugs used for benign prostatic obstruction (BPO).RESULTS: 132 men were included with a median age of 72 years. There was no significant difference between postoperative and long-term functional outcomes: Qmax (16.2 ml/s vs. 15.5 ml/s, p [ 0.27), PVR (26ml vs. 36 ml, p [ 0.74) and IPSS (6.5 vs. 6.4, p [ 0.92). Only the average Qol was different with 1.2 vs. 1.6, p <0.001. Among our population, 23 men (17%) underwent at least one reoperation (mean delay of 35 months) for adenomatous regrowth: 9 PVP (7%), 9 transurethral resection of the prostate (7%), 2 open simple prostatectomy (2%) and only 3 patients had an indwelling catheter (2%). Likewise, 25% of the patients had a new prescription for LUTS.CONCLUSIONS: PVP laser is a valid alternative for prostates over 80cc in the long-term for elderly men. Our study has shown that less than one in five men will require reoperation on the urinary system for adenomatous regrowth and that the failure rate of photovaporization remains low even for large prostates. Nevertheless, patients need to be informed that BPO symptoms could reappear with the need of medications in one quarter of the cases.