HoLEP vs Aquablation: BHP
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Hi, I've had recurring BHP for 12+ years, though I'm only 64. I've been on meds (finasteride and Tamsulosin) for at least that long. I'm pretty much ready to do something surgical about it. This past Summer I had my second cystoscopy in 5 years. In the first cystoscopy, they recommended TUVP, but I've come to find that the act of doing a cystoscopy temporarily resolves the problem - so I deferred. In the most recent cystoscopy, they found a 49 cc prostate with a very large bulbous median lobe. The urologist who did that retired over the Summer, and his replacement was recommending TURP. Before retiring, the URO recommended an MRI based on the cystoscopy, which suggested no cancer (PIRADS 2).
I went for a second opinion yesterday; this urologist reviewed the MRI that was done a week after the cystoscopy; he said the median lobe is actually a cyst in a place he's never seen before, blocking the urethra and appearing in images more like the bladder (urine-filled) than like the prostate. He walked me through all procedures available, and the two that rose to the top were HoLEP and Aquablation. It's my understanding that the Aquablation is perhaps the 'easiest' to recover from with fewer side effects, however it is also not possible to do a biopsy (whereas HoLEP allows for this). This second urologist didn't suggest a preference, but these two seemed to be at the top of his list (and he's highly experienced with HoLEP, though his facility has only just gotten an Aquablation machine).
A few thoughts come to mind:
- Given the recent MRI, do I need to be concerned about getting a biopsy?
- If that were the only criterion, should I lean towards aquablation?
- Given the uniqueness of my issue (a cyst, as well as prostate enlargement), is one procedure preferable?
- Should I wait a bit (9 months) until I'm on Medicaid, because it's more likely to cover more of the costs than a commercial policy I've gotten through the marketplaces?
I would really welcome thoughts on this, based on folks' experiences!
0 likes, 6 replies
bill24813 fb105060
Edited
I am in a similar situation . I have a large medium lobe. my choices were the same. I will be having the holep procedure Feb 8.
The holep is a 1 and done procedure. It doesn't leave much tissue behind. The prostate is like your nose and ears, it never stops growing. Tissue left behind will grow. TURP and Aquablation leave more tissue behind than holep. This increases the odds of a 2nd procedure later down the line. At 63, if I live long enough, the odds of a 2nd procedure are high, so I'm going for the holep.
My understanding is, that it takes a very skilled surgeon will multiple procedures under their belt in order to be proficient at the procedure. My surgeon meets that criteria.
Aquablation on the other hand is basically computer controlled. You are at the mercy of the ultrasounds accuracy and the surgeon's ability to program the system. It's really two procedures in one. Once the Aquablation process has been completed the surgeon still has to go in and clean up any bleeders and tissue with either a TURP loop/button or laser.
andrew57992 bill24813
Edited
Would suggest anyone considering any procedure, consult several Uro's. I consulted 4 uro's, all very well experienced, but most specializing in TURP and or Holep. The 1 who gave me most confidence did all including Aquablation, for which he is recommended. Eveyone's physiology and experience are different.
Never explained to me a TURP loop was necessary after Aquablation ( every Uro is different).
Had Aquablation on 9th October and apart from TWOC issues, as explained on other reports, am feeling OK. Stream is good no nocturia,ejaculation has returned to normal, NO RE.
In the end it is your body and your choice.
bill24813 andrew57992
Edited
I agree, get multiple opinions. This is my 4th urologist, second procedure (UROlift 1st) and forth cystoscopy in 28 months. Most urologist are proficient in TURP, it is the gold standard.
fb105060 bill24813
Posted
Best of luck with the HoLEP! and thanks for the wisdom.
This latest urologist I met with tells me he did 200 HoLEP procedures last year. His hospital has just gotten an Aquablation machine, so he's open to either procedure -- and is leaving it to me to decide. (Both, he tells me, will do fine with the medial cyst).
bill24813 fb105060
Posted
Sounds oddly familiar. My surgeon, as well, has recently added aquablasion. He is located at Mayo in Jacksonville Florida.
fb105060 bill24813
Posted
Perhaps just a reflection of the quickly emerging technology environment for BPH. My doctor is at Johns Hopkins in Baltimore.