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Researching HoLEP for my Dad

Posted , 13 users are following.

umamimommy
umamimommy

I am researching surgical options for BPH for my Dad (86cc, 76 years old). He lives in the USA, in Louisiana. His 75 year old surgeon recommends a suprapubic open prostatectomy, but my reading suggests we should explore HoLEP as an option.

I've called numerous urologists and have talked to larger medical centers, but could not locate anyone who performs HoLEP. I contacted Lumenis, a medical device/laser company that manufactures a holmium laser, and they were able to point me to only 2 surgeons in the entire state of Louisiana that use their product for HoLEP.    

My questions are:

1. Does anyone know of other methods to find urologists who perform HoLEP? Possibly other laser companies? When I Google, Lumenis is the only one that comes up, but there must be more?

2. It seems like HoLEP is the standard procedure in Europe and Asia. Does anyone know why the adoption rate here has been so low, given what seems like superior outcomes? It's been around for 20 years!

3. For those of you that have had HoLEP - were you able to have it done with just a spinal block? My Dad had a near death experience which under general anesthesia and is very, very concerned about that option. He prefers a spinal, if possible.

4. Are there other methods that we should also consider? Bi-polar? I don't know enough about that. We've ruled out Urolift and Greenlight/TURP. Someone posted about iTIND which sounds interesting, but it is in clinical trials, I believe?

Thank you very much for any pointers. 

 

0 likes, 35 replies

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  • rogcal
    rogcal umamimommy

    Posted

    I'm sorry that I shan't be able to help you with finding a surgeon in LA nor the rest of the US for that matter but in respect of HoLEP and spinal block they are made for each other.

    With a prostate size of 86cc a HoLEP procedure would be comfortably completed in less that an hour which is the usual working timescale associated with spinal block anaesthesia.

    The added bonus of less blood loss, discharge from hospital the same day and no catheter in place when you are at home, makes it ideal for someone of your father's age.

    My HoLEP history: 100cc prostate, spinal block anaesthesia (heart condition and diabetic), discharged the same day without a catheter.

    Incidentally, if your father is fit enough to take the journey why not consider having a HoLEP carried out in the UK.  It seems many chaps from the US are making the trip and are finding the overall cost works out less that having it done at home.  Good luck. 

    • umamimommy
      umamimommy rogcal

      Posted

      Thank you! It's helpful to know you were able to have HoLEP performed with a spinal. My Dad will be relieved to know that. I scheduled his consult with the HoLEP trained urologist for 5/24, so it will be nice to give him this info to relieve anxiety about anesthesia.

      His consult is 3 hours from him. Driving long distances and navigating unfamiliar roads is not as easy as it once was for him, but he will have to do it as this is his only current option due to his health insurance being tied to state Medicare. 

      We are concurrently applying to the insurance company to authorize him having the procedure done where I live (California) and I am also trying to locate options in Taiwan, where my Uncle/his brother lives. I am hearing that HoLEP runs about $6K USD out of pocket?? which sounds insanely low. I'm not sure if that includes the hospital stay.

      But the first order of business is to get him a second opinion from a surgeon who is trained/regularly performs different types of procedures so we can assess his true options.  

      Thanks again and glad that you are on the other side of this! I hope your results have been satisfactory?

       

    • jimjames
      jimjames umamimommy

      Posted

      I understand there are insurance issues involved, but often it's not the operation but the surgeon as well. 

      My understanding with Holep is that it requires significantly more training than some of the other procedures. Therefore, if you are going to do a procedure like this, do it with someone experienced who has done a ton of them. If you're not willing to travel to such a facility, then probably best to look for other surgical options with doctors well experienced in their particular type of surgery.

      Jim

    • rogcal
      rogcal umamimommy

      Posted

      Thank you, yes my results have been great and exactly as I had hoped for. One note of caution, I would strongly advise you research the surgeon who carries out any procedure i.e. complication rate, how many procedures carried out, etc.  Fortunately my Urologist was in early with the development and use of HoLEP as he was practising in New Zealand at the time and now trains other surgeons here in the UK and elsewhere in the world. Incidentally my journey time from the hospital following my procedure was just over 3 hours and it was pure heaven not to have to pull over somewhere to pee which was something that had plagued me for many years when urgency kicked in every 30 - 40 minutes or so.
  • jimjames
    jimjames umamimommy

    Posted

    Hi,

    We have a thread here (somewhere) that talks about Holep. In it, you will find references to doctors and centers here in the U.S. that perform it. 

    How many urologists have you seen? No offense to a "75 year old surgeon" (I'm getting up there in age as well smile ) but if he's the only person you've seen, I'd consider consulting with at least 1-2 more urologists, hopefully a bit younger. Doctors tend to recommend whatever procedures they are familiar with, and that may be the case here. 

    Finding the right doctor to perform a given procedure is the last step not the first. First step is finding out what is the best procedure for your dad. If you spend a day or so here (not a few minutes) reading through the different threads, you will familiarize yourself with the different approaches now being offered such as TURP, Greenlight, Urololift, PAE and non-surgical approaches such as certain medications and Self Catherization. 

    Jim

     

    • umamimommy
      umamimommy jimjames

      Posted

      Thank you. I mentioned the age of the surgeon because it IS a concern. This forum has been a fabulous resource that has helped us realize certain procedures (greenlight, Urolift) are not good options for him - thank you to all of you wonderful posters who take the time to share your experiences. 

      As far as fiding the right doctor - I feel that our immediate challenge is to find doctors we can consult - ones who are familiar with/have experience with different procedures. Based on our experience, and based on reading this forum, it sounds like the most surgeons are self-serving in their recommendations to patients. So it seems like our 2nd opinon/3rd opinion consults should be with Dr's who are at least trained. 

      Being told only TWO surgeons in the entire state perform HoLEP is hard to believe. But I don't know how to find more/corroborate that data point. I've spent a week calling all the urologists and medical centers/teaching hospitals in his area and talking to the front desks (who don't know) and leaving messages for the nurses (who don't always call back and don't always know)...very frustrating. Particularly when, based on my reading thus far, it is regularly performed outside of the US. 

      I did read (here) that the Mayo Clinic performs it. But again, we're also trying to work within the confines of insurance (at least initially). 

  • james87669
    james87669 umamimommy

    Posted

    I am replying as a 71 year old who will undergo the suprapubic prostatectomy some time this June. My surgery will be done by the DaVinci Robot and I expect the outcome to be just fine. With the Robot the cuts are small and the healing quicker. I think if you follow this thread most are younger men with the fear of loosing erections and (this is a given) ejaculation of semen. At seventy five I doubt that your Dad will father any more children so he could probably live with that consequence. I had a procedure about a year and a half ago that was suppose to leas at least trhee years and while minimally invasive (not surgery) was only good for about nine months. 

    Dont get me wrong, I also want to retain my sexual function, IT IS VERY IMPORTANT TO ME but realisticly my quality of life is suffering with things as they are, so I feel this is the best way and the one with the best track record. The method suggested for your Dad tells me that his prostate is too large for them to perform a TURP which does not involve major surgery and considered the"Gold Standard" to Urologists.

    I will share all that I can with you in your search for answers.

    • umamimommy
      umamimommy james87669

      Posted

      Thank you. Yes, his prostate is too large for TURP. Although I have "bipolar laser" TURP on my list to research, as I was told that may be size independent?

      May I ask which minimally invasive procedure you had done? My Dad is concerened about recurrence...it will be much harder for him to have surgery/recover 3-5 years from now.

      Thank you and best of luck. 

    • james87669
      james87669 umamimommy

      Posted

      I had the TUMT Trans Urethral Microwave Thermal therapy. Uses heat to destroy Prostate tissue to unblock the urethral passage. This has been around for some time and seemed to be the simplest method to me at the time. BUT it did not last. You will read here that some who have had similar bad results with PAE, Urolift and other methods.
  • ramblin
    ramblin umamimommy

    Posted

    Is the problem only BPH? Has he had a cystoscopy and MRI? How was prostate volume determined? My recommendation would be to pursue prostate artery embolization, but you will need to contact your nearest interventional radiologist to find out your closest provider. It is the least risky procedure, but is not appropriate for cancer treatment.
    • james87669
      james87669 ramblin

      Posted

      PAE is not approved by the FDA and not covered by Medicare. An important thing to consider since will be out of pocket and would be quite expensive. 
    • umamimommy
      umamimommy ramblin

      Posted

      Just BPH (although he has a hernia, too....he initially was interested in having it fixed at the same time, but has decided against that for now). 

      He's had a cystoscopy and ultrasound done (which is what, I think, determined the 86ml size). I think in the back of his mind, he is fearful of prostate cancer and thinks one of the benefits of an open procedure is that the surgeon can visualize the prostate/biopsy. But it's also one reason we're interested in HoLEP, since biopsy would be an option as well. 

      Thank you so much for pointing me towards PAE. That is also on my list to read about, so it's helpful to be able to prioritize it.  

    • james87669
      james87669 umamimommy

      Posted

      See my reply to ramblin --- PAE is not FDA approved and therefore not covered by Medicare. It would be quite expensive.
    • Carry-on_CMDR
      Carry-on_CMDR james87669

      Posted

      However, if he takes part in a clinical trial (there is a us gov't site which lists all active clinical trials, and there may be one convenient) I believe there would be very low, and possibly no costs related to the procedure and any hospitalization.

      It's worth checking out.  There is one in Tampa, where we live, but I have my problems under control now through CIC, and would personally wait until some direct intervention was actually necessary.  If this gentleman was about to be scheduled for surgery, then it is a little bit of research that should be worth doing.

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