Bipolar Turp, GreenLight, HoLEP

Well said, rde. HoLep is also the best in longevity, with 1% redo after 20 years.

" ..Several studies have followed HoLEP patients for between 5 and 10 years, with a re-operation rate of less than 1%. Note this is in stark contrast to TURP with a reported average re-operation rate of 7.4% and PVP with a re-operation rate of 5-6% [5].Apr 25, 2015.."

Hank:

Did they state a reason why the redo rate was higher for TURP? I would've thought that a redo would mostly be a result of prostate tissue growing back. Why would TURP be higher? Does HOLEP remove significantly more tissue?

HolEp has not been around for anything like 20 years. Even GL has not been around that long.

HoLEP, or Holmium Laser Enucleation of the Prostate was developed in New Zealand in the late 1990’s. It is normally done under general anaesthetic. The prostate is approached internally (endoscopically), through the urethra, without any cuts on the skin. The Holmium laser is used to peel out the obstructive core of the prostate in its entirety. This leads to maximal relief of prostate obstruction and a man will usually only require 1 HoLEP procedure in his lifetime. It is very unlikely that the prostate will regrow after HoLEP (0.7% need a re-operation up to 10yr after HoLEP compared to 10-15% after TURP, and more after green light laser surgery).

After HoLEP, the area of the prostate that is removed is sent for microscopic analysis. Cancer that would otherwise be undetected is found in 8%.

HoLEP is one of the most extensively researched procedures for BPH. 16 HoLEP randomised trials (the highest quality of clinical trial) have been published up to Dec 2014. The clinical trials comparing it to the previous “gold standard” of TURP, consistently show advantages for HoLEP that include: Less bleeding, fewer blood transfusions, shorter time with a catheter in place after surgery, and shorter hospital stay (90% of men having HoLEP are able to leave the hospital without a catheter the day after surgery, and in some cases there is no need to stay in hospital overnight). Meta-analyses which are studies analysing the results of large numbers of randomised trials, suggest that HoLEP relieves urinary symptoms and improves urinary flow rates more effectively than all other endoscopic procedures for BPH. The average symptom score improvement after HoLEP is 70-80% and flow rate improvements of up to 600% have been reported. Recent studies have shown that HoLEP is extremely effective at treating men in urinary retention. 98% of men with catheters before surgery are freed from their catheter dependence after HoLEP. This compares to 70% with green light laser and TURP surgery. Unlike all other endoscopic procedures for BPH, HoLEP is suitable for men with any size prostate.

If HoLEP is the best procedure for everyone as you say it is then why is everyone looking for other newer procedures which have not stood the test of time only to be largely disappointed and have to be done over? Would it not be better if more research is done as to prostate growth so that prevention can be instilled?

I don't think I said for everyone. People always look for something better and in the case of our NHS for cheaper options. That's why REZUM is now their flavour of the month. They want a cheap procedure and quick turn round.

Research on prostate growth is on going.

Well said, Derek.

HoLep is not available to everyone, mainly because it's difficult to learn. One would have to travel far to get it. And waiting list is long.

One of England's top Uro's told me that in the begining we thought that GL was a quick and easy procedure but we learnt that we had to give it more time.

Did they state a reason why the redo rate was higher for TURP?...Does HOLEP remove significantly more tissue?

From what I've read Holep basically removes all the prostate tissue leaving only the capsule. If that's the case, then there's nothing to grow back. TURP removes enough to open up the passage but there's prostate tissue left over and that will continue to grow. My uro told me that in his experience (and he's been doing it for 30 years), I might need another one in 10-15 years. I don't worry about that. I might get hit by a car next week when I'm jogging!

Derek,

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I had a Rezum. As it is an outpatient procedure, it is less expensive and has a quick turn around. Also, no RE is a plus. The big question is how long it will last as there is only 4 years of published data.

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HoLEP has been around for a while but it is not widely done unlike GLEP. I wonder why GLEP is widely done while HoLEP is not. Possibly, GLEP was easier to commercialize while HoLEP was not.

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With all things that are rare, HoLEP will cost more. If I had to do it again, I would do another Rezum because of its' minimal complications unless something new and better comes along.

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Steve

Are you in the UK ? And how was your recovery ?

The GL equipment is expensive but possibly no more than Holeps.

HoLep needs more training and experience and takes longer so that may be against it. The NHS hospital where I had GL went over to HoLep about seven years later. A couple of posters on here had it successfully there.

I am in the US. My Rezum recovery followed the standard time frame. I started to open up at 4 weeks and by 8 weeks I was peeing well. I had some blood in my pee for the 1st month. Because of bladder damage, my PVR's were still above 100 ml but now at 9 months, they have dropped below 100 ml. I suspect that the GLEP and HoLEP equipment are equally as expensive. I have heard that HoLEP requires more training.

Good explanation, Lee! I already knew that but wanted to let rde doing some research on his own. 😀 He is very good at it.