BPH: Aquablation or Robotic Simple Procedure
Posted , 5 users are following.
I moved recently to Southwest Florida.
My bladder size is 100 CC (per ultrasound and MRI). My Urologist wrote:” staged given his enlarged prostate size requiring more than 1 operation to be completely treated endoscopically. Also discussed the potential for robotic simple prostatectomy for a more definitive single therapy option” He never mentioned Aquablation. None of my previous urologists sighted the size of Prostate being 100C as reason to see TURP as unsuitable choice.
With medication ( Flowmax 0.8 mg+ 5mg proscar) my flow rate (16.8) voided volum(188) is fairly normal, I wake up two times a night for urination. I am 69 yrs old. Wondering if I should consider the RSP(robotic simple prostatectomy) or explore to find a physician doing Aquablation or consult for another opinion for TURP, green laser , HoLEP?
Anyone here has experience with Aquabation, RSP ? Any reference to educated myself ? Thanks in advance .
0 likes, 10 replies
anders08675 TusharJ
Edited
My situation was similar even the meds.I was too big for most procedures >100. Urologist originally suggested robotic simple prostatectomy. I was not thrilled with the idea of it. The part about having to go through the back of the bladder to get to the prostate, the length of hospital stay, and the recovery time, risk of infection.
I did my own research and found a doctor that performed HoLEP.
One procedure with no future treatments needed later, one overnight in hospital, minimal recoup time. Great flow, minimal PVR, I sleep through the night, no incontinence, no more meds, no external scars.
Could not be happier with my decision.
Just my 2cents
michael66435 anders08675
Posted
That's great news. My URO also recommended HoLEP at first. He said since my prostate size was 96cc I would do well. When I mention the concern of incontinence he said then you want to do TURP? But I thought the size was a factor in recommending HoLEP. I didn't ask him why so easy to change his mind but I'm getting around to asking a lot more. I'm guessing less chance of incontinence with TURP. But my size was a factor, in what way? I was also told that I would have retrograde ejaculation with HoLEP. I'm pretty sure he said definite RE. That was a big concern of mine but not so much my URO. I'm 65 and everything worked great before urinary retention/BPH. But now he made a point of saying less than 5% of his patients have RE . He said he's done 15-20.
Anders can you shed some light on RE?
I mentioned to him Aquablation and he said they don't do it. So I've been appealing and looking for Uro that do it in the Santa Clara County, CA. I have a consultation July 18th.
I'm worried that my pursuit of Aquablation and getting it covered by Medicare Senior Advantage or my insurance that I'll be left with 2 choices TURP or HoLEP. So your good outcome is sounding good. The RE is a concern still.
Thanks for sharing Tushrj and Aderso
anders08675 michael66435
Edited
Find my post here in the forum covering my entire HoLEP procedure with more detail.
Regarding RE. Yep. it is true. But for me, it was a non-issue. Too old to have/want kids at this age, and the fireworks are still there, erections still stout, everything working as it should, just nothing to clean up after the party. So if RE is a concern, HoLEP is off the table, or worth some serious consideration.
TusharJ michael66435
Edited
Michael66435,
My brother had Aquabation at Palo Alto two days back at Stanford university . Urologist is Dr. Commiter. Iplan to see the Urologist in Naples, FL who does Aquabation and green laste rprocedure on 6/26/23. I will provide an update once I see him. The discussion her gave me one more procedure to explore. That is HoLEP. Online source : https://www.urologytimes.com/view/phase-3-study-compares-aquablation-with-holep-in-patients-with-bph ranks both as same withHoLEP slightly better .
michael66435 TusharJ
Edited
Tusharj,
Yes that would be great to hear updates from you and your brother. I have an consultation appt for Oct with Dr Comiter . Also have consultation with Dr Brubaker July 18th. also out of Palo Alto affiliated with Sequoia Hospital. Right now I'm set on Aquablation and will take some convincing otherwise by either Dr Comiter or Dr Brubaker why I should be strongly considering TURP or HoLEP.
Like I have stated in previous post my Health Care plan with Kaiser Permanente doesn't offer Aquablation so I'm going through a stressful process of Appeals and Grievances . I'm on my 2nd appeal. The other option is switch insurance which has its own concerns but doable , or pay out of pocket and I'm getting conflicting info on how much I would have to pay. I'm also a Medicare Senior Advantage which I understand covers Aquablation but waiting on their decision too. July 5th they decide if they will cover while I'm still with Kaiser Permanente .
Good luck Tusharj. Wishing you well!!
michael66435 anders08675
Posted
Anderso8675
Great description of the party. ha ! So true. To old to have kids here too.
Glad to see you're happy with the outcome. That's awesome!
I'll check out you post.
Congratulations on a successful outcome.
TusharJ michael66435
Edited
My brother had Aquablation procedure by Dr. Comiter at Stanford is doing better after 6 weeks . All the best
michael66435 TusharJ
Posted
Tusharj thats great to hear your brother is doing well. I had a consultation scheduled with Dr Comiter for Oct 26th. I have had a catheter in since April 16th. I've had 2 trips to the ER with urinary retention, one by ambulance and the other a crazy 40 minute drive to the ER. The ambulance took me to the nearest hospital which was Mercy Folsom. 10 minute ride. I'm a Kaiser member switching insurance to get Aquablation.
Instead of waiting for Comiter consult then having to wait longer for procedure which could have been Nov or Dec , I'm scheduled for procedure already with Dr Brubaker Sept 26th to be done at Sequoia Hosp in Redwood City , Ca. I hope I'm making the right choice to go with Dr Brubaker. Procept gave me the ok as far as him being top notch.
That's great medication is holding you over. But if you ever get a sign of no urine coming out , make a move quickly and get yourself to ER. I waited like 6 hours the first time it happened till I was convinced something was real bad. By that time I couldn't walk and my wife couldn't drive me due to her health. I hope you never get to that point.
Thank you for the info you provided for us all.
I can't wait to get this done and be catheter free!!!
Steveareno TusharJ
Edited
I had Aquablation on June 5, 2023. Doing well. General Anesthesia for approximately 1 hr. and 40 min. One night in the hospital. My prostate was 182cc's in size...very large approximately the size of a large avocado. Normal prostate size in a 20yr old is 40cc's.
Google Aquablation research and you will see that the studies are Aquablation vs. TURP. I was not a candidate for TURP and my original urologist said that I would only be able to get a prostatectomy. That is when I started to do my own research. You can Google Aquablation and you will see that it is done with high pressure water and the doctor sets the perimeter of the prostate that he wants ablated by the robotics.
I am 16 days post-op and I am able to urinate with no problems. No pain from the procedure, the discomfort came from the bladder spasms after the surgery because in my case I needed to have the 24 French Catheter in for an addition 8 days.
You need to do your research and understand all of the different procedures that are out there for you to pick from.
Also, based on your age Medicare does cover it but you have to get approval. If you are under 65 with private insurance you also need to get it approved. My procedure through United Health care Medicare Advantage was approved. Procept is the company that makes the robot for this procedure and they have a reimbursement department that will guide you and your doctor to get it approved by writing the letter.
Procept has a great video and testimonials as well as YouTube has videos of the actual procedure with the doctor discussing the procedure.
Hope this helps.
Good Luck on whatever procedure you have in the future. Be informed and ask lots of questions about urinary incontinence and sexual function.
TusharJ
Posted
I consulted Dr.Colton ( Naples, FL) today for possible Surgery for BPH liek green laster, Aquabaltion, Robotic Simple Prostectomy or TURP. Dr. Coln does green laser as well aquabalion. He said I do not have much of PVR ( no Urine retention) and Qmax is 12 to 16. I wake up usuallay twice at night. so with these symptoms I do not need to rush to Aquablation or other procedure . My prosate size is about 100. However he suggested me to wait. I will consult him 3 months later. At present I will continue with medication ( 8 mg of flowmax amd5 mg of proscar)