BPH, Holep coming up but interesting situation past few days with cold meds

Hey Bill.

You do not say how old you are. Why not do something else. Are you still into sex. Most of the time your sex life can be messed up. Erection problems and retro ejaculation. Men find out after and it is to late.

I had a Urolift done when I was 58. He put in 4 clips and at 68 I'm still open and no problem. My erection are fine and my orgasm are more intense. Better then they were when I was younger.

You said that you had a median lobe. They can do the Midlift for that. All they do is clip it to one side and it is out of the way. It is worth looking into it. Most doctor that do not do it will tell you that it is not go. That it will not last. After 10 years I'm doing great.

If they do not to it they are just trying to get you to do what they do. It really comes down to money.

yes, I had a Euro lift done a little over 2 years ago with zero improvement. Unfortunately, my median lobe is large enough that it's essentially, completely blocking my flow. I would not have believed it if I had not actually seen it for myself. He could barely get the cystoscope through to inspect the bladder. No UroLift will help that. Before I actually saw the pictures of my fourth and last cystoscopy , I was thinking a PAE would do the trick. but after what I saw there's no way it would have worked. I have to have a procedure which removes tissue. Since my prostate was small 55 G my age is 63, given my longevity And the fact I didn't want to do this again and since my UroLift experience was so bad. lots of inflammation, 2 years to recover. I decided the HoLep procedure would do what I wanted. The only downside is retrograde ejaculation. I thought about aquablation but for me being on anticoagulants for my heart, it becomes a risk of long-term bleeding in order to recover. That's where the Holep shines for me. The long term bleeding risk are much much less than TURP or aquablation.

No problem

You do what you feel is right. At the time that you had the Urolift why did they not clip the median lobe to one side. It would have taken 2 clips. I think that would have opened you up and had a better results.

When I had my Urolift my prostate was 60 Gr and close tight. My doctor could not get the cystoscopy into the bladder. He tried me on Flomax and Rapaflo. It gave me retro. I said no way in hell I stopped them and had the Urolift 2 weeks later.

Can I ask a question. The doctor doing the Holep is he the same that did the Urolift?

Also did your doctor mention. A Ejaculation Sparing Holep. This is where they stop at 1 cm proximal or before the verumontanum. If he stays away from that it will preserve your ejaculation. It will be less in volume but you will still have it. ( That will happen because you have less prostate tissue.

Why give up something if you do not have to..........Ken

The urologist that put in my Urolift never said I had a median lobe issues. he did a cystoscopy before the surgery and one year later, not one mention of an issue with my median lobe. When things continued not to get better, a year after , I decided to go to another urologist. he confirmed a high bladder neck and medium lobe issue. so bottom line I suffered two years for nothing. the second surgeon offered TURP or TWIP. neither of which I was a fan of. That led me to my third urologist who did my 4th and last cystoscopy where I could actually see everything that was going on. He also suggested a TURP

I ended up questioning the urologist to the point where he referred me to the surgeon. The surgeon went over the options , which at 55 G he said I had many , but suggested the Holep since I was on lifetime anticoagulants for my heart. With the Holep, I would not need to have another bph surgery once it was performed. He said retrograde ejaculation was the only expected side effect. A friend of mine recently had the same procedure done by the same doctor. I confirmed that retrograde was the only side effect he suffered. I asked him about sex life he said it wasn't much different just no mess.

I looked into the Urolift for the median lobe,PAE,Aquablation and many others. After weighing my options and the two years of suffering with severe inflammation from the Urolift, my age at 63, and which procedure I would recover from the quickest, I decided the Holep would give 90% of the results I'm looking for.

The surgeon did say that he has had some patiences tell him a small amount of semen comes out in the normal direction, most going into the bladder

Hi Bill

Best wishes for the HOLEP surgery. I had a similar experience with Urolift - no effect on flow and caused painful inflammation (which my current urologist thinks is not uncommon and as a result of which he no longer offers it). I was told by more than one urologist that it wasn't possible to do HOLEP after Urolift, something to do with the capsules that are left in the prostate afterwards that would impact the morcellator that is used to extract the prostate that has been lasered. It would have been my first choice - I had a TURP instead after failed PVP laser treatment - but great if you have a surgeon who is willing to do HOLEP.

Inflammation has been a major issue for me: do you have any particular dos and don'ts regarding the diet?

Richard

If the Holep is what you are going for ask the doctor if he can do a ejaculation Sparing Holep. All he has to do is stay away from the verumontanum. 1 to 2 cm. The verumontanum covers the ejaculatory ducts.

If he can do that then there is only a 10% chance of retro. I have had a few friend that had it done and they do not have retro. It works out great. You will have less volumes because of the prostate tissue remover. It will be more then a few drops.

Good Luck

Hi Bill,

Let us know how your procedure goes! Good luck!

I am 58 and still into Sex 😃. Doctor said that ED should not be a problem with Holep. Retro only an issue if he takes out the whole gland. If only the Median lobe is removed, ejaculation should be ok.

My prostate is 105cc and the median lobe protrudes into the Bladder area so it blocks flow. Doc said he will take out the Median 1st and then judge how the channel looks. If it looks ok he will stop at that. If it still looks occluded he will take out the rest.

Interesting, I will ask although I do not want him to deviate too much from his normal process, that's how docs end up making mistakes.

Median lobe removal also preserves ejaculation.

https://www.sciencedirect.com/science/article/abs/pii/S0090429523000304

The author is my surgeon who will perform it in 2 days.

why 2 days..?

It was scheduled a while ago...I am trying to get it done in the winter so it doesn't interfere with my outdoor sports activities when the weather gets better