BPH - LARGE Prostate - CT Scan shows 220ML P Size - ThruLEP -is it good for a LARGE Prostate?
Posted , 10 users are following.
Presently on meds (Silodosin 8mg/D) n Bactrim for infections w Bleeding, for BPH until next decision time;
All DREs every year - sometimes 2/year is negative for Cancer; July 2019 CT at JHopkins is negative for Cancer along w DRE; PSA June, 2019 is 6.7;
Seeking out anyone who has done ThruLEP, for a large P? I know TURP, TULSA PRO, HoLEP are good for up to 80-100g P size. I hear PAE is good for LARGE P but not good if patient suffers with infections.
I recently am reading that ThruLEP is good for large P - it is a Thulium Laser Enucleation of the P......I need to hear experiences from others.......
0 likes, 34 replies
gene97713 Dogcajunatyahoo
Posted
TrueLEP will be no different from HoLEP. Technologies are similar to the best of my knowledge. I had excellent results from PAE with 130 g prostate, infections and regular bleeding, obstructions. Try it first, then, if no relive, probably robotic prostatectomy. Too big for laser enucleation in my diletante view.
Dogcajunatyahoo gene97713
Posted
Gene, TU for your comments. I am led to believe thst HoLEP is a no go as the size limit is 180g. Tulsa Pro is 100g. so i am very interested in Thulium Laser if it can address my 220ml size. my fallback will be robotic simple P surgery. Mike (Louisiana)
derek76 Dogcajunatyahoo
Posted
The Uro who did my GL in 2004 said that he had done a 200grm plus on a 92 year old as it was a very gentle procedure
derek76 Dogcajunatyahoo
Posted
Why is there a size limit ? They are not removing it all just enough to give back your flow by clearing the obstruction. In my case it was mainly the lateral lobes as the median he said was not to bad and he did a bladder neck sparing procedure.
gene97713 Dogcajunatyahoo
Posted
I'm afraid it's a bit of confusion here. Both lasers produced similar results. One is continues, another is pulsed. Power are are comparable 100W vs 125 W. I don't think the sizes are so different. The problem is the mount of heat you can transfer to the prostate without damaging the capsule and nerve bundles. We are speaking now about the skills of the operator and efficiency of the cooling technique.
If you can find an URO who will agree to perform the laser surgery on your 220 g prostate, go for it. I doubt you will find one in US. Then, try PAE and after PAE you can chose a technique if the relive won't be substantial. After PAE your prostate will shrink to 150 g, which night give you a relive or use laser enucleation surgery.
Dogcajunatyahoo gene97713
Posted
I got the recommend of ThuLIP from Univ of Illinois at Chicago. They are pacesetting Robotic Single Port Simple n Radical P Surgery as well as Cleveland Clinic. Recommendation was ThuLIP or Robotic SP Simple P Surgery for 220mL. It no doubt has my interest. Although, I wonder if ThuLip is once n done - OR will the P grow again and I face the same music in my mid to late 70s - ie. how long is ThuLip good for...I recognize every case is different - but sensing getting this done and done at 69 is better than continuing to deal with. I will continue to explore options as we enter this New Year. Happy New Year! I enjoy your posting of experiences - it is very helpful for those w this trying disease....
derek76 Dogcajunatyahoo
Posted
All prostates regrew eventually.
gene97713 derek76
Posted
That's a wrong statement. Clearing the obstruction created by a very large prostate will last not for long. Even with the same rate of regrow (which is obviously faster for larger prostates due to the specific nature of hormonal status of the individual), the size will increase by a larger amount per year. So it won't last long enough. Means, the operator has to remove much larger part of the prostate, ergo longer operative time, more heat transferred, longer general anesthesia, recovery time. Not as gentle, as many try to present it. Could be for a smaller prostates and younger age.
According to recent paper in Advances in Urology (June 7th, 2018) there is no observable difference in using TuLEP or HoLEP, except for availability and experience of operators of Tullium lasers. I'm afraid he information provided is false. Research that, above mention paper and learn the results for yourself.
Here is a brief excerpt from the paper:
Conclusion
Our comparison of HoLEP and ThuLEP has demonstrated the efficacy, safety and effectiveness of the two techniques for the treatment of symptomatic BPH. Results show that there are no significant clinical differences in the intraoperative and follow-up data between the two techniques, and they have equal efficacy for all adenoma volumes, with minimal complication rates and blood loss.
derek76 gene97713
Posted
For older patients how long it lasts may not be a great problem.
I had 80 grms removed from my 135 grm prostate in 2013.
Later the surgeon suggested that I take Avodart to reduce future growth.
I said at my age (then 79 ) will that be a problem ?
He glanced at his screen and said " Perhaps not." No signs of a problem so far.
tom86211 Dogcajunatyahoo
Posted
From my research in the past Thulium lasers are superior to Holmium lasers for BPH procedures but are not as common. Either would be an excellent choice for you since you have a very large prostate. You could also consider a simple prostatectomy. It would be worth it to research the procedure as a possibility. It also never hurts to get second, third, or fourth opinions from urologists who do the various procedures. You are fortunate that no cancer is showing up.
Dogcajunatyahoo tom86211
Posted
yes Tom...i am fortunate no sign of C. Only a large P. I am seeking out a COE that does the Thulium procedure. Limits on HoLEP is ag 150-189 g P. so that is out Tulsa Pro limit is 100g . it's either thuilium or robotic simple P surgery. i want to learn of the SE's of thulium. Mike in Louisiana
derek76 Dogcajunatyahoo
Posted
If you mean Thulium/Holmium laser I had that in 2013 for my 135 grm prostate. It took 3 1/2 hours to do and I was out of hospital on the third day. They had kept me a second night as I was still passing blood probably as I had been taking Warfarin until day before the operation. Because of that the catheter was left in for over a week but it was crystal clear when removed and no retention and PSA down from about 7.8 to 0.74 and prostate reduced to 55 grms. and no problems of infections since.
I had previously had GL in 2004 when my prostate was 75grms.that was also problem free.
Dogcajunatyahoo
Posted
D, where did y have y procedure n by whom? yes, it is Thulium Laser. Have been told that it can address 220ml size; If so, i need to find a COE that does this procedure . Tu for commenting Mike in Louisiana
derek76 Dogcajunatyahoo
Posted
I had it in England so a bit far from you. My man has been doing it for years and has demonstrated it around the world.
Look for RevoLix Thulium Technology or Lisa Laser for detailed information.
Truthmatters Dogcajunatyahoo
Posted
Have you considered Aquablation?
Dogcajunatyahoo Truthmatters
Posted
T, yes, I have read about it. I think I have read of 2 Drs in Georgia and 1 in NY that currently have good reviews of the procedure. My concern is the amount of debris that needs to come out w any type of ablation type process. Catheter time, n retention experiences due to debris blockage, etc.. PAE is interesting but my history of infections w bleeding may not be a match...