BPH - LARGE Prostate - CT Scan shows 220ML P Size - ThruLEP -is it good for a LARGE Prostate?

Russ, y are correct; The amount of time required to enuculate a 220ml size is the challenge for HoLEP (pulsating laser) and ThuLEP (steady laser); Both Medical Centers I am in touch w propose that they have done larger size than mine w success;

ThuLEP is proposing OUT PATIENT - 2 days catheter (Univ of Illinois) - hardly no experiences from ThuLEP in USA that I can find - I think it is prominent in Europe for some time now;

HoLEP - no details if OUTPATIENT or HOSPITAL time and no details of catheter time (Vanderbilt); Both advise SE of RE (ok with that); Univ of Illinois proposes no issue with Incontinence or Erections;

Not entirely true. I had bleeding from prostate veins and chronic infection, albeit my prostate was only 120-130g. After PAE and typical concurrent course of steroids and antibiotics (bactrim in my case) the infection has gone. So did the bleeding. PAE leaves capillari intact, targets only larger arteries to create infarctions and shrinking of the prostate but doesn't cut off all the blood supply to the prostate. It's enough to bring the antibiotics in, let alone that inflammation happens mostly in the bladder and urethral area not deeply in the prostate body, wher it's treatment is almost impossible in any case. I would start from PAE , which is not totally durable anyway,and then resort to HoLEP or TuLEP on a smaller prostate.

There is not much less to lose when you start with PAE, which is covered by insurance. Intrusive techniques are always in our future...

I had Thulium/Holmium laser surgery for my 135 grm prostate in England in 2013. It was a long procedure taking 3 1/2 hours and it removed 80grms with 37 grms saved to be checked for cancer cells. It was clear.

Gene,

I appreciate your research. I started with a PAE in 2017. Helped a bit (I estimate 20% improvement in BPH symptoms) but only lasted a year. Then, in April 2018 I had a bipolar TURP. I estimate improvement in flow of about 50%. However, my IPSS score is still about 20. I continue to research my next procedure. Holep is a possibility but is not done anywhere near me nor is it covered by my insurance. Also, I hate hospitals and don't want to have an overnight stay if possible. When I had my TURP I was back home in 4 1/2 hours. My urologist does either TURP or Greenlight.

Tom

Fyi, Univ of Illinois does ThuLEP as out patient - 2 day catheter ; no hospital stay....Other areas in US may be similar. but i cannot find other facilities that does ThuLEP - however, many places for HoLEP....

Look at similar Lisa Laser USA and RevoLix

Thank you for providing a specific example. There are few absolute truths. My point was that potentially reducing the ability to cure an infection is a risk that may be acceptable, or may not be. Dr and patient must weigh a risk like that against all others. There don't seem to be many clear-cut "easy button" decisions based on reading this board...certainly less so than a patient would think after speaking with many urologists who in my opinion are fairly programmed in recommending a course of action. If it were that easy I would have had mine fixed most likely at a cost (RE) a year or two ago.

Russ, I agree wholeheartedly with you, but the reason about infection fighting after PAE is far fetched according to my understanding of how antibiotics and blood supply works after PAE. Shouldn't be a factor in considering PAE. According to the vast experience in Portugal, Brazil,a and China PAE is 95% successful when performed correctly. It's also true that it's not always durable due to a personal hormonal status and age and less effective in patients with arterosclerotic depositions. Not always the skills of IR are adequate. It remains highly complicated procedure in technical terms, and most often rather than not, the patient is unaware of how successful was the intervention. Otherwise, the tales about median lobe and other predicaments are mostly the folklore of UROs and patients who have quite primitive understanding of vessels anatomy and how PAE affects prostate. It's not a panacea but for patients with a huge prostate > 130 g it's an escape door from much serious complications and wait to for less invasive procedure coming to the market.

I'm confident that mediocre results of PAE are due to less trained IR operator. Dr. Pisco from Portugal had an incredibly high level of success.

I'm having a holep done tomorrow and there will be no hospital stay. I guess it depends upon the Dr.

I'm surprised your insurance won't cover it because even the crappy insurance that I have, Connecticare on the individual market covers it.

Also, medicare covers it.

dantec,

I am with Kaiser Permanente. They only cover procedures done by Kaiser and to my knowledge, Holep isn't done in the Kaiser system.

Tom

Gene, I certainly am not an expert or formally trained in any of these areas, including details of how the network of arteries feeding and within the prostate are occluded and how they respond overtime.I'm fortunate compared to some of you gents in that my prostate is only about 80 gms but it still has been very problematic. I looked into PAE, met with an IR, and unfortunately walked away from that without the confidence I needed to proceed with it. It possibly had more to do with the individual IR than the procedure itself. I just was unable to get specific, confident, well explained answers to some of my questions. My comments about infections and PAE were based on something I read in a study or paper; I can't recall where it was that I read it but on a simplistic level it made sense.

80 g is a lot to make a lot of troubles. Your question regarding thw infection is to some extent academic. PAE is not an urgent procedure, why not to take care of the infection first and then in a week or two perform PAE. My PAE took care of my infections, but I had a standard protocol if steroids an antibiotics 5 days after. Only a good experienced IR (most if them are, contrary to URos) will tell you based on you clinical data and CT scans whether you are a good candidate for PAE. You opinion is insignificant, you are not educated enough in that area. In my diletante view it's alway worthwhile to try less invasive procedure first. If course, the final decision is upon you, if you have insurance coverage

Gene, no patient's opinion is insignificant. It is the patient's body, the patient's life, the patient's well being, the patient's state of mind, the patient's money, and the patient's decision. And in my case I've invested hundreds of hours of due diligence, including reading dozens of relevant published studies in medical literature, to investigate the various alternatives available and weigh the risks and benefits of each.

The IR I consulted told me I would be a good but not great candidate for the procedure. He saw CT imagery of my lower abdomen and operative notes from cystos and urolift procedures in addition to the basic medical history I provided. Going into that meeting I was viewing PAE as a low risk "why not" approach to mitigating my LUTS. Unfortunately, he was unable to provide confident answers to a few of the questions that I had which eroded my confidence in him. My ability to connect with the provider who's going to try to fix my issues is an important part of the equation to me and it just wasn't happening in this case. I was getting that "he's just OK" vibe.

I have a 70cc prostate and my IR also gave me a clear indication that he did not consider me a good candidate. He said his average prostate size is 180cc. In addition, the outcome for a patient with a medium size prostate like mine that also had chronic prostatitis like me did not have a good outcome.