Greenlight versus Acquablation

I've read that Dr. Miller at Vanderbilt also uses a "bladder neck" sparing version of HOLEP. Why can't all doctors do this? I thought the basic idea is that when they get near the bladder neck, they limit the ablation so that there is still a small amount of prostate material around the bladder neck. This would then spare the bladder neck. Is that your understanding, derek?

Gene: Look up aquablation again. They do not use steam; you are thinking of Rezum.

Yes, it generated less heat than TURP or laser enucleation of large prostates but required TRUS and intraurethral cystoscope inserted, mean stricture is possible. Still destroys some important area of prostate, less probability of impotence and incontinence but more of bleeding after surgery. requires overnight stay and perceived experimental by most insurances and Medicare. Any robotical procedure is expensive by nature of expensive instrumentation and software.

I will still chose PAE as the safest option.

I don't agree with most of this. Results aren't the same and Aquablation has the longest recovery of ANY BPH treatment. Many are still bleeding months after Aquablation.

Greenlight is an older procedure and in experienced hands it works well. Recovery can be messy - urgency is bad enough that many wear diapers for 1-4 weeks post op. Long term, the main problem with Greenlight is RE (dry orgasms). There is a 50/50 chance of it - almost no one does the bladder neck sparing procedure, so I wouldn't factor that in. If you don't care about RE, Greenlight is a good choice. In the wrong hands Greelight can do permanent damage and leave you incontinent. Make sure your doc has done hundreds of these if you opt for it.

Also covered by insurance is Rezum. RE is 5-10% and the worst case scenario is it doesn't work - although in about 90% of the cases it does. They don't put you under and it works fine with enlarged median lobes. Downside vxs Greenlight is most of the benefit comes weeks 6-12. while Greenlight works within a day or two. I would opt for Rezum first and if you aren't happy wiht the results, do Greenlight.

What exactly you disagree with in my brief statement. I mentioned possibility of bleeding. There is not always bleeding for aquablation. It's just a waterpeak knife. Fast and sharp. Allows precision due to the robotic drive and ultrasound imaging control of he stream by a special software that calculates the process in advance. The main difference is that both, TURP and RESUM, GL including, generate plenty of heat inside the prostate, heat is transferred to the surface of the capsule, where the bundles of critical nerves responsible for the erection and ejaculation are located. Damage to some nerves impairs erection and causes frequent ED up to three years after surgery. Nerves has the tendency to restore themselves sometimes and erections return, but not always. Any method works with enlarged median lobe because during any of the surgeries most of the body of the gland is resected or destroyed (ablated) one way or another. We are speaking about different level of thermal damage to the critical nerves. Not very well studied area. Mostly hypothesis.

So do you think I should try Resum first before the GL? It's less intrusive? If it doesn't work, I can get the GL. Or maybe my insurance will cover aquablation at that time.

What you're saying about the burning tissue and heat makes a lot of sense. You're saying that happens with Resum as well? Do men retain their sex lives better after Resum?

I also like the idea of Resum being outpatient, not full blown surgery.

This makes a lot of sense to me. I think you've changed my mind. I'm going see a resum doctor first. My GL doctor doesn't do reszum.

I don't regard GL as full blown surgery as there is no cutting or stitches involved. I travelled home by train on the second day and went to the races the next day. People were surprised to see me and asked if my operation had been cancelled 😃

You seem to be choosing what you want rather than what may better for you in your Uro's opinion. Many GL patients are out without a catheter the same or certainly the next day.

I haven't seen a URO who does Rezum. The problem with Uros is the old saying "When you're a hammer, everything looks like a nail." Each URO does his or her procedure and guess what? That's what they recommend. I do trust the URO who wants to do the GL/Aquablation. But I haven't seen a Rezum guy yet and it is less intrusive, less serious, less removal of tissue. From what I've read it works 80 percent of the time. People who have had it recommend it.

Plus it makes sense to me to try the more conservative alternative to surgery first. I can have a GL if it doesn't work. But you can't have a Rezum after a failed GL.

@Motto: Plus it makes sense to me to try the more conservative alternative to surgery first. I can have a GL if it doesn't work. But you can't have a Rezum after a failed GL.

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That was my logic too. Do the less invasive procedure with less complications and less morbidity first. If it does not work, then later you can do the more invasive procedure with more complications and more morbidity second.

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My Rezum worked as planned. I went from being completely blocked (median lobe) and over 10 months of catheters to I can pee again and I have no RE. I still have a PVR's over 100 ml which is most likely due to bladder damage. My stream is good.

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Cost of my Rezum was $2,500 out-of-pocket and then the added costs of the first consultation with the urologist outside of my Kaiser insurance plan and the cystoscopy. The same urologist who does the Rezum should do the cystoscopy too.

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When you see the urologist who does Rezum, find one that has done enough Rezums, at least 50. Don't go with a newbie.

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Steve

My thought process and experience has been similar to Steven's. Two years ago, I had a 54 gm prostate, median lobe issue, and typical BPH symptons. My stream is now passable, PVR is zero, and no RE. For me, Rezum was the lowest risk option that worked.

Bill