Greenlight versus Acquablation

Posted , 18 users are following.

So I've finally found a doctor I like. I dropped the creepy female uro who wanted really wanted to do a 12-needle biopsy for no damn reason. I got a doctor who came recommended by a friend, He operated on him and got a good result. The guy is a professor of Uro.

Anyway, he wanted to do a Greelight or Acquablation. I asked which one he thought I should have, which one has a better result, etc., and he said the Acqualbation because "it's cooler" cuz it uses a robot. But now my insurance has declined it. My insurance will pay for a Greenlight Lazer. Should I fight the insurance for the acquablation? His office is telling me they are both equal and in fact there's less bleeding with the lazer. Anyone have any thoughts? Thanks.

0 likes, 78 replies

Report / Delete

78 Replies

Next
  • Posted

    GL is tried and tested having been around for about 15 years and he is probably very experienced in them. If your median lobe is not the problem area and he does a bladder neck sparing version you will avoid RE.

    Report / Delete Reply
    • Posted

      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?

      Report / Delete Reply
  • Posted

    A study was just published a few weeks ago comparing Aquablation to TURP for guys with fairly large prostates (50-80g), and having a large middle lobe. They found aquablation beat TURP for results, plus the rate of retro ejaculation was 41% after TURP, versus only 2% for aquablation.

    Don't know how that compares to Greenlight, but it certainly seemed like it's no contest against a TURP.

    Report / Delete Reply
  • Posted

    Pretty much the same results. Both have the same complication rate (incontinence, impotence, less RE with aquablation). Both will damage the nerve bundles on the sides of the prostate by elevating the temperature of the prostate. One use laser to ablate, the other steam. Thermal damage is comparable. Go for the Urolift or PAE if you want to preserve these functions. Obviously everybody's anatomy, age, URO operator is different, so are the results. BTW in the previous postings somebody asked me if the Alprosadil is the right medicine to produce strong erections. To those who are strong proponents of removing the most part of the prostate inside the capsule, Alprostadin was first found inside the prostate, before it became an ED remedy. So, prostate inner mass does influence the erection by producing vasodilators. That might explain why BPH sufferers and postoperative patients after TURP and SRP suffer ED. Of course, there are other places where vasodilator is produced, but the inner prostate is an important organ for the erection and play an important role in ED.

    Of course, again, everybody's arterial system is different.

    Report / Delete Reply
    • Posted

      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.

      Report / Delete Reply
    • Posted

      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.

      Report / Delete Reply
    • Posted

      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.

      Report / Delete Reply
    • Posted

      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.

      Report / Delete Reply
    • Posted

      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 😃

      Report / Delete Reply
    • Posted

      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.

      Report / Delete Reply
    • Posted

      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.

      Report / Delete Reply
    • Posted

      @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.

      .

      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.

      .

      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.

      .

      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.

      .

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

      .

      Steve

      Report / Delete Reply
    • Posted

      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

      Report / Delete Reply

Join this discussion or start a new one?

New discussion Reply

Report or request deletion

Thanks for your help!

We want the forums to be a useful resource for our users but it is important to remember that the forums are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the forums is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.

newnav-down newnav-up