Greenlight versus Acquablation

I would look into Rezum too. Aquablation brings a long recovery and Holep gives you RE for life. If Rezum doesn't work, you can always do Holep or Aquablation. Also, make sure that your prostate is the main issue - the more failures you have the more that brings something else into play.

Just to second oldbuzzard on Rezum as the procedure to try first. I would definitely not do HoLEP because it will give you RE for life. With GLEP there is a 50 percent chance of RE. With Rezum it is under 10 percent. I had no RE from my Rezum.

.

I can't comment on Aquablation other than very few urologists are doing it.

.

Also make sure that you have a urodynamics test and cystoscopy to see if there is bladder damage that might prevent any BPH procedure from being successful. Finally, if you do chose Rezum, find a urologist who has been done over 50 of them.

I looked into Rezum, but they didn't want to do this because of the work I already had done. Thought it might be too risky and suggested I go to a teaching hospital. I was not a candidate for PAE because of the small prostate size.

I do have a weak bladder, perhaps caused by BPH. But what is the fix for that? All people I have ever seen have said that removing any obstruction will be the best for me and my weak bladder to overcome. And my personal experience has been just that, two times. The procedures just didn't last. So I have already done two less invasive/less risky procedures.

I am not a fan of RE, but I have it now because of the FLomax, so having it without the other issues Flomax brings sounds like an improvement.

"Holep gives you RE for life" Give the stats for that ridiculous statement..

Motoman,

.

You do not want to go to a teaching hospital for Rezum unless the urologist who does the Rezum has been doing them for a while. You absolutely do not want a newbie to be doing your Rezum.

.

Removing the obstruction may provide some help for a damaged bladder but it is worth getting a better understanding on the bladder damage. That is what a cystoscopy and urodynamics test will do.

.

For the record, I flunked the detrusor part of my urodynamics test and the cystoscopy showed moderate trabeculation so I had a damaged bladder from years of BPH. As me and oldbuzzard have said, bladder recovery is a slow process.

.

What I find interesting is that there is a lot in the medical literature on how bladder outlet obstruction (BOO) from BPH causes bladder damage, but there is nothing tracking bladder recovery after a BPH procedure to remove the BOO.

.

After my Rezum, my post void residuals (PVR's) measured by self-cathing were just under 150 ml. Now almost 11 months later, my PVR's are under 100 ml which for my age is OK. Bladder recovery is a slow process.

.

Also, to make the Rezum last, I am staying on Finasteride to prevent prostate regrowth. I have had no bad side effects from Finasteride and my bald spot has filled in which maybe is a good side effect 👍

.

Steve

I had Gl in 2004 with no retro when I was about 70 as my median lobe was not to bad and they did a bladder neck sparing version. I had thulium/holmiun laser similar to HoLep in 2013 by then I was part way to retro from Tamsulosin and nearing 80.

I'm now supporting Hank on the amount of misinformation being repeated as 'fact' on this Forum. It is time to start drawing the Moderators attention to much of it.

Do you realise that you can look at actual medical information on this site as it is run for British patients and Patient UK provides services for the UK medical system and patients.

You can search for professional articles on here like this one.

https://patient.info/doctor/benign-prostatic-hyperplasia

Derek,

Very few Uro surgeons offer sphincter (bladder neck) sparing GL or even HoLEP operations in USA. This site is not only of British patients. The majority are from USA and other English speaking countries. The misinformation on this forum is not that rampant as you suggest. It's rather that many patients are poorly educated in the anatomy of the bladder or prostate. In most case with clinical symptoms the median lobe is enlarged and is obstructing the bladder neck. So, sparing the bladder neck, and corresponding sphincters responsible for the RE is practically impossible. Most operating UROs won't even bother. I personally had a serious obstruction of the bladder neck (three full obstructions) over the course of 4 years) and proven moderate trabeculation of the bladder wall on my contrast CT scans and cystoscopy (including a diverticula of the wall just before my PAE in March 2018. It's all gone for the most part of it 6 month after PAE, except for the small volume of my bladder. Technically it could be probably extended to 1L or but usually, I have an urge, when it contains 150--200 cc. Never measured my residual after PAE. It was zero on ultrasound PVR instrument 3 months after PAE. . Probably around 100 cc now. Only one trip per night to the BR after 4 hrs of sleep. Rarely can wait more than 3-4 hours between the voids during the daytime. It's OK for my age 72. Unlikely the wall become more elastic with time. Everything returned to were it was roughly in my early 50th. So traveling back in time 20 year s is not that bad, given the relatively low invasiveness of PAE, of which you are a great critic. Read on what people right here about TURP and GL, when the prostate capsule starts to look like a prune due to the plenty of heat generated during TURP or GL. Some are luckier than others . ..

It's all about your age and unique skills and knowledge of your Uro performing the surgery.

I don't think that RE is such a menace at ages 60+, when searing a child is not such a priority for a male, but statistically all invasive BPH treatment results in 90% of RE and around 30% of ED and incontinence. The latter can be transient and improves in 2-3 years.

RE due to Flomax can be easily avoided in 90% of cases by switching to easily tolerable and inexpensive Alfuzosin, which is the same type, but more targeted alpha-blocker.

After both my GL and Thulium/Holmium laser procedures my PVR was negligible after having usually been over 300 mls and on one measurement 450 mls.

My PSA was down from about 9.8 to 5.0 after GL and from 7.8 to 0.74 after Thulium/Holmium.

My last surgeon suggested I take Avodart to prevent regrowth. I asked if at my age it would have time to. He glanced at his screen and said perhaps not.

Gene,

.

I have wondered how many on this forum are from the U.K. vs. U.S. given the populations of 66 million vs. 327 million. This forum is a great resource and it is unfortunate that in the U.S. we don't have something similar to this website. I am not holding my breath on this happening.

.

I agree that the misinformation on this forum is not that extensive but that many patients are poorly educated. During the 10 months of catheters before my Rezum, I had lots of time to educate myself with this forum being one of my resources.

.

During my "education period", I was fortunate to have a family member who was an MD for over 40 years and I have known for over 60 years to help me. As a retired research scientist, and under his guidance, I did the Internet research on the various BPH options available today.

.

We made a good team. When I comment on this forum, I try to present what we both learned about the various BPH options available today. Unfortunately as I learned, you may not get the information that you need to know from your urologist.

.

I agree that peeing like you did 20 years ago is great. If you have catheters, then you can measure your PNR's. It sounds like at age 72 after your BPH procedure you are doing good now.

.

Steve

Obviously the Forum was set up by a UK company for British patients but was discovered by others when searching. Though it does use an American spell checker. It has been often suggested that there should be somewhere to put your nationality in your heading but your version of English is usually apparent to most of us. The differences between our health care systems can cause confusion to many Brits who do not have your wider choice of doctors. also some of your newer procedures have not reached us. Using the old News Groups I knew about GL when it first started and was eagerly awaiting it.

Most here see an NHS consultant and that's it and find it difficult to get a second opinion far less several. I had quite a fight to be referred from Scotland where I was then living to an English hospital doing initial trials of it. Two other friends did the same and we all ended up having sucessfull GL's at different hospitals although one had his done privately rather than end up in a queue.

https://patient.info/terms-and-conditions

Derek,

You are mistaken again. BPH in UK and USA have the same features and treatments, the tails that everybody is so-o-o different is more of the medical tail. It's rather that the skill of the doctors performing TURP,PAE, HoLEP, etc. are so-o-o different. Secondary, most of us in US, except for those who are older than 65 yo, and not using a truncated version of Medicare (roughly(65%) are bounded to the HMO organizations, which are even worse than UK NHS-analog of our Medicare. HMO almost never will allow you the second opinion and in most cases will offer you the most outdated treatment. The major difference is that out medicine is exclusively for profit (even some hospitals will claim nonprofit status) and profit wind up in the pockets of doctors and clinic administrators.

For example, in UK NHS will offer you PAE or Resum as a less expensive treatment vs. TURP or HoLEP, while in US these are most likely paid out of pocket procedures or covered by Medicare if you choose the most expensive version of it, which typically will cost $350+ per month. Yes, thsi option allows to travel to any doctor or hospital in USA. Are you ready to pay regularly 4000 pounds per year for your hypothetical medical services?

REgarding the English> I believe that part of the correspondents on this forum are just not native English speakers. Has much less to do with British vs, American dialect of the language.

For some reasons we in US know much more about your NHS than you about our outdated and quirky multifaceted medical services that became unaffordable long ago. For instance, to have the PAE in US you have to pay out of pocket ($10000) or be extremely lucky to have doctor in the area who accepts Medicare and be 65 or older.

There is no guarantee with FLA, don't know where you heard that. I had my procedure done over 2.5 years ago, coming up on 3 years in February, I think I have given it enough time.

The Dr was great, the best I have ever had the pleasure of seeing/working with, and by a long ways. He went above and beyond for me with follow up, etc.

If you look, you will find others where the FLA wasn't successful. We are in the minority, but out there. Mostly smaller prostates. Mine had cysts fill with fluid where the tissue had been ablated.

Since I had decent results with both procedures, there is reason to believe a more robust procedure will have more lasting results. I had instant relief with both procedures, but it just didn't last.

I would not call FLA very invasive. That is what I would call TURP, Holep, Aquablation, etc. It is why I went for the less invasive procedures to begin with, supposedly I could try other procedures after. Which is why I am currently looking again.