HoLEP 4 weeks on.

Hi rogcal, 

Thanks, it really is a great op and will report again, probably for the last time at the 6 weeks stage.

I'm feeling so much better now I'm sleeping through the night and it's good to get off the two types of pills at last but in fairness the pills do work well until the prostate gets too big and in my case that was nearly after  ten years. 

Good luck to you.

tony

Thanks, If I was much younger and private I may have tried one of the many other newer treatments. Too be honest, I read about all the other treatments on here and couldn't find any other treatment that is, at this moment in time, simple and affective long time. No doubt there will be a better solution coming, especially for younger patients, but HoLEP for older patients seems an effective way forward.

My understanding is that Holep essentially carves out the prostate tissue, leaving only the prostate capsule.  Because the laser cuts the tissue rather than vaporizing it (like the Greenlight does), the chunks are flushed into the bladder and must be morcellated (i.e., chopped up) so they can pass through the resectiscope.  The process requires a lot of training, hence the relative lack of practitioners (at least in the US.)  

The button TURP is like a conventional TURP in that the channel is opened up but it uses a bipolar spherical shaped electrode that when energized creates a plasma field which vaporizes the tissue.  Advantages are less blood loss, no possibility of TUR syndrome, and somewhat less traumatic to the patient.  It requires little training since the process is so similar to the traditional TURP.

My urologist claims the button doesn't do as good a job at removing tissue as the loop resection.  He says he starts with a loop and then uses the plasma button to smooth the surface at the end of the procedure.  I am going to get a more thorough explanation during my next visit in 2 months.

If only the prostate capsule were left there would surely be no ejaculate ?

The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen.

The vasa deferentia  bring sperm from the testes to the seminal vesicles. The seminal vesicles contribute fluid to semen during ejaculation

My comments were based on things I have read (or thought I have read.)  I could be wrong.  It wouldn't be the first time!  I have also read that retro is just about a sure thing with Holep although the OP says it didn't happen with him.  A little knowledge is a dangerous thing which is why one should never assume information on an internet forum is correct.

It is very difficult to put a figure on retro fro this and other forums as successful patients drift away. I certainly did not get retro with GL. If the median lobe is not to bad and the bladder neck is avoided you should be OK. The Newcastle team who did mine used a bladder neck sparing version whenever possible.. 

I have an appointment today with a urologist who performs Holep. 

Are you able to exercise such as lifting light weights?

Hi,  

yes, started back at the gym a week ago, am taking it easy but doing bench press and stomach exercises no problems. I went the last time 2 days ago and forget I'd had an operation and not suffered any set back. 

Obviously you need to see what your doctor says about getting back to sports.

Good luck and be good to hear how you get on.

You were able to go the gym at 3 weeks after the Holep?  If yes, that’s great. 

The doctor I saw said Holep removes almost all of the prostate thus patients do not need retreatment or another procedure. He works in a major Medical Center and if I wanted another procedure such as Button Turp or Rezum (did say it’s relatively new without long term data), he would refer me.  

I would need to stay in the hospital for one night. 

I’m planning on seeing another urologist who does Button Turp and compare notes.  I am interested in seeing data comparing long term retreatment rates and other variables between Holep and BT. 

Keep up the good progress and don’t forget to do planks, 👍

Hi Phil, 

I should have said , 'went to gym at end of 3rd week'. 

Planks are something that I should do more. I do do burpees , single legs which is a kind of plank but should do the side and back too. 

Good luck with your research, there's plenty of actual accounts of most treatments on here so plenty of resource.

I read through the info on Newcastle urology website. Quite impressive amount of information for each procedure. 

What made you decide on Holep over GL?

Thank you

>>The doctor I saw said Holep removes almost all of the prostate

? - maybe it varies with size.  My uro said of my 28gramme prostate, about half was removed by Holep. 

It is commonly said Holep can remove more than greenlight, and makes re-operation less likely to be necessary after growth occurs.  I think it can remove more than TURP too, and is the most suitable for monster sized prostates.  I didn't have the impression that it removed almost all, though. 

It removes as much as the operator wants it to.

My understanding the Holep removes more tissue vs Turp or GL. 

Why ?No one wants to remove more tissue than is needed to create a good flow.

More tissue removed, (the capsule remains) from Holep means no additional procedure necessary. 

That is my understanding based on reading and the uro I consulted with on Friday. 

The Holep is more involved with a longer recovery time vs GL. 

If I get 5 years with GL, perhaps a new or improved procedure will be available. Or go with Holep and be done with bph.  

In all my years of reading I have never heard anyone say that HoLep is a one off with no future growth. Though if your one takes it all away it may do but with what consequences ?

No long recovery for Breeze he was soon back to normal without being completely cored.:-) 

Results of a 5 year study published in March 2018 on the Greenlight XPS 180watt system showed that only 1% (4 of 370) of the patients needed surgical re-intervention during the 5 year study period.  At the end of the study the average drop in IPSS score was 75%.

Whose study was it. Apart from regrowth after eight years I had been happy with the results although my flow was not as good as I had expected perhaps because of their  bladder neck sparing technique. However that was not a real problem.

Published by Canadian Urological Association Journal.  If you use this phrase in Google "photoselective vaporization of the prostate functional outcomes" it should be the sixth reference and it will point to an article in Sciencedirect.com from the Journal of Urology.  Not sure who the original publisher was but I think it was the Canadian journal.

>>In all my years of reading I have never heard anyone say that HoLep is a one off with no future growth

- that is exactly what I read before I had my holep, and also what the uro said... No guarantees said but holep has the lowesy chance that you come back for a repeat in 20 years, unlike with turp or gl; because more is taken out with holep. I don't think however it leaves you with only the capsule, in my case estimate was half left.

I think that they are taking away more than they need to as you still need prostate tissue to function. Perhaps Breeze will ask his excellent team at his follow up.

With the Thulium/Holmium procedure I had after my regrowth I was left with 55grms from a 135 grm prostate. It did not occur to ask after my original GL how much had been lasered. I was told in great detail what had been done with diagrams but not that.  

Can anyone recommend Holep Doctor in New York/PA area?

I've been researching help for my 87 year old dad and this sound promising.

Thank you.