HoLEP 4 weeks on.

Hi Gary, 

Good luck on your op and yes, it's a relief when it's over, I hope it goes well for you.

I envey your sun its quite chilly in south yorkshire and had to put the heating on.

Just don't go there in January or February :-)

We had a month there in each and the weather was dreadful. In 2008 fish were dying in the sea after the temperature dropped and Iguanas were falling from the trees while oranges froze.

Then we had rain and thunderstorms. We crossed the Sunshine bridge going to Tampa by bus in the worst rain I have ever seen. I offered my congratulations to the Greyhound driver who said it was the worst he had ever driven in.  

Ah the Iguanas. I was living in Auburn, NY (30 miles west of Syracuse)  then but heard from friends that the iguanas were falling out of the trees from the cold. I moved back to South Florida in 2013. The iguanas have made a big come back since then. The winter months are our dry season. Rainy season is from May 1 to Dec 31. You can however get some monster rains in the winter. It has been known to happen. 

BTW, my urine color has come back to normal. No blood any more. That is 11 days post surgery.

When out walking we came across two comatose ones on paths in Key West. There was a bird we could not identify in the botanical gardens. The staff  did not know what it was either and said it had been resting there for a couple of days and must have been blown off course.

Hi David, 

Good to hear from you and hope you make a good recovery. As stated before my blood cleared up at the 3.1/2 stage but it wasnt a problem for me. I remember the slight stinging and the dribbling but ditched the pads after about 10 days.  Are you peeing well and getting more sleep now?

My consultant impressed on me the need to do the pelvic floor exercises and gave me a leaflet about them. I had this for some 2 months before my op.

Good recuperation and look forward to hearing from your progress.

ps I didn't ask my consultant how much he would remove and didn't get to see him after the op because he was off duty. I will ask this when I ring next week for the results of the biopsy.

David what procedure did you have?

you had the plasma button turp, right?

Pelvic floor exercises must be new advice in the UK as they were not mentioned prior to my two lasers procedures in 2004 and 2013. 

Hi Derek, 

I can only think it helps in preventing mishaps with the kind of urgency that is happening with me explained earlier in my post. It's not happening much but only when I put off my first urges to go for a pee. I'm sure it will settle down soon but i'm able to hold on because of stronger pelvic floor muscles. 

Can you remember these types of urgencies in your early weeks/

Back in the early days of GL on the old prostate news group pelvic floor exercises were only mentioned by a few American posters. It was then something mainly only ladies did and not that many of them.

I don't remember any urgencies after my GL or later procedure and went out and about with utter confidence. 

When you have your follow up it will be interesting to see how little retention you have after voiding.

It was about six months before I went back to Newcastle for a follow up (in the bleak midwinter) but I had a post void check at a community clinic in Edinburgh after about a month and the doctor said practically nothing.

How long after the GL did you need another procedure?

Which procedure?

I’m considering Holep because I understand there will not be a need for future procedures. 

I needed it seven years later but it was done nine years later as my then local NHS hospital only did TURP and put obstacles  in my way. I eventually had Thulium/Holmium laser that is very similar to HoLep.

I don't think it is the procedure that determines how long it will be before you need a repeat procedure. All prostates regrow and each individual seems very different. As one urologist said that gland is like a weed

Two friends who were early GL patients like me have been vey different. One needed a repeat  after about four years and the other is only now having flow problems after fourteen years that Cialis is dealing with very well.    

Some UK urologists try to persuade patients to take Avodart on a daily basis after any procedure to stop any future need for a later procedure. I said an emphatic no to that and asked if at my age (then 79 ) it would have time to regrow. He glanced at my notes and said possibly not! He had reduced it from 135 to 55 grms.

I don't believe that HoLep is better than GL apart from it being able to save tissue for examination as did my Thulium/Holmium procedure where he saved 35 grms. I don't know how right she was but his nurse said that tissue saved from the centre of the gland is less likely to be cancerous than from the outer areas.  

 

Hi Derek,

Thanks for the interesting conversations above. I agree with not wanting to continue with the taking of pills after the op as non of us like taking pills especially ones with long term unknown outcomes. At the end of my 10 years off and on with dutasteride my breasts were getting tender so glad to be off then. If, say 10 years down the line i started with bph I wouldn't have a problem starting using the pills again because I know how effective they can be and then i would be 80 and would be glad that I'd had a good ten years break from the dreaded BPH.

When twice on Finasteride for a relatively short time I was beginning to grow breast and my wife was threatening to buy me a training bra. Several other drugs have had a similar effect on me. My GP actually arranged for me to have an ultrasound scan of my breasts. By the time the appoint date came they had gone back to normal. Evidently some teenage boys develop them due to hormonal changes.

It’s not easy deciding which procedure to go with. 

Although anecdotal, I know two people who had GL and are doing well. I have bladder stones, they didn’t. 

With that said, according to studies found on google, Holep lasted more years before a need the retreat vs GL. 

If more of the prostate is removed than GL, it’s not surprising. A higher number of pts had incontinence than GL. That’s concerning. 

I also found there are three different GL devices; one is called GreenLep which is better for larger prostates. 

Looking forward to hearing what another well respected urologist who does BT says. 

Until then the indecision is stressful. 

No, HoLEP.

I was fortunate that in 2004 there were not as many options as now,

Are all the GL ones mad by the same company? I know that there have been two later versions of the one used on my procedure.

The originator of the Greenlight laser was a company called AMS (I believe.)  They were purchased by the current manufacturer, Boston Scientific.  I also believe this technology is on its 3rd generation, each laser being more powerful than the one that preceded it.  I'm not sure what the benefits of higher power are other than (probably) shorter operation times.

It was a company called Laserscope who were then taken over by AMS. Many of us in the UK were helped by Laserscope's  rep Mike Degun who put us in touch with hospitals doing the original UK trials.Mike came as observer to many of our procedures.

When A friend was having his the laser failed to fire up during its set up and Mike dashed off to another hospital to borrow one. 

As with anything and in this case and after fourteen years all systems are upgraded and improved on. I don't know about now but the original laser rods cost  about three thousand pounds and if it was a long procedure a second one was needed. Patrick the first person ever to have GL PVP was so impressed that he bought share in Laserscope and became a disciple for the procedure on the then prostate news group. A British friend was much the same writing articles about it and doing radio inteviews.

My 75 grm prostate needed 57 minutes of actual lasing time with a total time in the theatre of about

2 1/2 hours. My 2013 Thulium/Holmium procedure took 3 1/2 hours. I was told that it would be too long a time to have a spinal injection. .

 

One of Patrick's posts from 2002:

Fred,

1.  A 100 gram prostate shouldn't require open surgery.

2.  A holmium laser is much more invasive than the new 80 watt KTP laser.

With the 80 W KTP laser there is almost no bleeding.  Check out at the laserscope web site. 

3.  With the KTP laserscope procedure you are looking at 1 to 2 days recovery time.

Patrick

 

in what year did you have the first procedure (GL?). 

If you initially  had a Holep , do you believe you would need a second procedure?

I had the GL in 2004. Yes, even with a HoLep your prostate will grow again. GL is such a simple and as my Uro said of it a gentle procedure procedure I would not mind having it every seven or eight years.You've read the Newcastle site and it seems to have more or less convinced you. When I told the Uro there who had done my GL that I needed another procedure he said in December 2012

" As far as the laser options are concerned, there have been 2 major upgrades to the Greenlight laser from the machine I used for your surgery.  We have had one of the latest machines here as part of a study which has allowed us to look at it and the consultants involved have been keen for us to continue with this latest machine.  Generally however in the department the view has been that we should adopt the HoLEP procedure and so that is the direction in which we are moving currently"

 

For yourself both laser options should be OK.  The key will be that the team looking after you have the laser that they are happy with.

 

The uro I saw on Friday said if I wanted,  he would refer me to specialists in GL, Rezum or PAE. 

He said Holep will mean I will not need another prostate procedure in the future. 

GL has considerably less recovery time with less chance of inconvenience. 

However, another GL in 5-8 years means general anesthesia at an older age with more risks. 

On the fence until the end of the month when I consult with two more urologists. One is very experienced with GL and the other Button Turp. 

The more you ask the more confused they will make you..

The one who says that HoLep is a once only procedure is that the operation he does?  

If you look at Cambridge Urology Partnership in the UK they  will agree with you man saying that less than 1% will need a reoperation compared to more than 15% after GL.