HOLEP or Aquablation

There are a few recent discussions on this topic and a number of older ones. Just scroll down the forum topics. Unfortunately there is no search feature.

I strongly suggest you check out other surgery options. I had my aquablation three weeks ago and a unsuccessful PAE several years ago - the former seems to have fixed my median lobe. I think very highly of both of these procedures. My sense is that your Uro doc needs some competition. You certainly need not blow away your sexual functionality.

My vote: life is too short, get your BPH fixed asap!

I had PAE about 5 years ago. The results have been mixed and variable. Bottom line is it reversed the decline and my prostate is stable with no side effects whatsoever. If my circumstances remain like this I could put up with it for the rest of my life. The question is should I? PAE is the best option for a least interventional "fix" and will buy you time without precluding any other option. Aquablation is something I have begun to research quite seriously and have been impressed with the claims and supporting data.

Should you be suitable for PAE you could use this as a first step until Aquablation has become more mainstream. I haven't yet researched Aquablation's availability as an NHS procedure but if it is it will be rare and possibly outside your area. If you would like to see how Aquablation is performed search on You Tube. It is an exciting prospect.

Be interested to know if Aquablation is available privately in the UK. Had BPH now for over 20 years and seeking best technology with best outcome.

I had the Holeup three years ago this week and would do it again. My only regret is waiting several years to have it done in the first place. I have retrograde, but not an issue, no incontinence, great flow, what's not to like?

I am copying this from the discussion entitled "Aquablation".

This is an excerpt from a NCBI published study** entitled

“Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate”:

“TUI is one of the most bothersome postoperative complications of HoLEP, both for patients and clinicians [2,7,14]. Involuntary loss of urine with a hygienic or social problem decreases the quality of life of patients significantly, and the complaints of the symptoms of incontinence can be very stressful to clinicians.

In several studies, TUI after HoLEP was shown to occur in up to 20% of patients, most of whom recovered within one year [2,7,14,16]. Shah et al [4] reported postoperative TUI in 10.7% of their sample; all but two of the patients showed improvement after a mean duration of 42.3 days (range, 1~110 days). In the present study, postoperative TUI occurred in 16.6% of all patients, 80.0% of whom showed recovery within three months. As shown above, the occurrence of postoperative TUI varied widely across studies. The main cause of these differences may have been the variation in the definition of postoperative TUI in each study. We defined any involuntary urine leak as TUI, including stress or urge urinary incontinence and postvoid dribbling. However, many other authors defined TUI exclusively as a complaint of stress urinary incontinence. Because postvoid dribbling can also disturb the lives of patients, our definition of TUI (including any kind of urine leak) seems to be more appropriate.

In the present study, the main predicting factors of the occurrence of TUI after HoLEP were the age of the patient and the total operation time. Older age and a longer operation time seemed to cause postoperative TUI more often, as well as delays in the recovery from this complication. We suggest that these factors are associated with urethral sphincter damage because of its compression, stretching, and tearing by the resectoscope during the operation. Older patients may have more fragile and sparse sphincteric tissue compared with younger ones; this may lead to increased susceptibility to damage caused by forcing the tissue.”**

BHG,

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If you are concerned about getting RE, then look into Rezum and a urologist that will avoid the verumontanum section of your prostate. In 3 days, I will be 1 year after a successful Rezum with no RE. I would absolutely not do a HoLEP as the sexual damage is the same as a TURP but it uses a laser instead of a wire loop so you bleed less. You may want to find another urologist. I saw 3 urologists until I chose the one who did my Rezum.

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Steve

Thank you all for the prompt and informative replies - all gratefully received.

PAE & Rezum seem to be other methods to consider as i have as yet to find a consultant reasonably locally with an ablation kit!

They were discussed with & ruled out by my Urologist; I am unsure of how the advice went re my suitability. An enlarged median lobe seemed to rule out Urolift but as he did not perform any of these procedures anyway.... it explains possible bias to Holep? Advice from this forum seems to be to shop around for another Urologist!!

At 72 guess I shouldn't worry too much about RE & impotence from Holep but in my head I'm still a young man and find it hard to grip the thought of the loss of any activity in that direction, (no matter how infrequent the opportunity may arise), and as for the likelyhood of incontinence...!!!

Please keep comments/advice coming.

In April I had a bipolar TURP and do NOT have RE, and no incontinence, other than what was there before. So, a good urologist can perform this operation and spare you the unwanted side effects you mention. It's worth getting a second or third opinion and getting some recommendations here.