HoLep surgery , anyone had it ?

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hi i was suppose to have a TURP surgery August 31st but im considering cancelling it and checking more into the HoLep it really sounds a lot better , a little less invasive and quicker recovery time and a less percent of retreatment , i am having to self cath now for the last month , i had a stone removed from my bladder , after that now i cant pee at all , i could before but nit empting my bladder ,, just wondering if anyone has had this HoLep or any info on it being better and easier than TURP , thanks

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    Hi David, I have looked into different choices for BPH for the last 4 years and concluded that hoLep is the best procedure out there, all things considered. hoLep is everything is better than Turp, with 2 exceptions :

    1. It's more expensive and many insurances may not cover it.
    2. Not many doctors can do hoLep so you may have to travel far to have it done.

      I am self cathing also but I can still pee therefore I haven't taken the jump yet.

      Hope this helps. Hank

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      David, just to be sure that you are not concerned with retro ejaculation. You most likely will get it. You will likely get it from TURP as well. Who is the good doctor ? Hank

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      yeah thats the inly bad thing is the retro but i was already having s little of that from the pulls , but with the Holep you can still get hard and have sex , but with the Turp mist likely not

      Dr, M. El Tayeb in Temple , excellent Dr.

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    • Edited

      Hi David,

      With the caveat that I'm not an MD, here's what I would say:

      TURP

      1. I've seen no empirical data that suggests TURP has a significant incidence of ED/impotence when it did not exist prior to the procedure. I believe it's less than 1%.
      2. There are many variants of TURP based on the surgical instrument used. The oldest involves using an instrument with a monopolar loop electrode where electrical current flows from the loop electrode to an electrode/pad that is adhered to the hip and buttock area. This is not used much any more because the flow of current to the external electrode can cause nerve damage. Plus the glycine solution used for irrigation with monopolar can enter the bloodstream and lead to an acute serious condition called TUR Syndrome...rare but can happen. I would avoid any surgeon who still uses a monopolar instrument to do TURPs. A bipolar loop in which the current returns to another electrode that is also part of the instrument is used now and is much safer because saline solution can be used to irrigate. Lasers can also be used as well as a button-shaped electrode that produces a field of plasma around it that vaporizes the tissue similar to the lasers. They all basically remove prostate tissue by resection or vaporization just using different surgical tools.
      3. Incidence of incontinence with Bipolar TURP and Green light laser is almost nonexistent. I'm referring to permanent or extended incontinence, not very brief post op leakage.
      4. Whether or not loss of normal ejaculation occurs with TURP is highly dependent on how the surgeon performs the procedure. Some are very aggressive in removing tissue and also resect the area where the ejaculatory ducts enter the urethra. Others may try to preserve normal ejaculation by preserving tissue around the verumontanum and not "coring out" to the capsule. With any random urologist doing a TURP you have to assume you will get RE but I've seen rates published in studies and trials ranging from below 10% up to 80%. There are published studies out there if you google "ejaculation preserving TURP" that discuss the technique. Those are the cases where RE incidence was very low - 10% in one I saw. There's also a video on youtube showing the procedure being done.
      5. Recovery time varies.
      6. Surgical time for TURP will be less than with HOLEP in most cases.
      7. It is not difficult to find a urologist who has done a lot of TURPs.

      HOLEP

      1. I'm not as familiar with HOLEP but there are some very well known advantages and disadvantages.
      2. It more so than TURP is usually a "one and done" procedure, although repeat treatment for TURP is also low.
      3. It is a standard procedure for very large prostates --> 100+ gms. Most forms of TURP take too long to scrape the tissue out once prostates get very large.
      4. It is among the better procedures for obtaining tissue for pathology.
      5. On the downside, it requires more surgical skill than any other prostate procedure with the possible exception of robotic prostatectomies. That means there are few urologists who are trained to do it and also means it is relatively expensive.
      6. I can't speak to the insurance coverage but could understand if it is more difficult to get covered unless you have a very large prostate.
      7. Because of the level of difficulty it takes longer to do, thus longer under anesthesia and the risk that adds.
      8. I suspect recovery times are comparable to TURP but don't know.

      As far as the degree of invasiveness goes, all BPH procedures other than UroLift and the new one that uses a temporary stent are invasive the way I see it. Even some that are promoted as minimally invasive don't really seem like it such as REZUM. Sure it can be done in the doctor's office, but you're jamming a needle through the urethra and injecting superheated steam into live tissue 5-15 times. Some would argue even Urolift is invasive given it punctures the prostate capsule and leaves foreign objects in your body forever.

      The one thing we can all agree on is BPH is a major hassle to deal with for those of us who have more severe cases. Good luck with your decision.

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