HoLEP treatment for BPH
Posted , 11 users are following.
Hi,
I have a BPH with ~48 gm and medium lobes extruding into the bladder. I had RESUM procedure with 7 shots 3 months ago but my symptoms did not improve at all. It got worst recently that I have LUTS symptoms and painful urination, weak stream, frequency etc. After seeing a new Dr and did the cystoscopy, the RESUM procedure did almost very little to the prostate.
My new Dr. is suggesting that I undergo HoLEP treatment. Can anyone provide inputs on the HoLEP outcomes?
Thanks,
Afu
0 likes, 16 replies
hank1953 Austinite
Edited
From what I learned after years of research, including on this forum, HoLEP is the best BPH procedure out there. The main problem is that it almost guarantees retro ejaculation. Hank
Austinite hank1953
Edited
thanks. I think at this point in my situation, retrograde ejaculation is not a major concern. I need to pee well.
hank1953 Austinite
Posted
Another problem is that it is not widely available because it requires expensive special equipment and the doctors need special training. It is more likely that you will have to travel out of town do you have it done. Other than that, it is the best, second to none. Hank
Austinite hank1953
Posted
I live in Austin so it is available here by my urologist. I am scheduled to do so on Sep. 20th.
afu
Austinite
Posted
Just curious: how do you know HoLEP is the best option? On what bases?
Thanks.
hank1953 Austinite
Edited
Data is available all over the internet. Below is a sample I got from Cambridge Eurology Partnership Website:
What is laser prostate surgery (HoLEP) and what are the benefits?
HoLEP, or Holmium Laser Enucleation of the Prostate was developed in New Zealand in the late 1990’s. It is normally done under general anaesthetic. The prostate is approached internally (endoscopically), through the urethra, without any cuts on the skin. The Holmium laser is used to peel out the obstructive core of the prostate in its entirety. This leads to maximal relief of prostate obstruction and a man will usually only require 1 HoLEP procedure in his lifetime. It is very unlikely that the prostate will regrow after HoLEP (0.7% need a re-operation up to 10yr after HoLEP compared to 10-15% after TURP, and more after green light laser surgery).
After HoLEP, the area of the prostate that is removed is sent for microscopic analysis. Cancer that would otherwise be undetected is found in 8%.
HoLEP is one of the most extensively researched procedures for BPH. 16 HoLEP randomised trials (the highest quality of clinical trial) have been published up to Dec 2014. The clinical trials comparing it to the previous “gold standard” of TURP, consistently show advantages for HoLEP that include: Less bleeding, fewer blood transfusions, shorter time with a catheter in place after surgery, and shorter hospital stay (90% of men having HoLEP are able to leave the hospital without a catheter the day after surgery, and in some cases there is no need to stay in hospital overnight). Meta-analyses which are studies analysing the results of large numbers of randomised trials, suggest that HoLEP relieves urinary symptoms and improves urinary flow rates more effectively than all other endoscopic procedures for BPH. The average symptom score improvement after HoLEP is 70-80% and flow rate improvements of up to 600% have been reported. Recent studies have shown that HoLEP is extremely effective at treating men in urinary retention. 98% of men with catheters before surgery are freed from their catheter dependence after HoLEP. This compares to 70% with green light laser and TURP surgery. Unlike all other endoscopic procedures for BPH, HoLEP is suitable for men with any size prostate.
hank1953 Austinite
Posted
You are lucky to have a urologist that also does HoLEP. Just curious, what is his name? Hank
Austinite hank1953
Edited
Lawrence Tsai with Austin Urology Institute. He's the first Dr. in Austin to do HoLEP using the facility at St. Davids Hospital.
I am three months after RESUM and my symptoms are worst than that before RESUM. I have pain during urination, weak, stop and frequency symptoms even when I am taking Flomax, Urogesic-blue, and Meloxicam. I did cystoscopy on Tuesday and found that there's still a tissue in my bladder neck area (Dr. said it's the dead prostate tissue and likely blood clot underneath). He think that RESUM did little to my BPH. However, there's one time today that my urine was pretty good. I am just wondering if I should just wait a few more weeks and see if the inflammation and flare up can go away, or just go for HoLEP.
hank1953 Austinite
Posted
If it's only been 3 months, I would wait a little bit longer. HoLEP is the best procedure but it would be even better if you could avoid it. Hank
compiler Austinite
Edited
Your prostate size is not very large. Had you taken finasteride or dutasteride before the Rezum? Do you feel any improvement on symptoms after the Rezum or no change at all or even worse?
Austinite compiler
Edited
I did take finasteride for a few months a few years ago and then stopped taking it. Before RESUM, I did not take Flomax or any alpha-blocker.
My prostate is relatively short so the medium lobe blockage on my urethra is significant.
4-6 weeks after RESUM, I did feel improvement with the stronger stream while I was taking Flomax. 6-8 weeks after RESUM (after I stopped taking Flomax), I experienced very bad LUTS symptoms and have been taking Flomax and Urogesic-blue in the last three weeks. My symptoms are much worst than that before RESUM. I am just not sure if this is part of the recovery with inflamation (I had a cystoscopy 2 days ago and there's still a scar tissue next to the bladder neck), local infection, or bladder/prostate spasm. If that's the case, I should not rush to do a HoLEP? I am scheduled to do so on Sep. 20th.
robert50905 Austinite
Edited
Hello,
I had the HoLEP procedure just 12 days ago on 17 Nov 22. As to my experience, I'm 65 and my prostate was approximately 150 grams. In 2020 I had a BPH procedure called a PAE. I'll spare you the details of that procedure (you can Google it), but the bottom line it was a complete failure. It didn't help with any of my BPH symptoms and my prostate only continued to grow. It also affected my sexual life in that it decreased the intensity of orgasms because the procedure decreases the amount of semen by about a third. When you don't have much to begin with (I guess due to my age and size of my prostate), a third is substantial. 😃 I've had every symptom of BPH for the past 15 years or so, except for complete urinary retention. After the HoLEP, I had no pain, but had a catheter for about 24 hours following the surgery (no fun). The first two nights after it was removed, I urinated 14-15 minutes each night, essentially about every 30 minutes. More fun. 😃 Since then, it's been 3-4 times per night, which is where it was prior to the HoLEP. The good news is the flow of urination is very good now. Most of my urine comes out in the first 10 seconds or so. A few more times of stopping and starting after that, and that's when the majority of the burning happens. However, those few more times is nothing like before the procedure when I would stop and start literally 25-30 times and be at the toilet for two minutes or more! I hope the frequency at night eventually decreases, or I'll be pretty disappointed. I still don't have any pain thankfully, but I do have burning on every urination, which I guess technically would be pain. 😃 I hope that stops soon because that sucks for sure. I'm still having frequent bleeding on urinating. I also have some urine leakage, so it's recommended to wear "adult diapers" for the leakage, which I do. Hopefully, that won't be much longer either. My post-surgical guidance is no sex for two weeks, but I'm wary of even trying it then, which would be in just a few days. I can still get an erection, which is good, but doctor told me from day one that the procedure would have no effect on that. I'll probably have retrograde ejaculation, so the thought of having that "new feeling," which from what I've heard is not all that great, is kind of messing with my mind already, so to speak. However, my orgasms weren't that great prior to HoLEP, which was probably due to a combination of my previous BPH procedure, my age, and the size of my prostate. I know it's early in my recovery, but I hope what I've shared will help.
tfits2 robert50905
Edited
Good string of comments here with regards to Holep. I am 71 and thinking of doing it as I get up every two hours at night to urinate. Also urinate way too many times during the day and often right after urinating I will feel the need to go. I have been told my prostate is 70 grams and that it is probably pressing on my bladder. I take the finesteride but cannot tolerate the tamsulosin. Not sure what they finesteride has done for me over the past couple of years. For those of you that have had the Holep procedure do you feel it was worthwhile as to treating your symptoms at this point. One urologist was anxious to rush me into Rezum but I wanted something more permanent. Another was anxious to rush me into TURP. I did more research and came up with Holep and a urologists I feel comfortable with! I don't think I mind the retrograde ejaculation nor does my wife. I think I mostly worry about potential incontinence and no resolution to the frequent need to urinate. I would appreciate any feedback you might have. Oh also I just watched a Netflix movie "The Bleeding Edge" which makes me hesitant. I recommend watching it and sharing it. Thanks.
anders08675 Austinite
Posted
Austinite,
I had a HoLEP procedure done with Dr. Tsai last month.
I just posted about my experience. It should be approved shortly.
I have only great things to say about the procedure and the entire experience.
If you have any questions about what I went through, Dr. Tsai, or St David's Surgical, please ask.
mike81026 Austinite
Posted
i had a holep about 15 months ago. took 3 months for everything to settle down and fully heal, but great since. Was able to urinate full stream immediately following catheter removal, which was the morning after the procedure. See my thread for running commentary.