Holep vs. Green Light vs. TURP
Posted , 24 users are following.
Good Afternoon Gentlemen & Ladies,
I just left my New Urologist's office (Stanford Med Center) yesterday at 5 pm. Long story short...
I am now narrowing down my final decision for seeking a resolution to my many years of BPH. I know we are All Different and have to find our own "Best Choice" to our own issues.
To give a bit of insight into my particular situation: - I'm over 60, very physically active, 35 years marriage, 2 adult kids, a relatively small prostate size, 38 grams, which is apparently growing inward and squeezing the urethra, more than it's growing outward. The CT Scan with & without contrast dye shows the prostrate is also pushing in on the bladder. No median lobe, strictures, or other side issues. Have been using CIC twice a week to keep my PVR's down from 100 to about 40-50 ml. I sought out PAE, both at San Diego State University Medical Center and Stanford University Medical Center. I was informed by an IR Doctor whom I respect, that I am not an "excellent" candidate for PAE, due to their preference to utilize PAE on sizes of 50 -100. Can NOT afford FLA, have ruled out Rezum, Mono TURP, and Urolift.
After much reading/research, having many DRE's, Ultrasounds, Cystoscopy, Flow Tests, trying various "Medications", and seeing 3 different Urologists and one Interventional Radiologist, I have come to the the conclusion that I want to cease battling this affliction and move forward with my Life and will likely get one of the following procedures in the next month or so.
Holep -
Green Light (PVP) -
TURP (button) -
At this time I would appreciate your valued thoughts, experiences, and rationale opinions on which procedure you believe has the Best Overall results. Feel free to include negative aspects of each, but please limit them to personal experiences, not third/fourth hand stories.
Thank you all in advance. And rest assured, I will keep you All updated as my procedure progresses, for other folks who follow and have yet to make their "Choice".
Respectfully,
Chuck
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0 likes, 71 replies
glenn77 chuck68670
Edited
Which ever surgery you elect, make sure the surgeon is well trained and experienced in doing that procedure. Ask how many of that procedure they have done in the last 6 months.I had a Greenlight
procedure in 2016 and didn't ask those questions. It was a disaster for me, leaving me totally incontinent
and with strictures in the external sphincter. It was a major FUBAR .
Glenn
chuck68670 glenn77
Posted
Glenn,
Thank you for sharing that with me sir. I hope you are able to find help to deal with those strictures in the external sphincter and / or a possible resolution to the incontinence. I will indeed take your recommendation to heart and inquire about the Surgeon's level of training and recent experience. That does sound very crucial to whatever procedure we choose. Although having said that, due to monetary considerations, I like many other people, have financial constraints and insurance limitations I must work within.
With your FUBAR descriptor, it sounds like your Surgeon may have been VA related. If that's the case, my heart goes out to you even more. I have many Family and Friends dealing with the VA healthcare "system".
Chuck
derek76 glenn77
Posted
When I had my GL in 2004 when it was being trialled in England I was only my Uro's eighth patient and I had every confidence in him.
When it regrew nine years later I spoke to him on advances since then and part of his reply was regarding GL and HoLep:
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.
tom86211 chuck68670
Posted
Chuck,
HoLEP is top of the list, but it normally used on larger prostates. You would have to speak with a urologist who does HoLEP to see if they are willing to work on a prostate of your size - probably, yes. You would have to go to either Southern California or the Mayo Clinic in Arizona - no HoLEP done in Northern California.
Plasma Button TURP or bipolar TURP would work out well for you, but might cause retro ejaculation. There are techniques used with the newer TURP techniques that might spare you this side effect. I had a bipolar TURP in April with excellent results - no pain, very easy, home after 4.5 hours, done at my local hospital 2 miles from my house, fully covered under my insurance.
Greenlight is not as effective as TURP, according to my urologist, and has some proponents here, but also some poor results.
Some questions you need answers to from the urologists you interview:
is the procedure covered by my insurance
will I have to travel far to have this done
will I have to stay in a hospital overnight or can I just go home after the surgery
for TURP do I want general or spinal anesthesia
what about catheters after the surgery (I had a Foley in for three days after)
Hope this helps your decision process,
Tom
hank1953 tom86211
Posted
Tom, where's in Southern California that one can get hoLEP ? Thanks.
chuck68670 tom86211
Posted
Tom,
I appreciate your post, it does help. I agree on Holep as a Top choice. And Stanford does Holep procedures. As far as retrograde ejaculation, my Uro says all 3 (TURP, Holep, and Green Light) have a very high likelihood of it. He did say that a "Neck sparring" technique could be used with Button TURP . In his experience (30 years) he has found both TURP & Green Light frequently require a repeat of some sort, within about 15 years. I'm not eager to think about going through this all again when I'm in my late 70's
I will seek answers to your suggested questions as well sir.
Chuck
TKM chuck68670
Posted
Chuck,
Are you saying there is a doctor at Stanford who can do a "neck sparing" Button TURP ? What is his name ? I live in the area and may talk to him about it. DO you know how many "neck sparing" Button TURPs he has done, and what his success rate is ?
Thomas
tom86211 chuck68670
Posted
Chuck,
You said that Stanford does HoLEP - this is the first I have heard about this being done in No. Calif. When I was researching this I could not find anyone in No. Cal. who did this, and no information on the Stanford Medical web site. If you can get the "neck sparing" technique done that would be ideal since, at your age, you should not lose any sexual function as a result of any BPH procedure. HoLEP appears to be the longest lasting of any of the techniques discussed here, but the modern TURPs also last a long time. I mentioned the advantage of having the TURP and HoLEP tissues sent to the lab - this avoids 12 core biopsies that can be brutal. I went through two of them. Would you be able to tell me the name of the urologist at Stanford who does HoLEP? I am familiar with some of the names there - a top facility.
Tom
chuck68670 TKM
Posted
Thomas,
Will PM you with contact info
Chuck
tom86211 hank1953
Posted
Hank,
Dr. Lance Patrick Walsh in Rancho Mirage - seems to have the best resume. Also, Dr. Richard David of Skyline Urology. Just found Dr. Thomas Chi at UCSF Urology in San Francisco. UCSF has a very impressive department. There may be more but that I haven't found yet.
Tom
chuck68670 tom86211
Posted
Tom,
Will PM you
Chuck
derek76 chuck68670
Posted
If you have GL or Holep you will find that they are very simple straightforward procedures. I travelled home by train on the second day and went to the races the next day. Friends were surprised to see me and asked if the procedure (I refuse to call it an operation) had been cancelled as I was so normal. Bladder neck sparing version so no RE.
My prostate as well recorded here was 75 grms and I was 70 at the time.
It regrew over the next nine years to 135 grms when I had Thulium/Holmium laser similar to HoLep and again and age was no problem. My first Uro had a patient well into his 90's with a massive prostate and he said that GL is a very gentle procedure.
Actually the next Uro I went to said that if I had TURP it would not have regrown in that timespan but that was the only procedure he did 😃
hank1953 tom86211
Posted
Thanks Tom. Will look into them. Hank
Nick0509 chuck68670
Posted
Hi Chuck,
I like you have fought BPH for years. Now 68 years old. Had two Biopsies, one blind and one 3D, both negative. PSA before Green Light (PVP) was 6.6. After Green Light (December 2018) it jumped to 9.9. Urologist puzzled to say the least. Will return next month for another PSA and flow test. On the plus side no more meds for me. able to sleep all night and can now empty bladder. No urge to go. Was rough at first, didn't like the catheter at all and passed blood for weeks. Would I do it again? Yes, definitely. Just wish my PSA would go down. By the way, no more biopsy for me. Too Invasive. Was awake for both of the them, just a local. Not Fun!
chuck68670 Nick0509
Posted
Nick,
Very helpful and concise post sir. Thank you, and Best of Luck with your next month check-up for another PSA and flow test.
Chuck