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
.
0 likes, 71 replies
tom86211 chuck68670
Posted
Chuck,
A couple of additional points: with HoLEP and TURP the tissue samples are sent to the lab so you get checked for prostate cancer at the same time - a two for one situation. Also, you and I had/have the identical sleep issues. My retention was causing me to get up at night and go to the bathroom 6-10x, severely disrupting my sleep. My TURP greatly improved my frequently/urgency issues as my bladder is now "calming down", but the sleep is still not resolved. I am thinking this has become a very bad habit. So, the longer you get used to getting up frequently at night the longer it will take you to break that habit. This is another reason you need to get some form of treatment once your questions have been answered.
Tom
chuck68670 tom86211
Posted
Tom,
I wholeheartedly agree with your assessment sir.
Chuck
hank1953 chuck68670
Posted
Chuck, I hate to tell you this but you are a poor candidate for surgery, with your very small bladder and very low PVR. I don't see how CIC twice a week helping either.
However, if you decide to have one, hoLEP is the best. Theoretically, it can be done on any size prostate, with the largest one was about 900g.
I would look into non surgery options if I were you.
I suspect that
chuck68670 hank1953
Posted
Thanks Hank.
For the bad & good news.
Chuck
jimjames chuck68670
Posted
Hi Chuck,
In back reading the thread, it seems that your main complaint is getting up at night to urinate. The term for this is nocturia or nocturia polyuria. Unforunately, what a lot of urologists don't tell you is that this condition is not always caused by the prostate and in those cases any type of prostate reduction procedure will not help. So first, you might want to do a simple void log to find out if your nocturia is being caused by something other than the prostate. If it turns out that more than 30% of your urine output is in the evening, then the cause may be other than the prostate, and as a number of men here have found out, a prostate reduction procedure won't help.
But assuming it is your prostate, you do realize that the procedures you mention will leave you with retrograde (dry) orgasms. It's not a big deal to many men, but it is to some. If you've never had a dry orgasm, I recommend to ask your doctor for a trial of a medication like Flomax so you can experience it and decide if you're OK with this for the rest of your life.
Speaking of Flomax, have you tried Flomax or Daily Cialis to see if they help your BPH symptons. Always a good idea before you get more agressive. Also, your PVR of 100 isn't very high in fact many urologists are happy with a PVR of 100 AFTER a surgery like TURP. So expecting more may not be realistic or even that beneficial. And while I'm an advocate of CIC, if your PVR is only 100, I really don't think you need it. Or does it go a lot higher when you don't self cath, and if it does, how high does it go.
You've mentioned three of the most agressive procedures out there, just want to make sure that you've thought this out. There are also some less agressive procedures like REZUM available that have worked for many and don't have the same incidence of sexual side effects as the ones you mentioned.
Personally, I chose CIC as my solution, but I understand that is not for everyone.
Jim
chuck68670 jimjames
Posted
Jim,
Thank you for caring, and thank you for All of your many posts on this forum sir. You are a stalworth part of the help, education, and information shared here.
After all the tests and consults I've had, I do believe (and the Urologists believe) that my prostate is in fact squeezing my urethra and preventing me from voiding completely. No other side issues (strictures, median lobe, infections, etc...). My peak stream has been repeatedly measured and is about 4.9 My CT scan (*wish I could get an MRI-3T but insurance won't cover and too expensive for me, hecka-doodle the CT scan cost me about $600 out of pocket), shows the precise prostate size and that it is pushing in on the bladder. Although relatively small compared to other guys' HUGE prostates, 39 and growing inward, it is causing very significant issues/BPH symptoms. I have tried Proscar, Flomax and 5 mg daily Cialis. At this point I would like not to have retro, however I consider that less important than suffering with this continuing 3+ years worth of s**t for sleep; and other problems.
I fully realize the three I have narrowed my choices down to are "aggressive". At this time I am seeking an aggressive solution. I have researched/considered and choose not to under go UroLift and Rezum. I do not want their "possible" (all be them rare) consequences. If money / insurance were not a major concern, I would definitely be seeking FLA, from some Doctor such as Dr. K
However that is not a viable option with my current finances.
CIC has helped tremendously for me, and others. It allows me to stop a "Snowballing" pressure build-up effect with my bladder PVR's. However I prefer not to be limited by having to do it all-the-time. And I see this BPH as a progressive affliction. I am very physically active: Surfing, Flying, Hiking, and work as a professional First Responder to other people's Emergencies. I am, and have been, gradually seeing my Life needs interfere with my Life activities. And if possible, I must stop that from progressing and even reverse it. The symptoms of BPH are not conducive to an active Life, and as it continues to progress will likely cause me to have to cease what I love... IF I don't take some positive action(s). CIC will soon not suffice as a viable option for me.
Thank you again sir, for caring. Though I disagree with the suggestion your options could work for me, I sincerely appreciate your efforts to help me and many other men.
Chuck
jimjames chuck68670
Posted
Chuck,
Fair enough on CIC, as you have already tried it....
BUT don't you owe yourself about ten minutes easy to find out if your night time problem might be nocturia and not an impinged prostate? You know, you can have both at the same time, but if so, don't expect a prostate reduction procedure to necessarily fix the nocturia.
Very simple. Just find a marked container like at the supermarket. Void into the container for 24 hours, writing down the time of each void and the amount. If it turns out that more than 30 per cent of your voids are during the night than you have nocturia. Chuck, it's real easy to do, and won't cost you anything.
Jim
Light1 chuck68670
Posted
Chuck,
I did a lot of research on Rezum before having the procedure and am not aware of possible side effects that are not also present and potentially more frequent and more serious with other operations you are considering. You might want to take another look at it. Maybe contact Dr Kevin McVary at Loyola, who as far as I can tell, is one of the most experienced in this procedure. If you have made up your mind then good luck.
I agree with you about Urolift, by the way.
Best wishes,
chuck68670 jimjames
Posted
Jim,
I have done the measuring cup gig for the last 3-4 months. Yes my night time voids do measure out percentage wise to about 30-40 percent of my overall (day & night) out put. Yes I might have both; if so, the BPH has caused the Nocturia. So tell me more on the treatment of Nocturia.
From what I understand, Nocturia in & of itself is only a symptom of some other underlying issue. I have checked, and to my knowledge and my doctors knowledge, no other issue has been found. No heart issues, no diabeties, no cancer, etc...So pray tell, what could be causing my Nocturia and what treatment(s) would address it ?
Chuck
PS - please forgive my insolence, not sleeping causes me to have a peaked sense of humor and be less patient.
chuck68670 Light1
Posted
Thanks on the Loyola tip, but can't afford to go to Illinois for a Rezum procedure.
As far as Urolift... yep, I ain't into anchors, cables, and spikes being shot into my LUT. Here's a Direct quote from a site pushing to sell the procedure:
.
"Urolift is effective to 60-90% of patients. However, 10% of patients require a different surgical procedure within 3 years of treatment with Urolift. Another 30% of patients either resume or start medications for enlarged prostate after treatment with Urolift."
Definitely NOT confidence inspiring.
hank1953 jimjames
Posted
Jim, welcome back little brother. We need you here, more than ever. Still having sardines and spinach ?
hank1953 chuck68670
Posted
Chuck, if you don't like retro ejaculation, then forget about hoLEP, TURP, or Greenlight.
jimjames chuck68670
Posted
Chuck,
I will get to your question at the end, but the more important question is -- If nocturia is causing you to get up at night to go to the bathroom, then why do you expect a prostate reduction procedure to fix the problem?
Here's the math. Let's say you void 2400 ml in 24 hours and 35% of that void is at night. That means you're voiding close to 900ml at night!
Now, even if you had a normal bladder and prostate (no BPH/luts) you would still get up at least two times during the night to urinate. Your bladder simply will not hold the 900ml!!!
I just want you to be aware of this because a number of men here have had TURPS, HOLEPs, Rezum's, etc. with the primary reason being they hated to get up at night to go to the bathroom. And a number of them have had "successful" procedures but still ended up getting up at night! The reason was nocturia.
So, your question is this -- do you want to risk the side effects of these surgeries, including almost guaranteed retrograde ejaculation -- and still end up getting up at night to go to the bathroom? Because that might be where you end up.
As to how to help your nocturia, you can research it as well as I can. You can try various things from compression stockings, to afternoon naps, to losing weight to a lower salt diet, to more exercise, to lowering your blood pressure, etc. Some of these may work, some may not, as nocturia becomes more and more common as we age.
I'm not saying don't have a turp or holep, just saying know what you're getting into and know that it may not stop you from getting up at night. As to FLA, which you mentioned, haven't been following the results lately, but even some of the FLA fans have doubts about FLA with smaller prostates, which is your case.
Jim
jimjames hank1953
Posted
Hey Hank,
Yes, sardines and spinach, two great foods! Hope this finds you well.
Jim
chuck68670 jimjames
Posted
Jim,
You failed to discuss the fact that BPH causes Nocturia. The math is the same, no matter the cause. Having a procedure (which you may not agree with) that will resolve my LUTS is far more likely to be Successful, than spending years CIC-ing and having my BPH progress and ruin my Bladder and ruin my Life.
.
Regarding all the suggested things to help alleviate Nocturia... well suffice it to say I get tons of exercise, have a very low salt diet, don't drink alcohol, drink 1-2 cups of coffee per week, eat an awesomely balanced diet, have excellent circulation & respiratory systems, my BP measured Tuesday at Stanford was 115 / 65 (stressful setting for me), with a resting pulse of 48. If I nap during the day, I cannot sleep at night. Due in large part to working 12 hour Night Shifts for almost 4 decades. When I do go to sleep, if I wake up at any point, my mind and body do not want to go back to sleep for at least 10-12 hours.
.
I realize you are trying to be helpful. However, you do not know my situation. Please quit speculating on it. You "truths" and "solutions" are not applicable to everyone else. Thank you for caring about and trying to help others.
Sincerely,
Chuck
jimjames chuck68670
Posted
Chuck,
BPH can cause you to get up at night by lowering bladder capacity, but BPH does not cause the kidneys to unload disproportionately at night, which is my point.
And Chuck, this is a PUBLIC forum, so when you ask questions here, people like me answer, not just for your benefit, but for the benefit of others with similar problems. So if you don't want someone like me to "speculate", then don't post.
Good luck with whatever procedure you decide on. I've made my points.
Jim
steven05114 jimjames
Posted
Jim,
.
I would like to know more about your sardine and spinach recipes. I need to get more oily fish in my diet and so far canned sardines are the lowest in sodium. Also, I had no complications from my Rezum, including no RE.
.
Steve
jimjames steven05114
Posted
Steve,
I think Hank may have been stirring the food pot, as he is known to do. Actually, I don't usually eat sardines with spinach although it can make a tasty salad. As far as canned sardines are concerned, they come both regular and low sodium as well as in water or oil. I tend to go with the low sodium in water but sometimes in oil. They make a great side dish with scrambled eggwhites. A salad on the side and you have a tasty and healthy meal. Great that you Rezum went well. I think we estimated that RE with Rezum was no more than 10% and glad you were with the majority.
Jim
jimjames steven05114
Posted
Don't want to leave out a good basic sardine sandwich. Canned sardines on your favorite bread/toast with lettuce, tomato and raw onion.
glenn77 chuck68670
Posted
Hi Chuck,
I wanted to add a couple of comments about nocturia to the discussion. You are probably aware that the effect of going from a sitting or standing position to a prone position when you go to bed is that any excess liquid accumulated in the legs will start to be processed out by the kidneys. So this is a reason that some men wear compression stockings.
My second comment is based on a discussion I had with a friend who had had a TURP procedure, and didn't get the results he expected in terms of reduced nocturia. He went to a new, and younger urologist, who said that current teaching includes the fact that sleep disturbance, rather than just the bladder call, can be the primary contributor to how much you get up in the night.So one becomes awake during the night because of sleep disturbance, and then senses bladder pressure and responds by going to the bathroom. His doctor prescribed a mild sleep aid, and he said that it made a great improvement in his ability to get long periods of sleep.
I had a similar experience after having a disastrous outcome to a procedure that left me totally incontinent. (I'll spare you the details.) Dealing with the aftermath of that, I was distraught and depressed for many months, and after getting up to got to the bathroom (being asleep on my back still allowed the bladder to fill even with constant leakage), I would stay awake for hours. I asked my GP about some help, and she prescribed the lowest dose of Alprazolam (0.25 mg). I took it a couple of nights, and it really helped me get back on track with my sleep.I ultimately was able to have an artificial sphincter implanted that restored continence.Very occasionally (I'm also adverse to taking medications) I will take 1/2 of the Alprazolam, just to take the edge of, and it gives me at least 4 uninterrupted hours of sleep AND the ability to go right back to sleep after peeing.
Good luck and all the best,
Glenn
derek76 jimjames
Posted
I've never heard of anyone eating scrambled egg whites before are they not rather insipid ?
chuck68670 glenn77
Posted
Glenn,
Thanks for that information. Glad to hear you did get the artificial sphincter implanted, which restored your continence. I remember reading some of your prior posts. I am happy to hear success stories, especially after knowing the disastrous problems you encountered and eventually were able to overcome sir.
.
As far as my issue(s), I am convinced the "Nocturia" is caused by my BPH restricting my urethra, which prevents complete voiding (*except when I CIC ), which causes my bladder fullness to wake me up. Then when I get up and can't start to pee for awhile, and can't pee much when I do finally start, I am already wide awake trying to go back to sleep, just to soon repeat the process. I realize after this long of a period doing this, I may develop a Sleep Pattern problem, but I am confident I can retrain my sleep pattern once the underlying issue (BPH) is resolved. Hence my willingness to sacrifice normal ejaculation, for relief. *I did discuss this indepth with my wife of 30+ years. She supports my choice. And as far as adverse to taking medications, Yes I too, resist chemical enhancements when possible/practical.
.
Best of Luck to you too Sir. And thanks again, for sharing your knowledge & experience. It does help.
Chuck
jimjames derek76
Posted
Hi Derek,
Very popular on this side of the pond with us cholesterol obsessed Americans 😃 Actually, you develop a taste and can ease off the statins a bit. Hope this finds you well.
Jim
jimjames glenn77
Posted
Glen,
Thanks for adding to the discussion and first off so very happy that you are now getting things under control. The young doctor is correct that in many cases sleep interrupted from other causes then triggers one to go the bathroom, at least that is what I've read. However, in cases of true nocturia polyuria, the sheer volume of urine unloaded by the kidneys at night is the culprit. Most of our bladders can only take so much.
Jim
derek76 jimjames
Posted
Sadly it does not find me well due to various aspects of fluorouquinolones I was prescribed for past prostate problems.
Statins are being pushed less on to patients now. My wife's reading is higher than mine and the doctor pointed to a letter on his wall with latest guidelines. Explain pros and cons to patient and let them make up their own minds. I asked him if he was still taking them and he said "No". To my knowledge he had been taking them for at least ten years and his parent died due to cardiac disease.
Nice to see you back in the Forum.