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
Light1 chuck68670
Posted
Thank you, Jimjames! Nice to hear from you.
russ_777 chuck68670
Posted
Chuck, you're in the same predicament many of us are in, trying to figure out which procedure is the best for our particular situations and the Doc with whom we're most comfortable. I'm at roughly the same point you are after taking the past 9 months to turnover every stone I could to make sure I'm making the right decision for me with the right Doc. I'm actually amazed at how much I've learned about anatomy, surgeries and how the male LUT works (or doesn't work). An IR I consulted with about PAE actually asked me if I was a physician. Not quite!
The one thing that you didn't explicitly say you've had done is a urodynamics study. That is the one diagnostic procedure that will tell you whether the problem is your bladder or your prostate....or possibly both. If you've only had uroflow tests done, I'd recommend you talk with your uro about having it done. Mine showed high pressures but poor flow, although I emptied completely. Classic case of obstruction. A word of caution if you do have it -- if you walk into the procedure room with any dignity, there's a good chance you'll walk out without it. It's not for the timid.
Of the procedures you've mentioned, my preference would be button TURP. It's unfortunate that once the phrase TURP is mentioned, many people are stuck on the reputation of monopolar TURP with its usual risks. Using bipolar electrodes where the cutting is taking place (whether button or loop) means the current does not flow through the body and thus the risk of complications such as TUR Syndrome is much lower. Monopolar is a bit of a misnomer, as there is a 2nd electrode -- attached to your skin. It's not a return electrode or grounding pad, as some say. By the way, Green Light Laser has the same disadvantage as button TURP compared to bipolar with a loop electrode....it takes longer.
The main disadvantage of button TURP is that it is a slower procedure because it removes tissue at a slower rate than bipolar TURP with a decent size loop electrode and traditional monopolar TURP, also using a loop electrode. The longer it takes the more total thermal energy there is to heat the gland in places you don't want it heated, all other things being equal...which they rarely are. But in your case since there is much less tissue to remove than usual, that disadvantage is offset to some degree. That's the way I'd look at it as far as the type of procedure goes,
I think the way any given surgeon performs a procedure, regardless of type, has a lot to do with the outcome, perhaps more so than the type of procedure used. Some use techniques that take extra caution to avoid injuring areas that are vital to preserving antegrade ejaculation. Others, perhaps because the patient doesn't care, just nuke it all with the exception of preserving the outer sphincter to avoid incontinence. With me, the surgeon and his/her technique was the most important factor.
Good luck!
chuck68670 russ_777
Posted
Russ,
Thank you very much sir. Your post was "Right-on-the-Money" , as far as the kind of informative posts I am seeking. Very simply, yet eloquently, presented. I will ask my Surgeon more inre the Bipolar and/or Button TURP.
Chuck
jimjames chuck68670
Posted
Russ,
I don't know your history. Have you had or are you going to have button TURP that preserved your antegrade ejaculation? If so, can you please share the name of the doctor and his success rate?
I have written here about antegrade ejaculation preserving TURP for a few years now, but other than some older studies with no follow ups, still haven't found someone who regularly performs it with good results.
Jim
tom86211 chuck68670
Posted
Chuck,
Our sleep issues are almost identical. Sounds like you are very interested in being healthy and may be on a high protein diet. If so this may be causing some insomnia issues. I have been on a protein diet for several years and lost 20 pounds, and find it's easy to keep my weight down. However, some research indicates a correlation between protein intake and insomnia. Recently I have begun to reduce my protein intake slowly and my sleep has been slightly improved. Just another angle for you to research,
Tom
chuck68670 tom86211
Posted
Cool.
Thanks Tom. I am taking in a slightly higher than normal amount of protein in my diet. I will try reducing it a bit, and see if I notice any difference.
tom86211 chuck68670
Posted
Chuck,
I have been on a high protein diet for a long time and have also cut out most sugar. In recent years protein has become a big deal in the diet and fitness world. A high protein/ low carb diet really does work to drop weight, but there may be long term negatives, including sleep disturbance. My fasting blood glucose is a bit high, so I am in a state of pre-diabetes despite doing a lot of exercise and keeping my weight down. I take my own fasting glucose numbers once a week and my average is about 105. Also my A1C is 5.7. Both numbers are a bit above the high end of normal. I don't want to start going back to carbs and sugar again, but if I can't sleep this isn't healthy either. As you said in a previous post, getting a good nights sleep is a very big deal.
Most of the others here who have had a bipolar or plasma button TURP eventually began to have improved sleep - getting up only 1-3x per night. But, I am still getting up about every 1:15 to 1:30. I don't think this is my bladder waking me up anymore because when I go to the bathroom very little comes out. If I can sleep more than 2 hours at a stretch it is a miracle for me. I have tried a variety of sleeping aids and very little works - also, the body adjusts to whatever I take. Don't want to get addicted to anything. So, I absolutely understand what you are dealing with.
Also, it's possible that no matter which procedure you get, you may still have sleep issues - there is no guarantee that all of your frequency/urgency/nocturia issues will be solved. One of the frustrating things about urinary issues is that results can vary so much from person to person. But, I believe your research will lead you to the best procedure and doctor for you.
Tom
chuck68670 tom86211
Posted
Tom,
You are Awesome. But don't let that go to your head. It's probably just because your experiences are so close too mine; it is good to hear commonalities of situations. BPH is a witch with a B. LOL
Although I have no intention, nor time, to monitor my glucose numbers nor A1C, I will keep your thoughts in mind as I work through adjusting my diet.
Thanks again Bro,
Chuck
tom86211 chuck68670
Posted
Chuck,
Just trying to be helpful. Won't go over the full list of prostate troubles and operations I have had, but it's been about 8 years of hell. First it was a bad UTI, then rising PSA, prostate cancer, radiation, BPH, PAE, then TURP. My last remaining issue is the disturbed sleep. If I can get that solved I will be very happy.
About the fasting glucose - I never gave this a thought until the past few years, when my FG numbers came back from the lab a little higher than normal. Because of the PSA testing before and after my radiation for the prostate cancer, I also get quarterly lab tests for CBC, Cholestrol, and blood sugar.
Last year my doctor ordered a little glucose meter and I use it after I get up once per week. It's very easy and has been an interesting learning experience. Some people who are on a Keto diet use the same type of meter to monitor their Ketone levels
At some point in your future you may get lab results back about your blood sugar. I didn't have any issues until I was in my late 60's. You should also be monitoring your cholesterol. Despite having finished 9 marathons, I had a minor cardiac "incident" in 2006 and have been checking my cholesterol ever since.
Feel free to PM me about any of these issues if you think they wouldn't be of interest to the general forum community.
Tom
randal149340 chuck68670
Posted
i had the greenlight and very happy with the results i went home the following day had no pain or bleeding and it made a difference in my life . I only get up one or twice a night to pee and i drink lots of water before i had the green light i would pee 4 to 5 times a night.
randal149340 chuck68670
Posted
i had the greenlight and very happy with the results i went home the following day had no pain or bleeding and it made a difference in my life . I only get up one or twice a night to pee and i drink lots of water before i had the green light i would pee 4 to 5 times a night.
randal149340 chuck68670
Posted
i had the greenlight and very happy with the results i went home the following day had no pain or bleeding and it made a difference in my life . I only get up one or twice a night to pee and i drink lots of water before i had the green light i would pee 4 to 5 times a night.
bill111222 chuck68670
Posted
Chuck,
I have followed your posts for a while and I am wondering which procedure you had done and how it all turned out. I had a Urolift done 3 months ago and it has been horrible with pain and no sleep. I am researching how to have the clips removed and have a holep or turp done. The uro says I need a turp to have only one side of the clips taken out as the other side is inaccessible. Please let me know what information you have on this subject and how you are doing now.
Best,
Bill
bill111222 chuck68670
Posted
I only see very old replies to you, Chuck. I sent you a message recently and have not seen a response. Are you still alive? (hopefully)
I had euro lift and have not had good results in the 3 months since it was performed. Have you had a procedure and what are the results?
I am looking for information on having the implants removed and going with the button turp for a re treatment. Any thoughts from you or anyone following this thread?
Thanks