I'm looking for information and/or experiences with HoLEP.
Posted , 13 users are following.
I have researched HoLEP and have concluded that it's one of the best treatments for BPH. I'm curious why there isn't more discussion on this blog about HoLEP. Can anyone advise me of their experience with HoLEP? Was it successful? Not successful? Were there resultant side effects? Who are the best doctors? Any information would be appreciated. Thanks.
0 likes, 35 replies
lester90053 JerryR
Posted
Everyone has a different opinion as which procedure is best without even knowing if they are eligible for it. Many who are soon discover that they may not have made the right choice. As to who are the best doctors you would have to consider a uro who has personally undergone a BPH procedure, but you would be hard pressed to find someone because doctors don't discuss their personal medical issues with their patients.
derek76 lester90053
Posted
Actually my GP is willing to and amused me once by saying I should a locum of his who has or has had everything I have. I think at the time he was even worse than me as he had to have a downstairs office as he could not manage the stairs:-)
andrew23481 JerryR
Posted
I believe Holep to be preferable to green-light as it is more controlled. I have heard it is especially suited to deal with larger prostates. My Uro offered it but so far I have gone with Urolift as the risk of side effects are less. He said I would most likely end up with retro-ejaculation with Holep; he didn't seem to think erectile dysfunction or incontinence would result.
hank1953 andrew23481
Posted
Andrew, your uro offered Holep. Can I have his name and location ? Thanks.
andrew23481 hank1953
Posted
I'm in the UK
hank1953 JerryR
Posted
Jerry, I did my own research and concluded that Holep IS by far the best treatment for BPH, if you're not concerned with retro ejaculation. The reason that it's not popular is it's expensive and usually not covered by insurance, and can also be done at very few locations. The reviews on this forum have been very positive.
MichaelVM7 hank1953
Posted
Hank,
My reply earlier (to JerryR) was intended for you. Sorry.
Michael
MichaelVM7 JerryR
Posted
Jerry,
You've probably done more research than I have, but from my own, as well as from conversations with men who've had PAE and FLA, I would put HoLEP in the top three BPH treatment options for men with large prostates (which may rule out Urolift): FLA, HoLEP, PAE.
There is some concern over the effectiveness of PAE with a large median lobe, but I've seen others on this site report that Dr Bagla has success even when treating the median lobe. FLA is a very attractive option and Dr Karamanian is quite amazing. However, costs out-of-pocket start around $21,000 and that does not include airfare-lodging-meals if you don't live in Houston. There are a number of good HoLEP practitioners out there - and it offers a much faster benefit in terms of urine flow and reduction in LUTS when compared to PAE, the latter of which compares favorably with TURP at about 9-12 months post-procedure.
Yes, as others have said, HoLEP (like TURP) will most likely result in RE.
If I had the $$ I would have already scheduled FLA with Dr K.
I have to look at what my insurance will cover. With worsening symptoms I am less concerned over RE and more concerned with quality of life. Nocturia has worsened in recent days and my body is feeling it after several poor quality nights.
Simple open prostatectomy is the most invasive option and a good surgeon can remove enough of the prostate that will allow a guy to urinate like a young man again. But it is major surgery and of all the options has the longest recovery time.
A man must overcome the mental hurdle of RE before choosing HoLEP (same as with TURP), but he's likely to see immediate results when done by a skilled doctor.
I do wish more HoLEP patients would post their outcomes on this site.
Can you share with us any more from your own research?
Thanks Jerry,
Michael
hank1953 MichaelVM7
Posted
Michael, FLA was on top of my list until last year, when many of the originally-very-optimistic patients reported failures, or worsening symptoms, two of them even reported RE. I was heartbroken and flabbergasted because the theory supporting FLA was sound, at least I thought it was. Another concern is until now, there are still no long term data for FLA. So how long will it last?
Holep, on the other hand, has been around for a long time, since 1995. Its effectiveness and longevity have been well proven and documented. If you want something that will make a difference for a long time, Holep is even better than TURP, without the bleeding and long recovery associated. Holep can handle small as well as very large prostates, even rivaling prostatectomy. Holep improvement in urine flow is about 20mL/sec (Urolift 3.7 mL/sec). Holep PVR improvement in retention is about 200 mL. Holep redo rate is something like 1% after 15 years. What procedure can claim that ? PAE? PAE was described as inconsistent. It works for some, yet not for others, without any good explanation. Some people had 2 PAEs and still have problems. From what I've read, PAE results are not that great.
MichaelVM7 hank1953
Posted
Hank,
Wow, great info
Thank you!
Michael
JerryR hank1953
Posted
Thanks Hank. Excellent information that supports my research. I'm 73 years old and am not concerned with RE unless it makes ejaculations painful. Any knowledge on that? I live in Florida and have come up with three names, Dr. Shah, Dr. Dora and Dr. Masel and a Dr. Cross (?in Oklahoma.) Any thoughts on this - anyone?
hank1953 JerryR
Posted
Michael, Jerry, you are welcome. Jerry, RE is not painful at all. Just not as much coming out, going into the bladder instead. However, the chance of RE is around 75% so you may not even get a chance to experience it. 😀
Few years back, I only heard Holep done at Mayo clinics. Nowadays, more and more facilities are providing it. Very encouraging !
hank1953 JerryR
Posted
Jerry, check Mayo clinic in Jacksonville, FL. If they do Holep, it would be great for you.
hank1953 JerryR
Posted
" ... Since September 2015, Scott & White – Temple has averaged almost 200 HoLEP procedures per year, making it the second highest volume among U.S. medical centers and the highest in Texas. The hospital’s expertise has drawn men locally and throughout Texas including from Houston, San Antonio, Dallas, Conroe, Bryan, as well as Oklahoma and New Mexico. Post-procedure, 99 percent of patients stayed in the hospital less than 24 hours, with a success rate of relieving urinary retention at 99.7 percent, an incontinence rate of less than 1 percent, a blood transfusion rate less than 2 percent, and a complications rate of less than 2 percent... "
Number one, I guess, is Mayo clinic, averaging 300 procedures per year.
Motoman hank1953
Posted
I am pretty sure Dr Lingeman at Indiana would be number 1 in the US for Holep. It is my understanding that he was the first or one of the first in the USA, and where a good number of the Mayo people were trained.
I also know of a good doc in Madrid, Spain if anyone is looking in Europe, or wants to travel. Holep there was gonna cost around $12000, with an overnight stay.
hank1953 Motoman
Posted
You are probably right but the above comparison are for US medical centers, not individual doctors. Are you considering Holep ?
Motoman hank1953
Posted
Holep is on my list, and I probably should have gone that way in hindsight. Probably would not be on this forum now if I had, as things would be working properly. Just didn't want the RE, as I am 56 years old. I was researching it quite a bit a couple years ago.
I had FLA 2 years ago, and it was good for 6-8 months, now not so great.
I am sure I will have another procedure in my future, just a question of when.
hank1953 Motoman
Posted
Are you the one that your doctor said that your prostate still feels "spongy" months after FLA ? Someone else also mentioned that his prostate was filled up with something else, not empty or collapsed as expected. Perhaps that is FLA only weakness.
Motoman hank1953
Posted
Mine was not described as spongy after FLA. But it didn't collapse either. It has cysts or some type of body fluid that took the place of the tissue, described as a bunch of tiny grapes in the MRI images.
I had a smaller hard prostate to begin with. That seems to be a common denominator from people on this forum.
I also had an Itind procedure done before that. It worked for 3-4 months. The doc that did that thought I should have the Holep. He said it would be one and done.
hank1953 Motoman
Posted
Sometimes ignorance is bliss. And luck, too. My younger brother went under for a bladder biopsy, woke up with a "bonus" TURP. He did not know anything about prostate before that. I was worried so much for him. He did have lots of bleeding and months of recovery. But now it turns out that he pees better, sex is better, and no RE.
With my bad retention, I will not risk anything but Holep. Just need to get mentally ready because I never had any surgery before.
andrew23481 hank1953
Posted
How could they just do a TURP he hadn't agreed to?
hank1953 andrew23481
Posted
It happened to others before also. I guess in one of those papers you signed but failed to read carefully gives the doctor the power to do what's deemed good for the patient. It was why some paranoid 😂 patients like Ken1955 made his surgeon signing a paper limiting doc to one and only one procedure beforehand.