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
stan98754 JerryR
Posted
effective method but not in case of big median lobe. you need first MRI scan to see exact anatomy. Stan
MichaelVM7 stan98754
Posted
Stan,
are you replying to HoLEP or PAE as not being effective in the case of a big median lobe?
Michael
andrew23481 MichaelVM7
Posted
I think he meant Holep but a median lobe is a problem to both methods. The median lobe pushes up on the bladder neck and if you start removing bladder neck to get at the median lobe you could end up incontinent imho. For PAE, cutting of blood to the median lobe is very difficult as its hard to get at.
hank1953 andrew23481
Posted
Median lobe is not a problem to Holep, or TURP, or greenlight. They all cut into it if it blocks the flow. Yes, there is a risk of incontinence but for Holep, it's less than 1%, and most will resolve with therapy. I've read a large study in Holep that indicated 1%. However, it also mentioned that coming into the procedure, there was already 1% incontinence among the patients. So basically it nets zero, if you do the math that way. š
hank1953 JerryR
Posted
This is from Cambridge Urology Partnership in UK:
"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)."
"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 āgold standardā 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."
uncklefester JerryR
Posted
I have not had HOLEP but it is my go to procedure if I had to do it today. I would consider FLAn but nit costly. There are a few exceptions but many men on this forum come here with failed procedures. HOLEP gets great reviews with very few problems. Only thing that sucks with HOLEP is RE. I'm surprised they haven't figured out how to save ejaculatory function.
JerryR
Posted
UncleFester, I'm 73 y/o and have no plans to father any more children. So I have no fear of RE unless it's painful. Is RE painful???
uncklefester JerryR
Posted
Jerry
I don't think its painful. I experienced it when I was on Tamsulosin. I haven't had a procedure yet. I responded very well to drug therapy. My day time flow is > 20 ml/sec. Night time flow can vary greatly. I'm 61 I'd like to keep ejaculatory function if I can. Back when I thought surgery was imminent I told my wife about the probability of RE. She was sad that ejaculating into her wasn't going to be part of sex anymore. I don't understand that but I'm a guy so I guess I shouldn't. I also have heard men with RE say sex wasn't the same anymore and they weren't happy about it. Others say no big deal.
I've been hoping and praying one of the injectable drugs like fexapotide triflutate would get FDA approval. I read an article the other day that they've applied for approval but information is pretty sparse
uncklefester JerryR
Posted
OK my last post was rather lengthy and the forum screwed it up. I'll return tomorrow and rewrite it.
JerryR
Posted
Thanks
donna14066 JerryR
Posted
I am a wife of a BPH sufferer---and am currently researching the many treatment options
Regarding HOLEP---University of California San Francisco, Dr. Thomas Chi, does this procedure.
He and his team are well regarded. At least this was true a few months ago. The way things change these days....who knows.
Best of luck, best of care to you all.
JerryR donna14066
Posted
Thanks Donna. Still researching.
derek76 JerryR
Posted
I had GL PVP in 2004 with quick recovery and no later problems. My prostate regrew and in 2013 I had Thulium/Holmium laser surgery that is quite similar to Holep again with good results and recovery.
Remember Forums like attract people who are in the main considering treatments and ones who have had treatments they are unhappy with the results of. So if you don't read much about a procedure remember that in the main happy people don't post:-)
Thulium/ Holmium actual procedure name RevoLix.
I'm not sure how much of the market they have. I had it in the UK by a surgeon who has demonstrated it around the world..
LISA Laser Products developed the RevoLix Thulium laser and applications in soft tissue surgery on the grounds of its understanding of laser tissue interaction and the LISA competence in laser technology.
The RevoLix Thulium laser is the only laser system ever developed specifically for soft tissue surgery. The RevoLix laser wavelength is 2 micron. This wavelength is absorbed in any tissue by the ubiquitous water molecule.
The RevoLix wavelength is similar to Holmium but the emission mode is continuous wave (cw) instead of pulsed - thus providing a continuous vaporization effect instead of tissue disruption as for the Holmium laser.
The strong absorption of the RevoLix wavelength in tissue, in any irrigation fluid and in water provides the immediate tissue effect, limited penetration, excellent hemostasis and
protection against collateral damage.
RevoLix unifies the advantages of formerly existing surgical laser principles in a single unit.
At 200 watt continuous wave the RevoLix tissue vaporization rate reaches 4 g/min - a safe alternative to mechanical tissue morcellation following Thulium laser enucleation of prostate (ThuLEP, ThuVEP).
RevoLix is a multi-disciplinary surgical laser for the application in urology (surgical protocols for the treatment of BPH include vaporization (ThuVAP), vaporesection (ThuVARP), enucleation (ThuLEP) and vapoenucleation (ThuVEP) of prostate - histology available), gynaecology, neurosurgery*, ENT and pneumology.