Independent advice in the UK
Posted , 13 users are following.
I am getting to the point where I want to consider surgery. BPH is getting worse and Tamsulosin has so many side effects, particularly on libido.I am considering HOLEP, Urolift or FLA but I know more about these procedures and the pros and cons than my Doctor, mainly due to this brilliant forum.
Considering HOLEP at Addenbrookes but is FLA or Urolift available in the UK and is there an unbiased Consultant ( some will say they don't exist ) in the UK to give advice on options or an independent report or paper that has reviewed all of the current surgical options in the UK. Look forward to your replies.
0 likes, 34 replies
derek76 andyr0
Posted
Overall the best results now seem to come from HoLep. As others will say the Freeman in Newcastle are probably the leaders in it whether NHS or Private.
paul96555 andyr0
Posted
The urologist I used, Marc Laniado, can do both urolift and holep (or turp). However, not at cambridge. Urolift is not fully reversible as they can only remove the inner tab, not the outer tab, and the tabs being metal do cause a permanent 16mm obscuration to any future MRI you may need if you have a P Ca scare. I believe if your prostate is poking up into your bladder causing a frequency issue urolift is unlikely to cure that. It stands a fair chance of improving flow but for some men is a fail or can need re-work. Holep has a very high success rate and is believed permanent, lifetime fix. It usually causea retro. Laniado now advertises a retro sparing holep but he didn't at the time I had mine done so never discussed. I would guess that the retro sparing holep would entail leaving top of prostate alone and that if you have a frequency issue it would be less likely to cure that, but still give the reliable very high flow rate that is the holep outcome. It is easy to find men on the net for whom urolift failed, but not for whom holep failed. However, I have never seen the overall urolift success rate neither initial nor endurance.
paul96555 andyr0
Posted
philip42830 paul96555
Posted
TKM andyr0
Posted
Andy,
More information about your condition is needed to offer useful advise.
What is the size of your prostate?
Do you have an enlarged median lobe, and how big is it?
Is the median lobe obstructing flow? (Is it a flap or ball valve)
What is your post void residual?
If you don't know these things you should get a Urologist to do the necessary tests. That may determine what procedure you go with. If your not ready for a procedure you can try CIC, self catheterization. I was able to stop Tamsulosin when I started CIC. If you want to try CIC get a Urologist's office to show you how to do it.
Thomas
mike24933 andyr0
Posted
I was attracted to Urolift because it seemed to offer less chance of complications. However I finally decided against it because I don't like the idea of an implant which is not totally reversible. My only other option was gyrus turp which I had done four weeks ago at an NHS hospital. I presume it will take some time for the wound to heal completely but so far I have been very happy with the result. The operation didn't cause me any pain and only slight discomfort. The post operative problems have been very slight. Best of all my flow rate has increased dramatically. I know it is a worrying thing to commit to and I put this off for as long as possible but in my experience the reality has been far less problematic than I envisaged. I am now pleased that I won't be left with any implant.
kenneth1955 mike24933
Posted
You just don't have a prostate I wish you well Ken
philip42830 mike24933
Posted
Great to hear it went so well. I totally agree, I felt the same as you did.
Keep getting better.
Philip.
kenneth1955 mike24933
Posted
Sorry Mike that was a little blunt but I guess that is why there are so many procedure we are all different and we all have different concerns and can deal with different side effect. For me I would never have my prostate cut for any reason because of retro. Just because I'm 63 today and not having kids no doctor is going to tell me I don't need it. I had a Urolift done 3 1/2 years ago and still wide open. Never feel them at all. I have a heart monitor in my chest for 2 years never feel that and I have a shunt in my heart don't feel that either. We all view life different we all have the right to pick a procedure that is right for us but I can not get it through my head that a man would rather have his prostate cut out then have a few clips put in that may do the same thing. Make a tunnel. I wish you well and hope all heal in time God Bless Ken
alanatcroydon mike24933
Posted
mike24933 kenneth1955
Posted
Hi Ken, I don't mind you being blunt. I couldn't get enough information on Urolift to convince me it was OK and my own intuition goes against it. I'm not suggesting there is any real problem with it. I have suffered for so long with flow restriction that I wanted the surest way to get rid of that problem. By the way I've had retro for years because of the drugs and it doesn't cause me a major problem. The NHS consultant gave me the most confidence to proceed with the turp. I've read all sorts of horror stories about it but maybe it depends on the skill of the surgeon.
Best wishes,
Mike
derek76 mike24933
Posted
kenneth1955 mike24933
Posted
It is a shame you could not get enough information on it. I was on Flomax and Rapaflo for 4 weeks and it only took a couple of days to dry me up. Dry orgasm sucked. I had no feeling what so ever. The built up was there and whey the orgasm hit. There was no feeling at all. I told my doctor and he said that is what happen from them pills I told him then I'm not taking them. That is when he told me about the Urolift. It was only out 6 month's when I had mine. I was my doctors 20th patient that he did it on. I am still wide open. It is something to try if you can before you start cutting away at ones body. And yes there are a lot of horror story's but I think it all depends on the skill of the doctor and I bet if you would have ask him he would have maybe did it a way that you may have not gotten retro. Who know. EP procedure have been around for years. There is a doctor in the UK that wrote a paper with some of the other doctors His name is Dr. Muir He said that you don't have to have retro any procedure excluding a Turp you can save the Verumontanum and you have a chance not to have it. But it also is the skill of the doctor. I hope all works out for you and things improve. We all deserve a good long enjoyable life Take care Ken
kenneth1955 alanatcroydon
Posted
Sorry Alan. Good evening all. I don't know who asked the question about if PAE could cause a stroke. I found this out when I was looking at some information on PAE. As there is no pathway from the prostate to the lungs or the brain it is impossible for the particles to cause blood clots in the lungs. Leading to a stroke. They all become lodge in the prostate. I also found out which I did not know that they do a simulation of the procedure first. Using a Cone Beam CT to make sure they have it in the right artery Have a good night all Ken .
mike24933 derek76
Posted
Hi Derek
Turp does allow collection of removed tissue for analysis. Also in my experience it caused very minimal bleeding or discomfort. I actually didn't have the option of HoLep. I am not suggesting that there is anything wrong with any procedure but turp seems to get a bad press and I think its worth saying to anyone in the same boat as I was that I am very happy with the outcome
derek76 mike24933
Posted
Such is the reputation of TURP that I turned it down in 1995 after a series of articles about it in the Daily Telegraph and waited for laser surgery to come on scene. Even my then GP said that he would not have TURP "too Bloody" he said.
There have been modifications to TURP and there are now several variations of it and a different flushing liquid is used during the procedure (hopefully) that does not lead to TUR syndrome (Fever and leading to possible heart problems five years down the line) .
The laser procedures are much better and kinder. I was back to normal life on day two after GL in 2004 for my 75grm prostate. In 2013 I had Thulium/Holmium laser (similar to HoLep) when my prostate had regrown to 135 grms and it also was no problem and overall a slightly better result in that my PSA dropped from over 7.0 to 0.74. With GL it went down to 5.0 from 9.4
The laser procedures are more expensive for the equipment costs but much less for the hospital stay and older Uro's seem not to want to learn new tricks and NHS not to want invest in equipment and training.
With the original GL lasers the laser rods cost three thousand pounds and only lasted for an hour. The lasing time for mine was 57 minutes. I didn't ask if they got to the end of the procedure or stopped to save money.