My HOLEP Experience
Posted , 17 users are following.
I have been suffering with BPH for many years. I have had a PAE which didn't work for me. I have been on Alfuzosin for many years.
I had my HOLEP done by Mr Tev Aho at the Nuffield Hospital in Cambridge.
I went in yesterday 8th August at 7am and had my surgery at 8.30am. I had a GA so was not aware about the procedure. I woke up without any pain at all. I had a catheter with a bag of saline to wash out the bladder for 20 hours. I had the catheter out at 6am this morning. I then out to show I could empty my bladder. This was fine, it just took time for my system to start again. I walked around the hospital and drunk water. by 10.30 I had given 3 samples the last one for 470 ml - so I was allowed to go home. I have a very slight bit soreness in my urethra, but I never had a stream which is so strong and my bladder feels empty after going to the toilet. I am a bit tired but haven't slept much during the treatment. I cannot than Mr Aho and his team enough for their patient care. I am so pleased I had a Holep.
2 likes, 115 replies
philip42830
Posted
Update day 7b: I forgot to mention, I don't have any leakage today. Philip
philip42830
Posted
Update day 9.: a lot less tired, no leakage at all. I was up in the night once, but what I am finding after HoLEP, is I would get up and not be able to pee, and go back to bed and get again; is once I get up I can completely void and go back to sleep. I had some spots of blood this morning but again that is normal. I am going for a long walk today, hopefully I should get up to an hour, which is a few miles. Can't believe it is only 9 days since the surgery and I am feeling so well.
dl0808 philip42830
Posted
Couldn't follow what u said. Have time to explain again?
philip42830 dl0808
Posted
dl0808 philip42830
Posted
After holep, you got up only once a night, " I can completely void and go back to sleep. "
before holep, u got up (not sure how often), but unable to pee.
Is my understanding correct?
philip42830 dl0808
Posted
After HoLEP, getting up one a night and able to completely empty my bladder and then able to go back to sleep.
Day 10: flow is really good.
dl0808 philip42830
Posted
Two more questions:
1) before HeLEP and unable to pee at night, so when day time came, no problem peeing?
2) I remember u had PAE before HoLEP , so it was a total failure?
philip42830 dl0808
Posted
1) the neck of my bladder was bent with the growth of my prostate, so I never had a good flow. During the day, I had more time to just try and pee, my symptoms varied, some days, I had more than a dribble and a bit of a flow, bit generally a very poor flow. My flow rate was on a test a did recently, I will dig out the details.
2) The PAE was a total failure, my arteries that supply blood to my prostate also supply blood to my bladder, if they had inserted the beads they would have cut the supply off to my bladder and it would had died. The procedure was very long - 4 - 5 hours on a very small hard metal table, almost tray and then I had to keep still for 5 hours afterwards to avoid post op bleeding. I ended up with really terrible back problems and was in pain for 3 months. I have a damaged disc in my lower back and the inactivity triggered muscle spasms, tightness and it took months to resolve.
dl0808 philip42830
Posted
Sorry to hear that u had such a terrible experince with PAE.
u don't have to answer all my questions and waste ur time.
PAE is relatively new hence more risk, there must be a reason u picked it as the first testament. Perhaps because of the bent bladder? Had u chosen HoLEP instead , it would have been a more correct decision, yes?
isn't that everyone's routing of the blood supply is the same? If blocking blood supply to the prostate will also cut off supply to the bladder, it should happen to everyone, yes?
philip42830 dl0808
Posted
PAE is relatively new hence more risk, there must be a reason u picked it as the first testament. Perhaps because of the bent bladder? Had u chosen HoLEP instead , it would have been a more correct decision, yes? - I read a lot of reviews on this forum and spoke to men who had gone for a PAE and were pleased with the results. I then went
to see the consultant radiologist who thought I was a very good candidate. I had CT scans, MRIs and Xray before which all looked possible. At that point no one knew I had a bent bladder neck, so I couldn't use that as part of the my decision making. If I had known I would have gone for a HoLEP.
isn't that everyone's routing of the blood supply is the same? If blocking blood supply to the prostate will also cut off supply to the bladder, it should happen to everyone, yes? No, the radiologists have to look at your artery branching and how they deliver blood supplies to organs and other parts of the body. We are all different, it takes hours under a scanner for the radiologists to work this out.
Philip.
dl0808 philip42830
Posted
For those who are wondering what is the advantages and disadvantages of the enucleation technique (which is used in HoLEP) vs ablative techniques, the perfect vehicle to answer this question is the green light laser because it can do both.
I came across the following study which gives us the answers.
Two groups of 60 consecutive patients with enlarged glands (greater than 80 ml) underwent GreenLight laser prostate enucleation or photoselective prostate vaporization (performed by the same surgeon and including the learning curve) and were retrospectively evaluated.
Summary of key results:
A) Operating time
"The operative time was significantly shorter in the GreenLight laser prostate enucleation group (60 vs 82 minutes). "
--- enucleation removes tissue a big block at a time and thus much quicker. 22 min is a very long time for BPH surgeries.
B) Complications
"Complication rates were comparable between the groups. "
--- I would have thought 82 min of PVP should have more complications.
"PVP Group had a higher rate of unplanned hospital readmission, " because " the surgical time was longer in the photoselective prostate vaporization group"
--- this makes sense.
C) Incontinence (seems to be transient)
"At 2 months the rate of urinary incontinence was significantly higher in the GreenLight laser prostate enucleation group (25% vs 3.4%) "
--- 25% incontinence seems to be the same as in HoLEP (17-23%, assume the worst case, it would be about 25%.)
"but incontinence rates were similar at 6 months (3.4% vs 0%)."
---- 3.4%/25%=0.14 that means that 84% of the 25% had recovered after 6 months. In HoLEP, 80% of those incontinence patients would recover after three months. So the two numbers agree with each other. It suggests that incontinence is due to the use of the enucleation technique. Note: PVP dropped to zero %.
D) Functional outcomes
"the maximum urinary flow rate had greatly improved, significantly favoring the GreenLight laser prostate enucleation group (+78% vs +64%)"
--- this is an objective parameter and it makes sense as enucleation( it peeled off the adenoma from the prostate capsule) removes more tissues than PVP
"At 6 months International Prostate Symptom Score quality of life and post-void residual urine volume had similarly decreased in the 2 groups after the procedure (compared to baseline)"
--- these two are subjective parameters, they are not sensitive.
"PVP Group had lower decreases in prostate size and prostate specific antigen"
--- this make sense as enucleation removes more tissues.
J Urol. 2016 Apr;195(4 Pt 1):1027-32. doi: 10.1016/j.juro.2015.10.080. Epub 2015 Oct 17.
Direct Comparison of GreenLight Laser XPS Photoselective Prostate Vaporization and GreenLight Laser En Bloc Enucleation of the Prostate in Enlarged Glands Greater than 80 ml: a Study of 120 Patients.
Misrai V1, Kerever S2, Phe V3, Zorn KC4, Peyronnet B5, Rouprêt M3.
Results
The operative time was significantly shorter in the GreenLight laser prostate enucleation group (60 vs 82 minutes, p <0.0001). Complication rates were comparable between the groups. At 2 months the rate of urinary incontinence was significantly higher in the GreenLight laser prostate enucleation group (25% vs 3.4%, p <0.0001) but incontinence rates were similar at 6 months (3.4% vs 0%, p=0.50). At 6 months International Prostate Symptom Score quality of life and post-void residual urine volume had similarly decreased in the 2 groups after the procedure (compared to baseline), whereas the maximum urinary flow rate had greatly improved, significantly favoring the GreenLight laser prostate enucleation group (+78% vs +64%, p <0.0001). Prostate size and prostate specific antigen reductions were significantly higher in the GreenLight laser prostate enucleation group (74% vs 57%, p <0.0001 and 67% vs 40%, respectively, p=0.007). The unplanned hospital readmission rates were similar in both groups (16.7% vs 6.7%, p=0.16).
CONCLUSIONS:
Photoselective vaporization of the prostate and GreenLight laser enucleation of the prostate are safe and provide satisfactory short-term functional outcomes in patients with a prostate volume greater than 80 ml. However, the surgical time was longer in the photoselective prostate vaporization group, which also had a higher rate of unplanned hospital readmission, and lower decreases in prostate specific antigen and prostate size
philip42830
Posted
It is 2 weeks today since I had my HoLEP.
I am delighted with the results.
All the problems before the HoLEP are resolved.
Sleeping through the night without any need to go to the bathroom.
RE is fine, work okay for me.
I won't be posting after today on the discussion, as I pretty much think my BPH issues are now resolved.
I will let you know what happens at my 3 month check up in November.
Take care and I hope you all find the procedure that meets your individual needs.
Philip.
dl0808 philip42830
Posted
I hope ur great result will persist in the coming months!
thanks for posting ur experience , it has help me to understand how good HoLEP could be and I am sure will help many readers of this thread!
philip42830 dl0808
Posted
DL
Thanks.
I have been on a very long BPH journey and this forum and the members have been fantastic. Sharing their experiences, offering support. I wouldn't have found my surgeon with the people that post on this forum.
It is an amazing group of people.
I hope I have helped people who are thinking about HoLEP. And will always answers any questions, if people PM me.
I can now put BPH behind me and get on with life.
Take good care everyone.
Philip.
kenneth1955 philip42830
Posted
Good evening Phil. Very happy for you. Sometimes it take a wile to find the right procedure for you. The journey is a long undertaken and I am glad your's worked out for you. Some procedure are not for everyone because we all have different concerns But the maine thing is that your happy. Take care and good luck Ken
philip42830 kenneth1955
Posted
kenneth1955 philip42830
Posted