My HoLEP prostatectomy

Hi Bill,

Do you know if you had a large median lobe? From what I have read, the prostatic artery embolization doesn't help if you have a large median lobe.

Wonder if you know how the holmium laser (holep) does with that condition?

I had 70g of a 120g.+ prostate removed with the GL laser, followed a year and a half later by a bladder neck resection and removal of stones. But I have a large median lobe pretty much intact that protrudes into the bladder. I think it's just a matter of time before this will caue a problem as my flow is already somewhat restricted just 9 months later.

Not sure how this will be addressed short of a prostatectomy.

My uro says that he will just go in with a button turp and remove the third lobe. He says the possibility is good that this lobe is causing the restriction and may solve the whole problem. 

That sounds like good news Ron. When are you scheduled? Looking forward to your updates.

Bob

Not scheduled yet, got to finish my project as I'm expecting weeks of recovery. Probably October 20th or thereabouts. I just looked up Holep on Wikipedia and they describe it as an increasing solution which is intended to replace Turp. Dang, how did i miss that?  My new uro is top-rated and i will ask his opinion today. I'll keep you posted. I appreciate your attention Bob, as I have stated before.   

Bill, read your HOLEP post with great interest. Can you give me some Google search words that will take me to the forum you mentioned? Don't give me a link, the moderator will erase it. Thanks, Ron 

I originally types into search "prostate larger than 100 grams" and found it. I just tried it again and saw a bunch of stuff on HoLEP that may be worth looking at.

Also, I noticed a very negative note from someone overseas from around 2 years ago on HoLEP. But that person may have gone to a doctor who was just learning how to do it. I also noticed some urologist out of Florida replied to it and gave the guy some names and links which attempted to further discredit HoLEP. So I clicked on the doctor and saw he touted himself as some top urologist but found he had 1 patient who posted a really bad experience from him. Point is, don't let urologists who do not do HoLEP scare you away, but do your homework and only go to guys who have performed MANY HoLEP procedures (I was told 30 or more to open).

I had Green Light PVP (75 grm  prostate) in 2005 here in England and recovery was practically instant.  On day two I travelled home 150 miles by train and the next day life was normal and I went to the races surprising people who knew that I had been having surgery on the Friday. I was not all that impressed by my flow but no more urgency and no retention.

 Over the next eight years my prostate re-grew to 125grms and last May I had Thulium Laser surgery at a different hospital. It has been done in the UK for a number of years but only recently in the USA. The surgeon who did it called PVP a commercial procedure and not a cure.

I was still passing blood on day two and was sent home with a catheter in and told to come back in two weeks to have it removed. Wearing the catheter was not to much of a problem and I was able to get out and about. With the catheter in I acquired an infection and had to take antibiotics. During that time my urine was pink and I was passing debris and a few blood clots. When the catheter was removed and my bladder flushed out my urine was clear from that moment. Again my flow was not brilliant but slowly improved.

The hospital where I had my original PVP now use the newer Green Light laser but mainly use HoLep laser.

Thanks for the feedback Derek. Greenlight did almost nothing for me. I also had a few emergency situations immedisately after, including the need for a suprapubic catheter (I think that is how it is spelled, where they have to puncture thhrough your abdoman because they cannot get a catheter in through your peins).

If I didn't mention it, I believe HoLEP was invented in Europe somewhere, so there should be doctors over there with good experience.

Here is input from the top HoLEP doctor in the US, Dr James Lingeman:

"The enlarged median lobes fellows do the best.  HoLEP is best for this as it combines the most complete removal of the tissue resulting in the best short and long term outcomes.  Further, patients can get back to regular activity in one week."

Hi Bill,

If you would not mind sharing the research paper and suggest some top Docs to perform HoLEP, I would really appreciate it.

I live in Austin, TX.

Thank you

Larry Whitaker

Emis Moderator comment: I have removed the email address/phone number as we do not publish these in the forums. If users wish to exchange contact details please use the Private Message service.

http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

Bill...the info you posted is highly useful for me and others with BPH.  My local internist has been monitoring my symptoms and PSA for the past several years.  The onset of symptoms began at 58, I'm 64 now.  Recent blood tests showed elevated PSA levels at 4.6. Symptoms have worsened to the unbearable stage.  Some days after morning coffee, I visit the urinal some 15 to 18 times, never emptying the bladder.  I sought out an appointment with a urologist at Mayo Clinic, Phoenix.  It's a 5 hour one way drive but I'm a previous patient and was able to set an appointment after one phone call.  After setting the appointment and leaving a message on the patient portal, the urologist, Dr Schneider phoned me on the cell and spent a door 10 minutes with me discussing my symptoms and medical history.  We all know there is a vast difference in the level of care and this kind of attention to patients sets the Mayo clinics apart from any other I've visited...maybe with the exception of The Steadman Clinic, Vail, CO.  

One of the purposes of the discussion with Dr Schneider was to schedule the tests necessary to completely evaluate my condition (BPH). 

June 30th was a full day of testing, resulting in the discovery of the prostate size...a little over 100+ and visibly intruding to the bladder.  Other than frequency, not emptying and night time attempts to empty, there is a sudden urgency with a burning sensation.  There are no infections...at least none were discovered.  

While scheduling the "tests" I opted against biopsy because of the risk for infection and the fact that any cancer beneath 6 on the Gleason scale is typically not treated...just further cause for anxiety in my opinion.  

Having had two complete shoulder replacements at Steadman Clinic, Vail, CO in 2014...right shoulder, June 2014, Left shoulder November 2014, I'm concerned with possibility of blood infection from the typical transrectal prostate biopsy.

My main concern is to "fix" the going issue with an immediate prostate procedure. After becoming aware of the HoLEP procedure, I'm convinced this is the way I should and will go.  As matter of fact, we scheduled the procedure at Mayo Phoenix for Wednesday 16 September.  Dr Scneider wants me to arrive Monday for tests and preparation.  

This is where I'm finally getting to the point of my post...Dr Schneider is very young.  I asked the nurses performing procedures this last visit..who is the HoLEP procedure doc at your clinic?  They didn't reply with Dr Schneider's name.  I can't recall the urologist they mentioned but Dr Schneider did say the urologist they mentioned would be on the team and available if there were complications.  Dr Schneider said he'd completed 58 of the HoLEP procedures and the "other" urologist...the more experienced one, has completed more than 400.  Has anyone heard of Dr Schneider, Mayo clinic, Phoenix and what would be your position in selecting the surgeon?  I really liked Dr Schmeider but experience is what concerns me.  I learn d at Steadman Clinic, during two complete shoulder replacements...the quality of the procedure is not wholly dependent upon the one surgeon but the team he puts together.  Maybe I'm answering my own question...I have faith that Mayo would assemble a top notch team for this, self-admitted, complicated procedure.  My other area of concern is going under general anesthesia for two hours once again.  Each of the two,shoulder procedures was two hours under a general along with a nerve block.  Remember, the first was June 2014, the second was November 2014.  Does anyone have an opinion or knowledge of the effects of a 64 year old man going under for that length of time again...the third time within 16 months?  Dr Schneider did not mention the option of a nerve block with no general and I forgot to ask.  I'm not over weight, in good enough shape to do 10-12 mile hikes at 7000' elevation and I'm not taking any meds except Ativan...stressful job and helps take the edge off for sleep.  I hope I didn't ramble to much...I appreciate forums such as this and I'm a firm believer in taking responsibility for your own health choices...I'm looking to be as informed as possible.  Information helps remove the stress!  Thanks a bunch for any and all help/advice

Hi Michael. I still read the posts and hope my experience will assist others. I've laid it all out in these forums so I won't repeat except to say that the other nuerologist at the Mayo was probably my surgeon, Dr Humphreys and that the entire Mayo experience was just off the chart successful. I have never heard of a residual negative effect of a general anesthesia. I understand your concern but I would say that a person in your physiccal condition has nothing to be concerned about from general anesthesia. Remember, that this sort of concern is exactly why wise patients go the the Mayos in the first place; because this is where you give yourself the best opportunity for a good outcome. Also, I would say that if Dr Schneider practices at the Mayo then he is probably a top notch professional, he has chosen to master a very difficult procedure, one that no more than a dozen or so surgeons in the US have mastered. There can be only one reason why he has chosen this field, because he knows that the liklihood of a good result for the patient is best with the Holep at the Mayo. 

Something just occurred to me, I has interviewed by several doctors at the Mayo before surgery, one was a tall, beautiful, young, woman Doctor and I don't recall her name. I know she was part of the Holep staff. Could this have been your Dr Schneider?

Hi Ron...Dr Schneider is tall, good looking but he's a nice guy, probably from NC.  He went to Med School at NC and was really attentive.  He performed the prostate sizing exam...not sure of the terminology, I'd normally look it up, but just got home from the long trip.  He also performed the procedure of inserting a camera through the urethra and into the bladder himself...that's when he pointed out.."Look at the screen, see how the prostate is protuding into the bladder"  Whoa...If I'd known it was that large I'd have been more proactive in seeking out a remedy.  I tried the meds and immediately quit because of sides.  It sounds like there are some long-term sides from some of the meds, so, probably a good thing they didn't agree with me.  I plan to send a note to the urology department, requesting that Dr Humphreys be present and available to assist Dr Schneider.  Dr Schneider said that he would be "available"...I just want to make sure he's readily available and an acitve member of the "team".  I totally agree....this is my third experience with Mayo, Scottsdale.  No comparison to my local choices for medical care.  Thanks for sharing.  Michael

Michael, you've done the research and made the best choice and since you were able to get off the meds quickly you should not experience the negative effect of long-term use. You deserve a good outcome and I'm sure you'll have it. Don't forget that due to the third lobe you'll probably be incontinent for a while, maybe weeks like me. The padded underwear the hospital supplies are totally embarrassing (don't let anyone see you in those!) and not very effective either. Get some Depends, no one will know you have them. I eventually bought some stretchy athletic underwear and cut the pad out of the Depends and stuffed it in. Works much better as you can change the pad whenever you choose.  

Best of luck and let us hear from you. Ron

Larry, I'm scheduled for the HoLEP procedure mid September at Mayo Clinic, Scottsdale.  Dr Mitchell Humphreys name always comes up on HoLEP searches.  He is training several urologists in the procedure including Daniel Schneider.  Dr Schneider will be performing my surgery but Dr Humphreys will be in the OR and "available". I've had several patient experiences at Mayo...they are heads and shoulders above other providers...In my personal opinion.  Mike

Ron, I know you reported good success with your HoLEP procedure several months ago.  How are you getting along these days?  Would you still recommend the procedure?  I'm looking into PAE but we seem to be well behind Europe with interventional radiology techniques.  Seems there's a new symptom that's driving me crazy...constant burning at the membranous urethra.  I've been checked for infections and there are none so I'm assuming this may have been aggravated when i was cathed at the Clinic.  Is this a symptom from BPH?  Hope you're doing well, Michael

Had Green Light 4 years ago. Took almost a year to recover. Retention has recurred 5 months ago. Wearing catheter. Now they want me to do TURP. I am 85 years of age and may not make it. Cannot find anyone to do HoLep in the New York City metro area with a population of over 10 Million people.

Need help.

The Equipment is made by Lumenis. You could contact them to find who is using it in NYC

Lumenis Inc. – Main Office 

2033 Gateway Place, Suite 200

San Jose, CA 95110

USA

Tel: 408-764-3000 

Fax: 408-764-3999 

Lumenis Inc. 

1870 South Milestone Drive

Salt Lake City, Utah. 84104

USA

Tel: 801-656-2300

Fax: 801-972-4884

What went wrong with your GL procedure?

Some hospitals here do both procedures.

Lester...the three Mayo clinics perform the HoLEP procedure.  I was scheduled for the procedure but have elected to try PAE.  If it doesn't work out, I'll be up for the HoLEP.  Good luck and keep us posted on your journey to good health.

GL only lasted 3 and a half years until I got into an auto accident and retention recurred. Urologists tell me that tissue returned. Lumenis found a HoLEP doctor near me who I contacted 2 months but he never replied. The next nearest doctor is in Philadelphia and he also never replied.

Thanks for your concern.

Are you near Huntingdon where Dr. Christopher DiBlasio seems to do it

at North Shore Medical Group.

My prostate was 75 grams when I had PVP in 2005 and had grown to 130 gram by 2013 when I had holmium laser. It is now 50grams but problem free.

Dr. DiBlasio is who I contacted. The problem with any of these procedures is that we dont know how long it will last.

 

Some prostates grow like weeds.

I had the HOLEP procedure with dr diblasio 5 days ago...He has a very good reputation in this area( huntington, Long Island) where I live...I do see some very positive results as my flow is like I haven't seen in 20 years! But I do have intense pain after urination and was up every hour last night...,I'm told that it can get worse before it gets better.. It will be a minimum of 2 weeks before the bladder readjusts to my new body..but I'm feeling very positive about this procedure and dr diblasio... Looking forward to getting through this stage as it is quite uncomfortable and painful...has anyone experienced this at the 5 day post op stage?

I did not have that problem after my GL PVP or Thulium Laser procedures nor any pain but my flow was not as good as I hoped for.

Good luck with the rest of your recovery

I think this is common with any prostate surgery. I experienced it with the Greenlight laser, extreme urgency and frequency for a few weeks, and eye-popping pain after every urination for more than 6 weeks. I found that hyperventilating while urinating took my mind off the spike of pain at the end. It's just healing.

Michael,

Curious as to if you had the PAE done--and where you went. Are you pleased with the results? I, too, checked into having a HoLEP done by Dr. Humphrys at the Mayo Clinic in Phoenix. Their facility and staff are impressive, and I thought it could be a backup option.

Currently I'm checking into having PAE done in Denver by Dr. Charles Nutting. They have my medical records and will let me know soon if I'm a candidate. Might check into having it done on the East Coast, too.

My prostate is quite large with a median lobe pressing into my bladder. At the first of the year I was hospitalized with acute urninary retention. I was told my bladder function probably won't return. Currently I'm learning to self cath--it's not for the faint hearted when you have a huge prostate. But it's taking the pressure off of having to make a hurried decision. My hope is that PAE will make self cathing easier. If it helps my bladder function again, that would be fantastic.

Stebrunner

Hi Bill

Great story and thank God you recommend HOLEP,

As for me well I have been wearing a catheter for about 6 weeks and also installed a valve in the past 2 weeks so this way my bladder get to do some work while I wait for the HOLEP operation. I seen 3 different urologist and each proposed a different method, the first one proposed the old TURP, the second one proposed Green Light surgey and the 3rd one HOLEP, I seeked his advise after doing a lot of research and found that urologist the only one in Montreal, Canada doing HOLEP. I just hope that after the operation I will be able to pee normally. I all started when I felt sick and nauseated and went to the ER, they checked me out and found high level of my creatinine 230 and didn't know why but found out that I had 750ml of urine in my bladder after void. I never had problems urinating but could not empty completely my bladder and apparently it went back in my system and increased my creatine, they installed a catheter for 5 days and then I had a systoscopy and following that they ask me to try to pee and I could not which I couldn't understand since I was urinating fine before they put the cath and systoscopy, in any case they put back a cath that I have now for about 6 weeks, of course I had to change it about 2 weeks ago to a new one, they also told me that my prostate was huge and needed to be operated, just hoping that all the retention I had for God knows how long did not damage my bladder, so for the 1st month I gave my bladder a rest by wearing the cath and bags and now I have the valve so hopefully my bladder will get back to normal once I get the HOLEP.

Thanks

John

Hi John:

    Did you have your Holep done in Montreal? If so, could you provide details about  your experience? Apparently, it's the only place in Canada where the procedure is done. 

Reg

Hi Bill , I just saw your comments on this site & I registered in order to be able to communicate with you .

Regarding Holep , which I have been told by Dr.Hermendra Shah to go for it & he has done over 2000 procedures. My questions :

How accurate are they on ED as a non issue

& incontinence....I'm 67 years in good health as per my blood tests & my prostate is 85 gr. & choking my urine flow .Bladder function is very good .

Also you mentioned IR ! WHAT IS IT ? WHERE CAN I GO FOR IT ?

YOUR ADVICE IS GREATLY APPRECIATED.

GUS

Hi Bill, can you tell me who is top HoLEP surgeon in phila area. Thanks!

Hi Bill,

Can you tell me if you think Holep is safe for a high risk senior?  My dad is not voiding and we have to decide on something asap.  Thanks for any advice.