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Researching HoLEP for my Dad

Posted , 13 users are following.

umamimommy
umamimommy

I am researching surgical options for BPH for my Dad (86cc, 76 years old). He lives in the USA, in Louisiana. His 75 year old surgeon recommends a suprapubic open prostatectomy, but my reading suggests we should explore HoLEP as an option.

I've called numerous urologists and have talked to larger medical centers, but could not locate anyone who performs HoLEP. I contacted Lumenis, a medical device/laser company that manufactures a holmium laser, and they were able to point me to only 2 surgeons in the entire state of Louisiana that use their product for HoLEP.    

My questions are:

1. Does anyone know of other methods to find urologists who perform HoLEP? Possibly other laser companies? When I Google, Lumenis is the only one that comes up, but there must be more?

2. It seems like HoLEP is the standard procedure in Europe and Asia. Does anyone know why the adoption rate here has been so low, given what seems like superior outcomes? It's been around for 20 years!

3. For those of you that have had HoLEP - were you able to have it done with just a spinal block? My Dad had a near death experience which under general anesthesia and is very, very concerned about that option. He prefers a spinal, if possible.

4. Are there other methods that we should also consider? Bi-polar? I don't know enough about that. We've ruled out Urolift and Greenlight/TURP. Someone posted about iTIND which sounds interesting, but it is in clinical trials, I believe?

Thank you very much for any pointers. 

 

0 likes, 35 replies

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  • umamimommy
    umamimommy

    Posted

    One other burning question for me is why urologists wait so long to recommend options? My Dad has been on medication for many years, without much benefit (getting up 5-6 times/night to use the restroom, etc.) 

    Reading this forum, it sounds like many other are/were in the same boat...regretting being on meds for so long instead of just taking care of the problem a bit earlier (when younger selves can tolerate surgery better). 

    Just curious what the thoughts are out there. Is it standard procedure to just keep throwing meds at the thing, all the while knowing they keep growing??

    • jimjames
      jimjames umamimommy

      Posted

      It's called "watch n' wait" and how long to wait can be subjective, even though there is something called the IPSS Score (international prostate symptom score) that many urologist use to help codify things.

      Some folks would rather get up 5-6 times per night than to have a surgery that might for example leave them with side effects such as retrograde ejaculation and other possible issues. Others, in that position, would rather take care of the problem right away with surgery. 

      Personally, I didn't like any of the surgical options three years ago, so even when my bladder for all intent and purposes stopped functioning, I decided to go on a program of self catherization to take care of the retention problem and extend my watch and wait period. Others here have taken more direct action with surgery, some extremely satisfied, some not so much.

      Jim

       

  • umamimommy
    umamimommy

    Posted

    Also, one more follow up question (thank you for indulging a newbie like me):

    When I made the consult appt for my Dad today, I asked the nurse how many HoLEP procedures the Dr. had done. She said she didn't know. Then I asked how many years he's been performing them and her answer was, "a long time". 

    I do intend to ask the Dr. during my Dad's visit (I will be there via Facetime), but wondering if any of you know how to find this kind of info out? Do you take the Dr's word for it, or is there a way to corroborate?? 

    • james87669
      james87669 umamimommy

      Posted

      The Hospital should have the Doctor's background and all specialties and also patient feedback.
    • oldbuzzard
      oldbuzzard umamimommy

      Posted

      HoLep isn't the most current of procedures. My sense is that if you want to go with a laser, the green laser is a better option. Has he tried apha or beta blockers? Another option is what I had done - my results have not been good so far, but apparently I'm an outlier. Rezum is non invasive and for most, quite effective. Why have you ruled out Urolift?

      I would look for a younger, well schooled Urologist - maybe at someplace like Tulane or another teaching hospital. Seems to me that HoLEP is not the most effective/least invasive option out there.

    • stewarta
      stewarta umamimommy

      Posted

      As a 69 year old with first-hand experience in this area, I wouldn't do a thing without having a 3T MRI. The results will tell you if their is/are lesions in the prostate that need to be investigated further with a MRI guided biopsy.

      Then you will know better why the prostate is enlarged. If there is nothing of concern other than BPH, check further on PAE. The other surgeries are like rolling dice in terms of outcomes. Yes, I do understand about your monetary concerns.

    • umamimommy
      umamimommy oldbuzzard

      Posted

      I had not come across Rezum yet, so thank you. Will add it to the list.

      Urolift's website says it's used for prostate up to 80g, so my Dad's is too large/borderline (86). But my Dad is concerence about having to have surgery down the line any way. I believe it was on these forums that we read that ppl had had that experience and regretted Urolift for that reason?

      HoLEP is not being performed at Tulane, unfortunately. But it goes to your first point...is HoLEP considered outdated? And if so, what is better?

      The research papers I've read make HoLEP sound promising: less bleeding, less blood transfusions, shoerter hospital stay. It's unclear to me why it's difficult to find surgeons in the US...so am wondering if there is something I'm missing/overlooking? (as in whay a teaching hospital like Tulane does not have it). 

       

    • oldbuzzard
      oldbuzzard umamimommy

      Posted

      I think it's yesterday's treatment. The green laser is a newer, less envasive form of treatment (no hospital stay) and things like PAE and Rezum are newer and less invasive still. I strongly urge him to try alpha (rapiflo, alfusozin) and beta blockers (Avodart) as they may provide some real relief while he pursues a more permanent solution.                        
    • derek76
      derek76 oldbuzzard

      Posted

      HoLep Is Laser -Holmium Laser Enucleation of the prostate (HoLep)

      Versions of Holmium have been around for a long time and I turned it down and waited for GL to reach our shores.  Holep is the latest version of Holmium. GL has been around since about 2003 and the present machines are at least the second generation.

      I had GL PVP (75 grm prostate age 72) in 2006 in England and it would have been day surgery with a return visit to have catheter removed and a flow and retention test the next day if I had lived locally. As it was done late in the day and I had a two hour train journey home they kept me overnight. 

      By 2012 my prostate had regrown to 135grms and I had Thulmium/Holmium Laser surgery in a different part of the country. He used the two types of laser one to take out 37 grms of tissue for biopsy and the other for the fine work.  As I was on Warfarin I bled more than normal and went home with a catheter in. Some write ups put Thulium laser ahead of Holep.

      The hospital where I had the GL PVP later went over to HoLep although they did not consider GL to be any less effective.  

       

  • Trustme
    Trustme umamimommy

    Posted

    Google Focal laser ablation.  It has been used for prostate cancer but a doctor is now using it to treat BPH.  The procedure is done through the rectum, not the urethra.
  • nealpros
    nealpros umamimommy

    Posted

    Other methods include prostate artery embolism (PAE) (done by an interventional radiologist, so it's NEVER recommend by a urologist since they make no money on it), and Urolift. You can find a wealth of information on both on this blog, and by searching the web. Don't even consider what his doctor is recommending unless your dad has severe cancer.

    Neal

  • tom86211
    tom86211 umamimommy

    Posted

    What we all want is relief of BPH symptoms with minimum side effects, and that would include cost, travel time and expenses, hospitalization, catheters, blood loss, infection, pain, later loss of sexual function (including retro ejaculation), and long term effectiveness. 

    Almost all of the current treatments have been discussed on this formum. It appears as if the best results with the least side effects are obtained with PAE, then Urolift coming in at second. 

    Focal Laser Ablation (so far only done by Dr. Sperling out of Livingston, NJ) looks very promising. 

    Below those we have iTind, the various laser techniques (HOLEP being the best, but requiring specialized training), also REZUM, and not discussed much, plasma button TURP as opposed to mono and bipolar TURP (least favorite procedure discussed here). Mono and bipolar TURP are cutting procedures, whereas the plasma button vaporizes the prostate tissue so there is much less bleeding. 

    Anytime the prostate is heated, as with laser or steam (REZUM) there can be tissue swelling BEFORE the treated prostate tissue begins to shrink, so there may be days or longer that a Foley catheter is required. I had this for 5 weeks and I got used to it. Some people hate it. 

    Anyway, there are many factors to consider. 

    HOLEP is performed at the Mayo Clinic in both Rochester, MN and Arizona. Also, various doctors get excellent reviews elsewhere (Dr. Lingeman, Univ of Indiana), Dr. Krambeck (Mayo), Dr. Miller (Vanderbilt). 

    Before deciding on any treatment you need to check with your insurance provider to find out if that procedure is covered. Travel costs for required treatments are usually tax deductible. 

    Don't rule out PAE or Urolift as they receive excellent reviews elsewhere on this forum. I was scheduled for a PAE through Kaiser in Oakland, CA, but found out I was not eligible because of prior radiation treatment for prostate cancer. 

    Tom

    • Fitz2017
      Fitz2017 tom86211

      Posted

      (April 2017)  I have just returned Indianapolis where Dr Krambeck performed a HoLEP 3 days ago. Everyone at IU was very good. After the surgery, I stayed 30 hours in the hospital where the catheter was used to flush many litres of saline solution thru my system. The entire trip and procedure were easy -- even the flight home 2 days after the procedure.   So far:  minor incontinence for 1 day, blood in urine is decreasing, no pain, some discomfort (but minimal), minor dribbling does require the use of some sort of pad in front of the penis.  So far, so good. 
    • james87669
      james87669 Fitz2017

      Posted

      Glad to hear that all went well for you. I had mine done last June and I am very happy with the outcome. For me, I was in Depends for about a month and pads for about two more months. Then all was well after that. Some bleeding initally but absolutely no pain. To be honest my sexual responce has actually improved. I love the ability to pee like I did as a teenager.
    • Fitz2017
      Fitz2017 3465lake

      Posted

      Certainly. If you can send me your phone number or email, we can communicate privately. All in all, my experience was positive.
    • 3465lake
      3465lake

      Posted

      It looks like the system will not let us exchange phone numbers or emails.  Not sure how to bypass this.

      3465lake

    • Fitz2017
      Fitz2017 3465lake

      Posted

      I saw a tab for "private messages", but I'm not sure how it works. I'm quite happy to talk and share my experience, but we'll need to figure out how to do that.

    • jimjames
      jimjames Fitz2017

      Posted

      Hi Fitz, 

      You click on the "envelope" image to the right of the name of the person you want to message privately. It takes you to another page where you can have private conversations and exchange information like email addresses and phone number. 

      Jim

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