Surgery next week - Hood sparing technique Greenlight enucleation
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Since I've gotten so much out of this community the past year, I will be recording my experience post my prostate procedure. I'm due to have it June 7th next Wednesday early in the monring at 8am. I wanted to get aquablation done but my insurance didn't cover it and I found an expert that does 300 voiding surgeries a year (no cancer), does both greenlight and aquablation and felt greenlight might be slightly better given the asymmetry of my lobe pushing into the bladder.
He does greenlight enucleation (more akin to HOLEP) vs greenlight ablation (although as one of the foremost skilled practicioners of this) he switches between 80W, 120W and 180W as he needs to to accomplish the enucleation. Whereas HOLEP has a near 100% chance of retrograde ejaculation, he estimates a 30% chance of retrograde to me because he is doing the lateral walls all the way to the capsule like HOLEP (20%) and a piece that is pushing into the prostate creating a ball valve (not median lobe though, lateral lobe growing up - 12% just treating the median lobe type thing). also because he is one of the advocates of hood sparing technique which is not unlike ep-TURP (ejaculation sparing).
My understanding is that not many doctors do the Greenlight enucleation (esp hood sparing) and this professor teaches on greenlight to others. He was in the early clinical trials of aquablation too. Catheter is expected to be in one day overnight in the hospital (because I requested to stay in the hospital if I was going to have a catheter in (don't want to have to pull it out myself)).
Wish me luck and will document my journey in case it helps someone else that can't get the aquablation done. Either way with the ball valve whoever did the aquablation on me would have had to TURP near the bladder neck so I feel good about this doctor being so confident with this skill at modulating the laser as needed to clean that up. The hood sparing is also nice since he will guard distance from the veru like the aquablation does. I believe by going to the capsule he will be able to take more tissue away than even an aquablation and results of greenlight enucleation are as good as TURP and should last 15 - 20 years if I'm lucky.
a month away from turning 53, 75 gram prostate, experiencing frequency (go once an hour during day) and hesitation starting, nocturia - wake up 2-3 times a night, don't drink much water (<1 L a day), PVR of 100ml when my bladder hits 250ml, genearlly pee small quantities (less than 70ml), slow flow of less than 10ml/s for sure. last year, flared up to 12-15 times wake up a night, frequency of every 15 min, dribbling and many near retention events. The flare up has gotten better but I'm still having issues and hoping for improvement from here.
0 likes, 10 replies
Steveareno cali-mike1970
Edited
Mike. Good luck on 6/7 (Wed). I will pray for a successful surgery.
I am so surprised that insurance does not pay for Aquablation especially with the information that you shared.
Aquablation is proven to work from all the research that I have done. Medicare covers it and usually insurance companies follow it even if you are not 65yo. If you don't mind...who is your insurance carrier? Just curious...
All the best and I look forward to reading about your journey.
On another note: I am having my Aquablation on Monday 6/5 at 10:30am. I am praying for a successful procedure and can't wait. Indwelling catheter is in 67 days! Can't wait to get'r done!
cali-mike1970 Steveareno
Edited
florida blue (blue cross in FL) but i am an out of state resident in CA. I have heard of them covering it in FL.
i think it was more my doctor did not do a good job of getting them the medical documentation needed. that said, I'm getting my procedure done in texas at methodist hospital which knows how to deal with blue cross and they also said that once denied it can be an issue. we didn't appeal it and my new doctor convinced me greenlight would be better for me anyway so i didn't appeal it.
cali-mike1970
Posted
Update on day 2 after surgery
Day of surgery: better than expected, was given the option to go home with a smaller cathether or stay in hospital and get an irrigation cathether put in to justify the insurance stay. i went with staying in the hospital which was a good choice, given the management of bladder spasm medication preemptively, pyridium and change out of bags. generally had good clear color from the beginning and positive signals being given. doc said procedure went well and enucleation was completed. the cathether was on low irrigation and somewhat uncomfortable at first but got better as the day went on. didn't sleep much overnight and was very tired of the cathether the next day, counting the hours over night to get it taken out and irritation inside the penile head was increasing.
Day 2: relieved and ecstatic - cathether came out early, was up and moving around, 3 voids under a diuretic stress test were very successful with 2 of the 3 having nothing left in the bladder and more volume than I've passed in many years 230ml. flow wasn't race horse though but more strong than usual
removing the catheter was surprisingly easy and the "burning" on initial pees and since have been very manageable, not even sure if I need tylenol to endure it but staying on it
frequency much improved and flow stayed good for most of the day; drinking about 3 L
Overnight - woke up after 4 hours and expected a big pee with force but reverted to normal, 150 ml
2 hours later did a bit more but less than 100ml and with low force like normal
Day 3: starting with a feeling that things have regressed to normal. A bit distressing, Some blood coming out with each pee and still seeing pyridium orange but no longer using. I guess this will be a roller coaster and not sure why I would have done so well the first day but reverted so fast.
Anyone see this up and down so fast after full carve out enucleation (HOLEP)?
Thanks
cali-mike1970
Edited
One week out now and have had a good recovery, really no pain that some azo and tylenol didn't take care of for a few days. Still get some small amounts of blood at the beginning of pees.
Mixed feelings, but generally happy the protrusion lobe obstruction is gone. So far, things are performing best with 2 Flomax a day! (spincther opens more easily). I was hoping not to need to be on that with the procedure. Doc says stay on it until I can pee better on my own.
POSITIVE: The times when I get good flow pressure and pretty big void output for me of around 250 to 300ml (what doc wants to see) is when I'm driving somewhere and holding the urge for a good 20-30 minutes and I've drunken a good amount of water in the hour preceding on pace for a 2 liter+ day. That is a definite improvement and very satisfying and this definitely wasn't happening before the procedure. My protrustion / ball valve was definitely not making more than 150ml ever happen for me and I'd have to go back a short time later to keep voiding.
NEGATIVE: When Flomax is wearing off, I notice my volume output drops significantly and stream weakens. The fact that at night after the morning Flomax wears off, I'm still seeing a week stream, non complete voiding (don't feel retained but know I have to go back and get a bit more out, and start/stop makes me wonder if there is something else than just enlarged prostate going on. Or it could just be that bladder volumes are low since I stop drinking as much water at 7/8pm. Spinchter takes long to open and maybe its not fully opening when I'm not on Flomax. This leads me to take a 2nd flomax pill at night to have more complete voids overnight when I wake up, which is still 3-4 times a night since I'm still sleeping lightly thinking about all this. When I take a sleep aid, I sleep 7 hours straight without waking up so it's just the level of deepness of my sleep that pays mind to the bladder signal.
Things are improving and I'm happy I got the procedure, but for right now it seems to me obstruction was not the only issue and I still need pharmacological help to function acceptably. Hoping it improves in the coming weeks.
For anyone that got HOLEP (enucelation like I did), did your flow stay strong from the moment the procedure was completed all the way through recovery (meaning no more blood)? Or did you still have a weaker relative stream at times and that got progressively better as hold times improved? Thx
anders08675 cali-mike1970
Posted
After our last conversation, I pulled out the graduated measuring container I got from the urologist, and a stopwatch. (Yes, it probably looks funny if anyone could see)
A little more than a month out from the HoLEP..No more blood, and I am averaging about 30ml/sec (+/-) with a volume from around 200ml to a high of 350ml.
cali-mike1970 anders08675
Edited
Yeah, 11 days out and I fear I've got something else going on, but we'll see. Had the most amount of blood today (after having relatively little even the first few days after the procedure) and back to many small spurts (many under 50ml) and maybe a couple during the day of 150ml. I drank my 2L of water so not sure where the rest of it is (maybe my bladder). Tonight won't be fun since I feel backed up (if I wasn't scared to catheter myself I would).
the bleeding today and yesterday I assume is the re-emergence the docs talk about at the 2-3 week mark. I saw a scab come out today.
I'm hoping its a scab that is stopping me up as opposed to something more serious and that things improve and go back to some of my better void outputs and flow strength. I guess the most concerning thing is the lack of consistent flow since the day after the operation.
Assuming it's too soon to worry about the bladder neck closing up too much or anything but I'll ask my doctor.
not_too_shabby cali-mike1970
Edited
Keep us posted Mike on your recovery. I had a median lobe only TURP and my flow rates did vary significantly during the recovery. Did the doctor say anything about your bladder health before the procedure? At 53, I would hope that it is still ok.
cali-mike1970
Posted
From Day 12 after procedure, things really improved. Flow was consistently strong, frequency spacing out and volume good on most voids with 2-2.5L of water a day.
I suspect inflammation finally came down and results are becoming more consistent. I feel like the spincter is also opening easier now too so less hesitation. The only issue is when I don't drink enough water and I get a smaller quantity, seems like then the flow rate is weaker which is to be expected.
I also tried at Day 14 and 15 weeks to see if I got RE. Don't think I technically did as some ejaculate came out. Not as much as before though and maybe more watery. Felt a bit irritated afterwards (almost slight pain on day 15) so going to lay off for another week before trying again. My doc told me it was OK after 2 weeks, despite lots of places documenting a longer 4 to 6 weeks timeframe.
I would call it a success if things continue as they are going. I'm only 2 weeks out.
cali-mike1970
Posted
OK last post for awhile documenting my recovery. It's been one month today. Here are my observations:
having pain at the end of my urination (moderate, sometimes mild). not sure what is causing that; hopefully it goes away but it feels kinda permanent. It goes away after a couple of minutes
orgasms are less intense and very little comes out. I'm still on floxmax sometimes however so not sure I'm almost at full RE. either way it's much reduced and maybe because of that the feeling of horniness has been much less the past couple of weeks.
frequency and urge remains for me. I think I have some level of OAB/IC. stretching, mybetriq and anti-histamines help me manage that.
waking up 1-2 times a night; void volumes are not as high overnight as in the morning
Still happy I did it and try to reframe from 'i lost alot of pleasure of sexual climax' to 'things still work, can still get some level of relief and hope it gets better/i get used to it'.
michael55618 cali-mike1970
Posted
Hi, sorry to hear that your surgery results are not yet where you want to be. I had a different procedure than you (Aquablation) but I can tell you that one month out, I still felt terrible. Also, the recovery for my libido was VERY slow. My first few ejaculations post-surgery were pretty weak. I'm 10 months out, and I can say that my libido really only came back in the last 2-3 months. Also, if your symptoms persist, I would talk to your doctor about whether you have scar tissue.