The Urolift procedure; patient views and questions

Just Google Urolift and your State and something should come up. The Mayo Clinics do it. Or just Google the company Urolift dot com who can advise you.

Chuck, there is another alternative, a better one. My prostate was 114mg, too large for urolift and my prostate had a third lobe besides. No Urolift for me on both counts. So I sought another solution, found HOlep,(Holmium Laser Enucleation of the Prostate),  studied it extensively and found a surgeon to do it last week at the Mayo Clinic in Phoenix, October 31st. Today, a week later I have experienced no pain, with no pain medication, very little blood, and I am, one week later, living my life very normally daily.  I'm not supposed to lift anything heavy for a while but I do so without problems. My third lobe was pushed up into my bladder and when cored out it left my bladder neck stretched out to the point that I was incontinent totally last week. I have had to wear Depend Real Fit underwear since leaving the hospital but it's getting much better every day. In another week, maybe two, I'll be able to hold my urine normally. But you know what, I don't really care. I'm off any medications of any kind, I'm going to get my sex life back by taking testosterone shots and Cialis. Already I'm seeing an improvement in that area with no pills at all. If I have to wear the undies for the rest of my life changing twice a day, what the heck?  The long term prognosis is that my prostate will not grow anymore forever. A one-stop shop.  The HOlep procedure is done in the Mayo clinics and a few Universtity teaching hospitals around the country. The reason so few do it is because TURP , Green Light Laser a a few other butchery methods are so much easier for the surgeon to perform. HOlep requires a very steep learning curve for the surgeon and not many want to train at the side of an accomplished HOlep surgeon. They would rather just roto-rooter your prostate and if you are in intense pain for months and have more procedures in the future as your prostate grows then that's just too bad, they can't be bothered to learn a procedure that is truly minimally-invasive. Urolift is a stop-gap measure and if it works for you to keep you off the castrating meds for a few years, then great. Just keep in mind that HOlep can be done on a prostate of any size and configuration and it is at least a very long-term solution. Be aware that the Mayo Clinics do not accept Medicare Advantage plans althought some of the Universities may, I don't know.

I'll be glad to offer more of my experience if you are interested. Good luck. 

 

Ron;  THANK YOU very much for your reply and the very good info.  May I ask who your Doctor was at the Mayo???   Please let me know after you completely heal up how the sex life goes???  My biggest "fear" at age 64 is losing that and that would be devastating emotionally to me.  I truly appreciate hearing from you. 

Dr Humphreys at the Phoenix Mayo was my surgeon.  He trained under Dr Lingaman at Indiana University Hospital. Dr Lingaman brought the procedure to the US during the 90's and most Drs employing the technique in the US trained with him. There are HOlep surgeons in Boston, Indianapolis, Nashville,  at the Mayo Clinics in Minnesota, Florida and Arizona, and I am sure there are others although I could find none in Texas.

I expected the procedure to be superior to TURP, TUVP, Green Light Laser, open prostatectomy (horror) and a host of other techniques but I had no idea how painless it would be. The whole Mayo Clinic experience was one of utmost care and concern. I met two anesthesiologists and one of his Urologist understudies in extensive private interviews. They and the numerous nursing staff all just exude professionalism, caring and competence. I knew that the Mayo Clinics are rated as the best in the US but the whole experience exceeded my expectations.  Somehow the Drs have found a way to clean out the interior (enucleation) of a prostate of any size and configuration, leaving mostly just the outer capsule and a painless result. How in the world they can do this is beyond me but I'll take it. The only pain I experienced was really just discomfort during urination and that was gone by the 7th day, yesterday. I believe that my experience has been less painful than what I hear about urolift for many patients and the HOlep result for most patients is permanent, not a stop-gap. I'm sure that there is variation among patients but my prostae was very large with a third lobe protruding into the bladder and I am 76 years old.

As far as your sex life goes the sooner you get off the meds the better. If your sex life is ok before Holep it will be better afterwards, I think you can count on that. I'm 76 but losing my sex life is a large fear for me too and after twelve years or so on the meds I have some work to do in that regard but I'm already seeing some indications that it will be ok before long. There will be dry ejaculation as a result of Holep and any other routine that removes prostate tissue. Only urolift avoids this result but urolift  won't last forever. The meds caused that for me years ago but I really don't mind.

i know my experience may not be replicated with many other patients but I went into this with the idea of giving myself the absolutely best chance available for a successful result.  I am certain that I accomplished that and I thank God for the Mayo Clinic, Drs Humphrey and Lingaman and the information available on the internet.

I will continue to advise my experience as it develops and best wishes to you!

Ron.       

Ron;  THANK YOU very much for the speedy reply.  May God Bless You everyday .    Lets keep in touch.  ChuckP

You bet, pardner! Ron

Chuck, I'm now at 17 days post-HOlep and my conditions continue to improve. The pink urine stopped at 7 days, any discomfort ended at 8 days and I'm now holding my urine fairly well for four hours at a time including overnight. My stream improved daily for about 14 days and is now stable at peeing like a fire-hose every four hours or so around the clock. I wear one depends in 24 hours, changing it every morning and it is practically dry every time.  If my condition never gets any better I'll be happy. I've done none of the kegel exercises and that would probably make me 100%, I just think I'll get to 100% continent eventually anyway.

It's really ironic that when it became obvious that something had to be done as the meds had just run out I really wanted to have the urolift procedure as it was so minimally invasive, quick and easy etc. I was really disappointed when I didn't qualify for urolift and had to seek something else. When I discovered Holep I didn't really expect it to be as minimally-invasive as urolift. Instead, now I read about all the urolift patients with no help from the procedure, symptoms worse than before the procedure, pain and bleeding etc and my experience has been superior to urolift in every way. I'm just simply amazed.

I should comment about my sex life post-Holep and I can say that it is better than before.  Not like 20 years ago but I think the prognosis is good, I'm very encouraged that all systems are improved and getting better.

Chuck, the future is here, Turp is no longer the "Gold Standard" in BPH surgery, especially not for the patient. Urolift is a good stop-gap to get you off the meds and in my view anything that will stop the pharma-cological castration is a viable procedure. But I no longer believe that Urolift is preferable. My experience proves to me that HOlep is the best way to go for an enlarged prostate of any size and configuration and it would be so if it only lasted a few years like all of the other procedures do. But it is not just for a few years, my surgeon said that less than 1% of his patients have any further problems, ever.

For all of these reasons I feel that HOlep, at least as done by my surgeon at the Mayo is the new "Gold Standard".

There are some caveats with Holep, it does cause retrograde ejaculation like all of the other procedures except for urolift.

It is also expensive, I don't have all of the billing and reimbusements yet but it  appears that Medicare and a supplement policy will pay for almost all of the expense for HOlep done at the Mayo clinics. I don't know about private insurance or the actual cost if paid out of pocket. I'll know for sure soon.  

If you anticipate a HOlep procedure, the Medicare enrollment period, done once per year,  is happening right now. I would avoid Medicare Advantage Plans as they pay less than the traditional Medicare and for this reason the Mayo Clinics do not accept Medicare Advantage and probably other Drs do the same.   

I first learned about urolift in on-line BPH forums. Then I learned about HOlep the same way. My life has been greatly improved by these forums and further research on the web.  I am very grateful to the dozens of BPH sufferers who have chimed in their experiences, some favorable to a certain procedure and others not so much. I intend to give back as best I can and I will continue to relate my experience post-op. I can't really talk about a "recovery" as I haven't really had to recover from the surgery at all.  .  

Best wishes to you and to all those who seek to gather information from these forums, they are truly a wonderful resource!

Ron in Texas

     

Ron;  Thank You for the update.  It sounds like "HOLEP" did the trick for you.  I don't like the reverse ejaculation but I could live with it.  How many times during the night are you getting up to go to the bathroom????   Iam averaging 4 times a night even though I had "PAE" surgery back on September 10th of this year.  Lets keep in touch.  I can tell that you are a very good man.    ChuckP

Thanks, Chuck. My bathroom visits are just about normal, every 2 to 4 hours around the clock including before bedtime at 11:30, up to pee about 3 and again around 7 or so. I haven't tried a six-pack before bedtime but I think i could handle that ok. Before HOlep I had to dry out taking no liquid after 8PM to avoid being up so much. if I did that now I don't believe I would be up at all.

Big difference between euro lift and holep is retrograde ejaculation. I wish I had had urolift because I really despise RE. Dr. Humphreys did mine at the Mayo in Phoenix.  He did an excellent job but I would've rather not had it then to deal with the RE which I find to be very unsatisfactory.

Hi JWB,  you're forgetting another major difference, urolift is probably a few years solution while Holep may be once-and-done for the rest of your life. Dr Humphreys told me that no more than 1% have problems in the future. I don't like RE either but I already had it from the meds and got used to it. It may go away, though, I don't know the liklihood of that.

If you don't mind would you share with me the cost of your procedure? I'm negotiating but at this point it was about $19,500 and I'm on the hook for the $1500 not paid so far by my Medicare and Supplement. Were you on Medicare or private? (or out of pocket, of course, hope not). 

I'm sure you have read about how easy my procedure was, sounds like yours was good also. I'm still amazed at how they can expose all of the inside of the capsule to raw salty urine without any pain and very little blood! Truly amazing. 

Nice to hear from you

Ron

Your was very easy and I recovered quickly it is the premium gold standard in tissue removal prostate surgery. I don't argue that point and my cost was approximately $20,000. I have insurance through work that covered 80% of it.I just have been really unhappy with the retrograde ejaculation. I had some special complications afterwards that basically have given me a very poor orgasmic experience. So I would not do it over again if I had the chance. I would try the Urolift first.  

I'm sure you regret the RE as you're considerably younger. There's still some settling-out time for both of us. Hopefully, your situation will improve. best of luck.

Ron

Im. Trying to decide between holep & bipolar turp. Would appreciate any insight from anyone who has had either of these 2 surgeries & how pleased you are with your results/ side effects. Etc.............

I am also in this. Also, I have read all the posts and don't remember anyone saying, "I had the urolift procedure, and after I healed up, my stream was much stronger and I only get up to urinate once per night now, and only urinate once every 4 hours during the day. " Have I missed it, or does the urolift procedure just not work very well?

Hi Nealpros

I just read your post. I actually had my Urolift done three months ago, 4 stiches. The first couple of weeks were a bit tough, toilet all the time, but gradually got better. I have no issues now, feel well, no problem. At night, sometimes I sleep through, sometimes wake up once, few times twice. I would say for me the Urolift worked very well, I am very happy with the results. Cheers, Roland

I've done a fair bit of research on Urolift and I think many of the failures could be due to a poor selection on patients

If you meet the following criteria, you'd have a good chance of success from what I've read

1) Prostate size <80g

2) no protruding median lobe

3) no evidence of a high bladder neck, or decompensated (overstretched) bladder

i have a cystoscopy next week and if i qualify on all points will give urolift a go i think

mal 2)="" no="" protruding="" median="" lobe="" 3)="" no="" evidence="" of="" a="" high="" bladder="" neck,="" or="" decompensated="" (overstretched)="" bladder="" i="" have="" a="" cystoscopy="" next="" week="" and="" if="" i="" qualify="" on="" all="" points="" will="" give="" urolift="" a="" go="" i="" think="">

2) no protruding median lobe

3) no evidence of a high bladder neck, or decompensated (overstretched) bladder

i have a cystoscopy next week and if i qualify on all points will give urolift a go i think

mal>

Mal  I think you will be very please with it.  I have mine done 4 month's ago and very happy with it.  I had my doctor put a cathether in after to be safe.  Not a fan of them.  I have a problem peeing on demand so I told my doctor about it.  He know how I am It was in for only 2 day was gret in a week no meds and doing fine.  He told me that it is up to the doctor and the patient.  If you have read some of the other post some of the men that had it done ended up back in the hospital 4 to 10 hours after because they could not pee.  Had to have a catheter put in.  If the doctor does it after the procedure you are still out and you don't feel it.  It save time and money  Ken   Good luck 

good point Kenneth. Luckily my Urologist prefers to use a catheter and an overnight hospital stay, to be on the safe side. I wouldn't fancy rushing to A and E soon after I got home from Urolift,  and had the thing inserted while I was awake :-(

That is good.  Like I said not a fan but it was the best thing at the time.  Just drink a lot of water to clear the blood.  Had mine done at 9AM was home by 11:30AM  At the end of the day the urine in the bag was almost clear.  Also a good thing to do it Stop and get a few male pads.  The day I had my catheter out.  I never had one but I was ready for it.  I was suppose to go home and rest after but I went and met some friends.  It only took me 15 minutes to get there but I felt I had to pee and getting out of the car I could not hold it.  I peed it seemed like 5 minutes and it felt great.  The pad held it all.  That was the only time that happen.  I just didn't what to pee my pants.  It's better to be prepared  Ken

Thanks for the info. It's reassuring to find people with good results.

Neal

Thanks for your input too.

Let us know how your appointment and procedure go.

Neal

A few completely amateur thoughts on suitability for Urolift : I am 49, my prostate size is only 22cc, but it's grown inwards (so, BPH even tho' not large) giving poor flow for years, and a need to pee 2 or 3 times per night.  All quite bearable and once voided, bladder felt empty.  From April, something changed overnight - prostatitis ? - and I felt a need to pee all the time, bladder didn't feel empty after, and I was only peeing a few drops; no longer possible to ignore.  I would say prostatitis (even tho' no temperature or UTI), and if I was my private uro', I'd have given me antibiotics as first line, but he didn't.  He did offer alpha blockers, but as both parents have had cataracts so I may do one day, I declined (google "floppy iris syndrome").  He suggested urolift or holep - he does both - but on asking a few questions about urolift, I had uncertainties.  Cystoscopy indicated prostate pressing up on bladder, causing the irritation to it, and I don't see that urolift would help with that at all - might make it worse ?  Urolift impedes MRI scanning (16mm dead zone around the tabs), partly mucking up later attempts at cancer diagnosis (MRI first, used to guide a transperineal biopsy) if needed, and in my case that 22cc prostate may double by the time I'm 60 ; so the outer tabs might seem likely to grow in as the prostate expands, causing complications with a holep (see post above).  He couldn't give a good answer on that, noting that there is limited long term experience with urolifts and moved the topic on to holep, which I later had.  A question I didn't ask is, if you have a needle biopsy, mightn't the needles cut through a urolift thread, leaving outer tabs if not ingrown, held on insecurely - might they work loose during exercise and change position outside of the prostate, the ends poking you in bladder/prostate ?  Same if have to remove inner tabs prior to HOLEP/PVP/TURP - outer tabs only held on then by static friction of thread inside prostate ?  He perhaps pushed urolift a little at first as he may have expected me to fear RE, being 49 - but unlike some, I didn't.

Hi Ron, I'm Almost 87 years old.with urine retention.Are Their any doctors in Chicago the do the Holep procedure? Was their a lot of isde effects. I "m afraid to have the Turp they want to do on me. Thanks for the info??

Hi Paul,I don't understand what this size means? I My prostate is about 4 cm long with obstructing lateral lobes.Do you know the size in grams? My urologist is so hard to communicate with.

Hi Ron, Thanks for that info on Holep. Ron were you in complete urine retention? No Natural voids?

Thanks for the info.

frank,

I met all of the criteria and it has been a compete flop.  Forget getting anyone from Urolift to even enter a discussion.  Please take note that they have testimonials but do not have a place for testimonials to be given.  Sounds like the ones they have are paid for.  It is so hard for me to believe that Medicare would foot the bill that they did.  I would say the total cost to Medicare was near 50K.  They wonder why Medicare is in trouble.

Sorry you had a bad experience. It is clear from the posts on this forum that everyone's experience varies based on their doctor, their bodies and their condition. I am at 2 and a half years since having had the urolift procedure. I had 5 fasteners put in. No catheter afterward, drove myself home and started working "gently" from home the next day. It was almost immediate relief and the improvement has remained since then. I do wonder, since the prostate continues to grow, how long I will experience the benefit, but am glad I had it done. And the Urolift folks were in the room during the procedure. Good luck. Bob

Interesting post, care to elaborate?

Hello  I don't know why Releroy had a bad outcome.  Did they make sure that the prostate was the problem not the bladder.  I had mine done 3 1/2 years ago.  I was good to go in 2 weeks.  I am still wide open.  I am sorry that he had a problem.  Maybe they did not put in enough clips.  I had 4  Have a great day  Ken

Feel your pain. I had the procedure in March. Text book perfect procedure. 100% totally failure and now worse off, have to double my Tamsulosin that I went in for. Going back for a scope next month, see what went wrong. Also going to change MD, had to go to ER for catherter, despite being assured I wouldn’t need one. Took weeks to get back to comfortable then no change. Total BS in my experience.

Mac  So sorry that it did not work for you.  Let's hope the Scope find out what was the problem.  Good luck  Ken

Kenneth brings up a good point about bladder issues.  I am now thinking that pressure-flow studies should be done more often to ascertain how much is a bladder issue versus obstruction.  An overriding bladder issue can make a procedure a failure.  

Henry made a post on a different blog that Dr. Bagla was seeing patients that had failed Urolift.  I will try to get more information on this, what is happening here.  

I will post this for anyone that is interested.  Dr. Bagla found a number of patients who underwent Urolift and had MRI afterwards to be running into an issue. The metal from the Urolift is interfering with the imaging and creating an artifact that could potentially interfere with diagnosis or staging of prostate cancer. He is putting together a manuscript on this. Anyone interested who has had an MRI, he can include their imaging in his review.  Cam

Yep I was told you can flush your medications and not get up one time at night. So BS is the way to describe Urolift.

Sure I would like more info. I am going in to see Dr. Sept 4 for a 6 month appraisal of the matter.

Thanks Cam.  If your prostate is the problem The Urolift is a good procedure Because it makes the tunnel like the other procedures.  But if you have a underline bladder issue It will not fix that problem Just like any other procedure will not do it either.  Ken  

I also had a really bad experience with the meds.......retrograde ejaculation as well as other bad stuff. I came really close to doing the urolift but the I was still tramatized by the meds (which I stopped taking after 3 days). My primary care Dr. suggested Cialis 5 mg and I decided to give that a try before doing urolift. The Cialis (plus I do herbal supplements) has worked wonders and I don't have to worry about any adverse actions regarding my sex life (in fact, it is the opposite). I'm going to stay with the Cialis.....I've gone from waking up every other hour to go to bathroom down to 1-2 times throughout the night. If you haven't tried Cialis, that might be another option.