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TUIBN/TUIP - Holmium Laser vs. Electric Current (success and likelihood of RE)

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Dave56806
Dave56806

Hi everyone, I was hoping to learn from your experience before undergoing another procedure...

I'm 46, no kids (yet) but wants them one day, diagnosed with BPH (60cc prostate) as well as elevated & obstructed bladder neck (PBNO).

I've been dealing with a weak stream for years now and basically with every LUTS symptom possible.

I've reached a point in life where I need to solve this problem once and for all, before it gets much worse.

I had TUIP done in 2020 (using Holmium Laser), but it didn't solve my problem. Then, 5 months later, I had Rezum done (same Uro), but that didn't solve my problem either. I'm peeing slightly better, but definitely not something to be proud of. Also, I have minor RE today - I believe my previous Uro was more "careful" when he did the TUIP and Rezum because he knew I was very concerned about retrograde ejaculation given my age and family plans.

My current Uro recommends doing another TUIBN/TUIP, probably a much "deeper" procedure this time around, and said my chances for RE are 70%. He said RE is actually a "desired" outcome because it means your bladder neck is open which lets you pee more freely. This Uro is not using Laser, but he's a real expert using electric current resectoscope and a very well known surgeon here.

I'm really concerned about RE and not sure what to do... Based on your experience:

  1. Is it even possible to do a deep incision of the bladder neck/prostate without suffering from RE afterwards? Does it solely depend on the surgeon's expertise/technique?
  2. Is Holmuim Laser more recommended than electric current resectoscope when it comes to successful results AND lower chances of RE?

I appreciate your help and anything you can share with me on this topic.

Thanks!

1 like, 1 reply

1 Reply

  • carl29026
    carl29026 Dave56806

    Posted

    @Dave56806 I have been studying HoLep for some time and conclude that all therapies of prostate with BPH aim to reduce prostatic volume. Are Bladder neck and ejaculatory ducts at risk? I imagine it depends on how skilled and experienced the surgeon is. The Holep laser offers shorter operating time, lower costs, less catheterization, complete adenoma removal, immediate gratification, and permanent treatment. With Holep, is there a 'true' minimum volume of prostate with/ enlarged median lobe to be ablated for a 'successful' endpoint with regards to BPH?

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