Turp operation or laser ?or leave alone?

Sorry, I meant to address my reply to tampafd, not graham.

Bob

Thanks for your reply Bob

Hi Bob or anyone else, I am 58, a pilot, an flight instructor, so I sit in airplanes a lot. In the last year 3 times I have locked up and could not pee.  The retension was so bad all 3 times I had to go to the ER to get foley cathetered out. This last time (2 weeks ago) was really bad. I had to go to 2 different ER hospitals. The first one did not have a catheter that would work. The second one did, but they actully called in my Urologist Doc at 2:00 a.m.. He was not happy about getting called in the middle of the night, but he helped me out.  I had that catheter and leg bag for a week, it came out last week, then after 5 hours of not being able to pee, I had to go back to the Doc's office to get another catheter put in.  My Doc (Urologist) wants to do a button TURP to open up my prostrate. Do you are have any words or wisdom or advise on this. I am real hesitent about the surgery,but I do not want to keep locking up and having to get cathetered out.

Thanks, Jon 

Hi Jon. I was blocking up almost every night around 3AM or so and that is what decided me on getting the GL laser. I had sharp kidney pains, felt like I was bursting to go,  and only drinking a couple of ounces of Jack Daniels mixed with 4 or 5 ounces of plain seltzer and walking in circles around my kitchen for 10 minutes would get the flow started. Needless to say that was not a permanent solution.

The other deciding factor was my PVR was measured by sonogram as 400+ ml., so after I voided, 400ml was still left in my bladder. I knew this would permanently damage my bladder ofver time. So I had no choice. But a year or so prior to the GL I was in the ER to get catheterized. I had 1400 ml of urine and it was most excruciating driving to the ER in a snowstorm, running in and begging to be cathed. After that experience in the ER I learned to cath myself by looking at info online. I found the self lubricating single use caths called the coloplast speedi cath. I started with size 12FR but needed to go up to 14 FR which were more rigid. I was blocked so bad the 12FR would just double up inside me and not get past the prostate. The 14FR were rigid enough to gently push through without bending. Being able to self cath took away all the panic of needing to go to the ER. Most of the time the Jack Daniels worked but when it didn't the cath did, in the comfort of my own bathroom.

If I had it to do all over again, I'd proably opt for the button turp or holep procedure in preference to the Greenlight. After the Greenlight I needed a bladder resection and the removal of scar tissue, so it wasn't a one stop solution. But my prostate was over 120g. with a prominent median lobe that I still have.

Hi Jon,

Have you considered learning how to self catherize yourself?  It's a useful skill to have until you make a decision regarding an operation. No calling the doctor in the middle of the night. No going to the ER. With a little practice it just takes five minutes and your bladder is completely empty. I went on a self cath program in preparation for a button TURP and it it worked out so well that I decided to forgo the operation until something better comes along. That was almost two years ago and I'm still in no rush for an operation as the self cathing has worked out so well. Right now I cath  3 to 4 times a day and most of the time sleep right through the night without a bathroom visit. Prior to that I had to use the bathroom at least every two hours day and night. Another advantage of self cathing  is that it can actually help rehabilitate a flaccid bladder that you probably have because of your retention problem. That doesn't mean it will go back to normal but it could get better so if you ever decided to get an operation down the road you should be looking at a better result.

Jim

Hi Jon, welcome to the forum. Bob and Jim are giving you good advice about self-cathing. It's just part of the tool kit you need to manage BPH sanely. I learned how to self-cath on Bobs advice using the catheter he recommended 

Chances are that TURP will sove your problem for awhile, it usually does, it's just when it doesn't work that the real problems begin. You will have retrograde ejaculation with any of the surgical procedures except urolift but there are posters who have problems after urolift too and urolift is not a long-term solution probably. . 

Your age is a factor too. Your prostate will have several decades to regrow after being opened up. You'll see in my posts below, about my Holep procedure in October, that it really worked beyond imagination for me. I'm now almost 60 days post-op and I haven't had the first problem. 

As I have said many times, knowing what I know now, I would never take the first Med, usually Flomax, as it's just a slippery slope to the really destructive meds eventually.

One reason I recommend Holep is that it is done only in a dozen locations around the country, all of them the fineist medical schools in the country. The Doctors who perform the procedure have extensive training by a much more-experienced surgeon and have the very latest equipment funded by University Hospitals or as in my case the Mayo Clinics.

I read these post and others for five months and became convinced that it is really wise to seek that procedure that would most-likely have a good result as a bad result can have really dire consequences.  

There is a down-side to Holep that I have discovered; it is very expensive. I knew that medicare and a supplement policy would cover most of it but that I would be out of pocket for some of it also. I'm not sure all of the accounting is complete but it appears that the procedure costs about $19,000 and I'm looking at maybe $1600 out of pocket. I haven't tried to negotiate with the Mayo yet but I will when all is settled. There are two main advantages to Holep if we can use my experience as the rule. (1) There is actually no pain and very nearly no recovery required. My surgery was on a Friday and on Sunday my son and I drove 110 miles to an old mining town and walked the steep streets of that town all day without any problem. I'm in good shape but I am 76. My son gave me no slack and I kept up with him just fine. I could have flown an airplane that day, two days after surgery with no problem.

(2) The other major advantage, which could be even more advantageous at your age, is that the Holep surgeon uses a very precise laser, not anything like green light, and can approach the capsule of the prostate very closely and thus is able to remove a larger portion of the prostate tissue while avoiding over-heating. My surgeon advised me that another procedure caused by the prostate growing back or any other problem had a less that 1% liklihood.

Another problem with Holep may be that getting scheduled can take several months as all of the surgeons are booked up. I was really lucky to find one in thirty days. If you learn how to self-cath you'll gain time to make the best decision posible. There was one poster who ignored a pain that developed during self-cathing, an infection had occurred that caused him to lose a testicle. So, if it hurts don't ignor it, get to a doctor for anti-biotics.  

Best of luck to you as you begin your journey to a BPH solution, please keep us posted as many thousands of patients can benefit from your experience, especially younger ones as you are a decade or so younger than most guys in these forums.

Bty the way, don't expect your urologist to share my opinion of Holep. I have found that they guard their use of TURP or even Green Light jealously as these are the procedures that most of them use. I will bet you however if any of the three uros I consulted needed BPH surgery they would find a Holep surgeon without so much reservation.

MERRY CHRISTMAS to you all, or HAPPY HOLIDAYS, HAPPY HANAKKAH (SP?) whatever you prefer.  

(You too, CS!)

Ron 

        

     

Jon,

I didn't see Bob's post on self-cathing, but like Bob, I also found that Coloplast's Speedicath to be the best catheter after trying over a dozen different ones. Of course, what's most comfortable for me, may not be the best for you, but my advice would be to start with Speedicath. And assuming you have an enlarged prostate, you want the Speedicath with the Coude tip. The Coude tip makes it easier for the catheter to navigate around the prostate on its way to the bladder. This is very important.

As Bob suggested, the 14 Fr sized catheter is easier to use than the smaller 12Fr size. I would therefore start with the 14 and then after you get the hang of it, try the smaller 12 Fr. As Bob noted, the 12Fr can have a tendency to "double over" because it's more flexible, but I found that after I got my technique down, this problem went away. The advantage of the smaller size is less trauma although either size seems to slip pretty easily in because of its hydrophilic coating.

The Speedicath is a single-use catheter which may or may not be a factor depending on your insurance, etc. So, if for example, you're cathing four times a day, you would need 120 a month. Alternatively, there are many catheters out there without the hydrophilic coating that can be used multiple times. In fact, some people use a single catheter for a week or more which can really keep the cost down if out of pocket. But cost aside, I'd start with the Spedicath.

If you go this route, I'd be happy to share some technique related pointers that should make things easier. Unfortunately, the average urologist knows next to little about self-cathing and the best way to do it.

Meanwhile, I'll just mention a couple of things. First, I highly recommend you ask (insist really) your doctor for prophylactic antibiotics before your first self cath. Some people sail right through from the beginning, others (like myself) suffer for the first several weeks, and most fall somewhere inbetween. The prophylactic antibiotics will help prevent a UTI which often happens in the very beginning as your body adjusts to the catheter. The other thing is to expect some degree of discomfort for the first two weeks, but don't let that discourage you because after your body adjusts, self-cathing is no more traumatic than brushing your teeth.

Jim

Hi Ron, Can I ask where your Holep surgeon/Urologist is located?  I had not heard of or come across the Holep procedure until I saw your post. To be real honist I had never heard of any of the BPH, prostrate opening up, procedures until a little over 2 weeks ago. Just after my 3rd and then 4th lock up. My big retension lock ups have come at about 6 month intervals; #1 in November 2013, #2 in June 2014, then #3 December 8th. #4 was actually the same day the 3rd foley came out. 

(My 3rd foley catheter came out on Monday December 15th at 11:30 a.m. and by 3:00 p.m. I could not pee (again)! I went back at my Urologist office for the 4th one. It is still in with the bag hanging on my leg.  Needless to say I cannot fly right now and I am going to be grounded until something is done or I take a chance of having this foley taken out to see what happens.  My Urologist had given me several self catheters after my 2nd lock up back in June, but no training on the best way to use them. I thought since I had seen it done with the foley's, then I sould be able to do it myself. I even did a quick internet search and review before trying it myself. But all I did was bloody up the bathroom until I had my wife take me to the ER.) 

Maybe, I was not paying attention or did not want to, but now I need to know as much as possible to make the best decision on what to do.  I have really just begun studying the differences between GL lasor and Holmium Lasor and the Button TURP.  My Urologist seems to only do Button TURP's and seems to think it is the best direction to open up the prostrate. His practice seems to be one of the biggest and most successful in my area, so I haven't strayed from him yet.  He and his staff have been good at answering all my questions. He has also advised that I need to keep this foley catheter in until we do the Button to precent me from locking up again.   At this point I am scheduled for the Button TURP on Friday Jan 2nd. but this could change.

Thanks for your help. Merry Christmas!

Jon

 

Hi Jon, my Holep was done by Dr Humpreys at the Mayo Clinic in Phoenix.

There are three Mayos, plus the procedure is done at a few major University Hospitals as well. I know it is done in Minneapolis, Nashville, Boston, In Ohio, California, and others. I don't know how many but a couple of dozen at most. It is also done overseas in the UK countries and it actually originated in New Zealand. As I stated in my first reply, don't expect your Dr to speak well of Holep. As you stated he is a TURP guy as most Uros are. If he is a major practitioner you can bet that he evaluated Holep and decided that he did not want to do the intense and extensive training necessary nor did he want the expense of Holep equipment. It's a shame as I believe it's clear that Holep is easier on the patient while TURP and GL are easier on the surgeon.  

If you are lucky in a perverse sort of way and your prostate is too large for TURP you can only do a supra pubic simple prostatectomy or Holep. That's the choices that were given to me and I chose to stay away from a major incision below my navel, into my bladder and then core out the prostate thru the bladder neck. I told my uro No thanks and began the search for a Holep surgeon. Fortunately Holep can be done on a prostate of any size and configuration. I believe that I will be thankful for Dr Humphreys' and for the Mayo Clinic for the rest of my life.

My best to you and your family during the Holidays. Keep us posted on your progress.

Ron   

Ron, why do you post stuff like you said to jon55991? I know you mean well and you are trying to help people but in your quixotic quest to sell HoLep to all you are doing a disservice to some. When I go to jury duty I have to swear to tell the truth, the whole truth and nothing but the truth. You no doubt are doing two of those but in your post to john55991 you are not telling the whole truth and perhaps don't realize it. You told john55991 that 2 days after surgery, I quote: "I could have flown an airplane that day, two days after surgery with no problem." Why don't you tell john55991 the whole story, that you were incontinent for quite a while, that you had to fly home to Texas on Depends and change them several times during the trip, and that even a month later you still had some degree of incontinence (which I hope is all gone by now). When you leave out important information like that and say that you could have flown ok you are only telling part of the story and this is misleading to people like john55991 who are trying to make some important decisions.  Again I know you mean well but this is the sort of information I find objectionable in your posts.  HoLep is not the answer to all, it is only the answer for those with huge prostates (100+).  Those with smaller prostates like mine (aroung 70) will do far better with a Plasma Button Vaporization which is less risky than HoLep, can be done by many surgeons, and does not require one to fly hundreds of miles to the few places that do HoLep well.  And go ahead, start flaming away...

 

Cs, what stuff are you talking about? You are outright calling me a liar. I'll stick by what I said, there's no reason why I couldn't have flown an airplane wearing Depends as Jon said he has from time to time. If he can fly commercially wearing Depends I could certainly fly a Cessna as I did many years ago and it's no big deal, easier than driving a car except for the a mental part. Got to keep your wits about you as there aren't as many second chances.  But I was in no pain at all, not ever and there's no reason I couldn't have cranked up a 172 and flown until I had to change my Depends. Would you lighten up? There's nothing I have said about my experience that is not absolutely true. I know that I am revealing HOlep to many who never had heard of it as an alternative to other procedures. It was an unbelievable experience for me and I'm going to bring my experience to others, right here in these forums. Thank you very much.  

The very purpose of these forums is to relate real-life experiences of actual medical procedures, in an honest attempt to help others make wise, informed opinions. These forums have done that for me and I'm giving back with what i know is factual from my own experience.

Several posters have stated to both of us, to Bob and many others that they have learned a lot from what we write. We have an excellent forum going, a lot of people in the English-speaking world read our posts daily and are the better for it. But your vitriol is helping no one and is detrimental to my objective and what should be yours; to give back to the forums that have helped me personally so much.  

You will be much more useful here if you will realize that everyone who goes to a urologist will be told about TURP or greenlight. They will probably not be told about HOLEP, but they will learn it here as I did.

You need to realize that TURP is not the only surgical procedure and may not be the best one for surgery on a prostate of any size, not just large ones. There is the cost factor and the availabilty of a HOlep surgeon factor as well, though. 

With my input there are at least hundreds of BPH sufferers, probably  thousands, who will know about the HOlep procedure and consider it as an alternative to the "Gold Standard", TURP.  Isn't that the purpose of these forums?  Why can you not join me in an open forum describing actual experiences with the intent of helping BPH sufferers everywhere?

I am providing a valuable function with my description of my experience with Holep. I am always careful to note that someone else's experience may not be the same. It couldn't be better but it could be worse. But people are not stupid they know that everyone has different problems and their outcome could be different and probably will.

But I resent your stating that I am lying CS and your posts are becoming more and more strident. 

I have a suggestion, I think we both agree that the quality of the facility the surgeon uses, although you never say so, and the training and experience of the surgeon and his support staff are extremely important in these times when rampant hospital infections, incompetence, understaffing, surgical, medication and anesthesiology errors are an increasing cause of patient injury and death and that these factors are exceeding necessary to a good outcome regardless of the procedure chosen.   

I thoroughly believe that and will have no procedure done anywhere except in a large University hospital. Maybe others will pick up on that and question whether their medical facilities and personnel are the best available.We pay a ton for medical care and we deserve the best.

Enuff said.

Happy New Year, 

Ron

I didn't call you anything. The only person using the word "lier" is you. You did call me a bunch of names in an earlier post which the moderator removed after seeing your offensive words.

You also need to learn that I did not have a TURP, I had a PBVP which is often called a Button TURP but is nothing like a TURP. Two very different procedures!!!!

Happy New Year to you too!!!   

Hi Jim,

I am interested in your " technique related pointers that should make things easier "  to self cath if you would not mind sharing them with me.

Thank you,

Larry

 

Hi Ron,

Having been through a TUMT, a GL, a cold wire removal of prostatic urethral membrane growth, self cathing and surgery to resection the bladder neck and remove bladder stones I have a bit of a different perspective. I took flomax for several months at a time on three different ocasions. If it would have kept my symptoms in check I would have continued to take it for life despite muscle weakness and nasal congestion. But it always stopped working after a few months leading me from one procedure to the next. Maybe I didn't take it long enough, but I never noticed any sexual side effects. If there had been I would have lived with them. I don't know if they actually can castrate a man, maybe lessen the ability to have and maintain an erection without a cialis or other pill, but that's not necessarily the end of a sex life.

I thought I was giving myself the best shot by getting a highly respected surgeon with hundreds of GL's to his credit, but there was only so much he could do with me. My body had issues with the bladder neck, bladder, scar tissue and bladder stones. None of these issues could be resolved with any procedure. And there's millions of women with the same issues of frequency, inability to urinate, urgency, pain, etc., and they have no prostate. I think that the reality is that our state of mediecine just has partial answers that work for many people but you never know if you will be one of the people for whom they don't do the whole job.

Bob

Ron,

I meant to say , none of my issues aside from the enlarged prostate could have been resolved with any single prostate procedure, turp, holep, or even a radical prostectomy. ANd reducing the size of the prostate was just a partial solution to part of the problem. My uro just had to address each issue as it came up.

Bob

Bob, I do believe that of all the dozens of respondents in this forum you have had the largest variety of issues. I believe that I expressed my sympathy before but let me do so again. You know we get engrossed in our own infirmaties, (not to be minimalized) but we fail to recognize that others have far worse difficulty.  Like the guys with PC, for example, as bad as our BPH may be it isn't life-threatening. I don't know, you might prefer cancer to all of the issues you have had.  When a guy with cancer comes into the BPH forums I just clam up, I don't know how to deal with that in another person.  

 

Ron, You misjudge me. I'm not complaining in the least. I know my issues are trivial compared to life threatening cancers, etc. And I'm much better off than I was, and hope to be so for some time to come. I'm just trying to introduce a little reality in what seems to be an overly optimistic view of finding the right procedure, the right doctor etc. The fact is all the procedures and medications can fail or succeed to a greater or lesser extent. I truly believe our own bodies are the most important factor, for better or worse.

Bob

I didn't mean at all that you are complaining.  Your experience and that of many others I have read has made me very cautious about my first procedure coming up pretty soon. As you know I have researched solutions to my problem almost every day for about six months and I don't believe that there is much more info out there that i haven't read.  A typical example is a web page by a urologist nearby listing  all of the options available. Among others he lists Turp, Tump, Tuit, Tuvp, GL, simple prostatectomy, and yes Holep. Then he chooses his procedure, Turp,  as the "Gold Standard", naturally. But nowhere in his web page is there another word about Holep. They avoid it like the plague. I believe that Holep is actually the Gold Standard but only in the hands of a very experienced surgeon. At any rate I will have it done this year and I am going to drive a thousand miles there, and a week or so later a thousand miles back home. I anticipate no more difficulty or medication for ten years at least.  We'll see, and I will report the full experience here. . .    

Hi Ron, I wish you the best of luck. I am pretty sure I am an anomoly anyway. My wife says if there's a side effect or an adverse reaction I will get it.

Bob

I'm fairly certain that i have posted my Holep results to about everyone in the BPH universe but in case I haven't let me reiterate here.

I decided on the Mayo Clinic in Phoenix and Dr Humphreys as my ability to control my urine had degraded to the embarrassment stage. (I didn't know about depends real fi)  and I felt that I coudn't wait any longer. He  offered to do all the pre-op procedures and the surgery in one visit over three days, release from the hospital the next, stay in a hotel for two days and then go home. As I was afraid of what might happen on the plane I wore depends real fit as underwear and I made it just fine, changing at the airport in Phoenix.  I flew out of Austin on 10-28-14, 

I checked into the Clinic the next day and over two days saw the surgeon, another surgeon, two anesthesists and was extremely impressed with the whole Mayo routine. The Dr did all of the cystoscoping, ultrasound, etc himself which impressed me and announced that Saturday Morning you'll be peeing like a 17 year old. That would be 11-1-14. 

So, Friday am 10-31 the surgery was done with general anesthesia and when I woke up a nurse was there, asking abou the level of pain on a scale on 1 to 10 and I replied maybe 1 or 2, not much. So she gave me no pain medication and I have not needed any to-date which is now 19 days. There was a bit of blood when the catheter was taken out and then pink urine for the next 7 days. My flow was a bit weak for a few days but got stronger each day. As my third lobe was protruding into the bladder the neck was really stretched out and I was totally incontinent initially. That's gotten better and now I keep a pad in my underwear but it's usually dry when I change it once, maybe twice per day.

The overall experience with the Mayo, and the Holep procedure as performed by Dr Humphreys and his extensive staff was far beyond expectation although with all my research I knew that I had every reason to expect a good result. As I have stated, I've had sprained ankles that were far more painful and troublesome than this Holep surgery.

My son came to check me out and we stayed at the hotel that day then drove about a hundred miles up to Jerome on Sunday and investigated that old mining town for the whole day. Jerome is built on a steep mountainside and everything is managed on foot. I located a bathroom upon arrival and every two hours had to return to change my Depends. I'm used to strenuous walking so I made the day as easily as my son who is very athletic.  

On 11-1 we flew out ofo Phoenix to Houston (change depends) then to Austin (change again) then my son drove me home about 60 miles.

i was able to do anything I wanted from that day forward. Now I need to find a bathroom every 3-4 hours around the clock, once at night and I get normal urges about thirty minutes beforehand which I have not experienced for thirty years or so.

As and aside, let me say this; if I had swallowed my ego and just worn the dang Depends during family jeeping trips, office meetings, road trips, flights, ball games, etc no one would have ever had to know that I had a pee problem. But as I had refused to even consider wearing a "diaper" everyone knew and I'm sure giggled behind my back. I can't have a do-over but that's one thing I would do differently, for sure. There are many of you out there who might profit from all of my experience!  Does my experience sound familiar?

So, I'm here to tell you that TURP is no longer the "gold standard" for BPH surgery. HOlep is clearly a much less-invasive solution if done by an experienced surgeon, and there is the not-to-be-minimalized fact that Holep is a one-time routine. Dr Humphreys advised me that less than 1% of his patients have to have another procedure later.

I am now 19 days post-op my continence improves a bit daily even though I have done no Kegel excercises at all, not once, my sex life is better than before the surgery, and at 76 with the damn meds for years doing a number on me, I consider that to be a miracle.  

My best to all of you, I hope this account of my experience is helpful.

Ron 

 

Hi Ron,

Very happy things worked out so well with the holep procedure. I think many people who need a procedure will look into the holep instead of the greenlight or other lasers based on your report.Since you reported your sex life is better than ever, are you experiencing retro, and if so, does it effect your sex life at all? I know some people have an issue with it, and others say it doesn't matter.

Bob

I guess that I never answered this post. Sorry. Actually I have had RE caused by the meds for years so it's nothing new with Holep. I just accepted RE as inevitable and learned to live with it. You'll accept a lot of things in order to have some sort of acceptable daily routine.

My sex life improved somewhat immediately after Holep but it has hit the wall and is just ok now. I guess I'll have to accept the fact that I'm getting old. 

. Your willingness to share your experience helped me in several ways and I'm grateful to you for that.

My best to you and your family during the holidays.

Ron 

Hi Ron,  Thank you for your writting your story.  I too have been down the depends route. As a pilot and flight instructor I just cannot just pull over on the side of the road or find a restroom when I need to go. So the depends in the cockpit has worked for me, but I have not liked it.  I knew I was going to need to get something done soon when this last summer I was sometimes looking for the restroom ever 30 to 45 minutes or so. Then with this last lock up and foley I must get something going soon. I am in the Memphis, TN area and Nashville would be closet for me, and I will check out the Urologist in that area that do the Holep.  I have a meeting with my Doc/Urologist on 12/31/14 and he has already been good about answering my questions.  I hope to be more knowlegable about the Helep and PlasmaButton Vaporization before I get to his office. The last time I talked to him on the phone he did talk about some research being done other places. So, he maybe he will be reseptive with me asking about the Holep vis the PlasmaButton Vaporization since that he seems to be what he doing a lot of and the way he is leading me. I am going to keep an eye on this forum for anyone that has had a PlasmaButton Vaporization done and what their outcomes have been.

Jon 

The Dr in Nashville, at Vanderbilt University medical School is a Lady Uro, last name Miller. Most of the Doctors, maybe all of them in the US,  doing the Holep procedure including Dr Miller, and my Doc, Dr Humphreys were trained by Dr Lingeman at Indiana University Med school. He brought the procedure to the US 15 years ago or so and has done over 3000 of these procedures personally.

We dont see much discussion of the PlasmaButton Vaporization in these forums but it seems i recall that my long-term local uro used that procedure before converting to TURP a few years ago.  I do know that Green light Laser seems to have the most failures and I would avoid it completely.  

As I mentioned since your Doc is a TURP practicioner he will probably have nothing good to say about Holep or any other type. There is a new procedure developed in Israel called DAT something or other that is gaining some followers. I think you have to go to Israel for the procedure.

Let us know what you decide and again, best wishes to you.

Ron 

  

My understanding is that button turp is a newer version of the classical turp procedure with certain benefits.  The Israeli procedure you're talking about is called Gat Goren and has some similarities to PVP (prostate laser ablation) which is offered here in the states

(continuation of last post to Jon/Ron)

Holep is advantageous for very large prostates that are candidates for open prostatectomy. If your prostate Is operable by Turp you should expect equal results with either Holep or Turp. The advantage for Holep appears to be faster recovery.  The disadvantage is that fewer places offer it and it is more operator dependent on results. If you decide to go Holep make sure the person doing the actual operation has tons of experience in Holep. Not sure that the advantages of Holep would be enough to sway me over Turp if I had a good local doctor unless my prostate was too big for a succesful Turp. Gat goren , PVP and Urollift have the advantage of fewer side effects and no retrograde ejaculation. These procedures are newer however with less of a track record. 

Correction to my last two posts:

I meant to say "Prostate artery embolization (PAE)" in both of the posts, not "PVP". Too many initials, too little time

If you want to read about Plasma Button just see my many posts about it on this site. Had it in August and it is simply superb. My IPSS score went from 21 to 5.  Just click on my moniker CS123 and you can read all my posts. Good luck. 

I could not find much on the older post about your Plasma Button, but I am glad to here you had a good experence with it.  I did look up the IPSS score information and I would hit around 18.   Thanks, Jon

Hi CS;  I hope you and your family had a Very Merrry Christmas.  Can you tell me one more time how long after your surgery did you have to self cath???    Thank You and I do appreciate your help.

ChuckP, I never had to self cath. I came out of surgery with a cath in place which was removed the next morning in the hospital - end of story. No cath again, no incontinence ever, no problems other than minor pain/discomfort for 1-2 weeks and was told to take it easy for 6 weeks which I did.  My Plasma Button (PBVP) was a piece of cake and totally successful.  If your prostate is not huge (under 100g) get a Plasma, if your prostate is indeed huge then consider a HoLep.  HoLep is far riskier than than Button and should only be tried on those with huge prostates whose only alternative is open prostatectomy.

John, on your reply to me above just click on my moniker CS123.  When you do a new web page will open up and at the bottom of that page you will see a listing of my "replies", newest first.  If you then click on "see all replies" you will see all of mine. Just read them one by one and in there if you take a little time you will see my complete story regarding my Plasma Button Vaporization of the Prostate, the formal name for the so called Button TURP which is nothing like a conventional TURP at all.

CS123,  Thank you for this.  I am feeling better about the Button Plasma Vaporization procedure after reading what you just posted. My Doc/Urologist has said, I am to be in his office about 11:00 a.m. and go home later that afternoon and not stay in the hospital overnight. I have had my foley cath in for the last 12 days and I am not scheduled to get it out for another week. My Doc/Urologist has said, it should come out just before my ButtonPlasma procedure, so that I do not run the risk of another lock up insedent.  I am really ready to get this thing out and the bag off of my leg.  I am still concerned about having the procedure done, but if it will stop the retension/lock-ups and allow me to not have to make "pee" runs to the restroom every 30-45 minutes, then I think ready to do it, even if it means about 6 to 9 weeks of recovery time.  Something I  have not been able to find on the net yet is how does the Doc/Urologist measure the prostrate size?  If someone could answer this quetion, I would appreciate it.  Thanks, Jon

CS123, Great. Thanks. Jon

John, the Uro measures your prostate with an untrasound probe inserted through the rectum, no big deal, or he can estimate it (just an estimate) by doing a rectal digital exam.  The recovery time for a Plasma Button in no big deal also.  Don't know how many surgeries you have had in your life but compared to others I have had this one was a piece of cake as I keep saying.

The ultrasound to measure the prostate size  can also be done below the belly just above the the pubic hair area. The normal formula is height x width x length x 1/2. It's just an estimate though because the prostate may not be a uniform oval shape. If you have enlarged lobes it may look more irregular than spherical. It can also be measured with an mri or cat scan.

All very true. The belly route as you say is an estimate but it is inexpensive. An MRIs and Cat Scans are more involved and costly but more reliable. I have had both (not on my prostate). My last MRI (of a shoulder) was close to $1,000.

Should have mentioned also...  For insurance purposes a Plasma Button is classified as day surgery for most insurers since they tend to follow Medicare which classifies it as such. The Uro then has the option to keep you overnight in the hospital if he deems appropriate and Medicare or others will cover if the Uro thinks it is prudent (excuses can be bleeding or many others for instance). I recommend that if you are given the option that you spend one night. Hospitals are never fun but if you go home the same day there is a possibility (just tha,t a possibility) that swelling due to trauma will shut you up later in the day and you will have to return asap to be cathed again. I was a so-called day patient, kept overnight, cath came out the next morning, able to urinate ok (three times as one time is not enough to test) and then discharged early afternoon with no problems whatsoever other than some discomfort.  Given Norco 20 pills (4 times a day for 5 days) to take at home if needed, took Norco 2 evenings only to sleep better but really needed as pain/discomfort was minimal. Some burning during urination (which is normal for all procedures as the lining is obviously removed) and the burning lasted about 2 weeks at which time a new lining is formed sufficiently. You can take pyridium for the burning if you are uncomfortable (can get over the counter or with Rx).

Don't sweat it, I did more than I needed to as most of us tend to do. I am 68 and if I have to have this done again in 10-15 years (typical life of a good successful procedure including HoLep no matter what others say) I will not sweat it then. The life of a procedure is simply dependent on two things, how much of the prostate is actually removed (with 80-90% being a good successful procedure) as what stays behind will continue to grow.  Secondly genetics, some will grow faster than others depending on your genes and DNA. For those that are old eonugh 75+ a second procedure may never be needed for reasons that are obvious, their life expectancy on average is less than 90.

In my post above, first paragraph, I wrote "but really needed as pain/discomfort was minimal".  Should have said "but really not needed as pain/discomfort was minimal". Sorry.

CS,  This is good information. I have a meeting with my Doc/Uro a few days before the scheduled Button procedure and I just need to be able to get answers to as many of my questions as possible.  It looks like to me the ButtonPlasma Vaporization and the Holmium laser enucleation of the prostate (HoLEP) are the 2 gold standards available. My Doc/Uro seems to be leaning on the Button and I want his stand on the HoLEP also. I know he lectures around the country on prostrate issues and he maybe knowledgeable about the HoLEP procedure also.  From what I have found the HoLEP maybe less painfull than the Button and may heal faster, but is generally better for larger prostrates, and I don't know the size of mine. From what I have found, both procedures seem to have about the same outcomes.  I am 58 and would like for it to last as long as possible.  As for as, the need to have it done again in 10 - 15 years, the one thing my Doc/Uro did say when I tallked to him on the phone was, it is just a "maybe" if you will need to do it agian.  I am going to ask that question again.  I hear what you are saying about the overnight stay in the hospital, I was in the hospital from Sept 22, 2011 - Nov. 28, 2011 with a pancretic problem and pancretic surgery.  I do not and did not have cancer!  So an overnight stay in the hospital for this would be like a walk in the park for me. But,  after going to the ER 3 times now to get cath'ed out, and with the possibility of a complication after the procedure, I think I am going to opt for the overnight hospital stay.  Thanks,  Jon

CS;  Thank You for your reply.  If I do anything it will be what you had done the "Button Turp".   Thank You again.  I appreciate you very much.

John, where are you getting your information about HoLep? If it is from a poster here I caution you to take everything with a grain of salt. HoLep needs to be done by a very experienced Uro who is specifically trained on HoLep and there are only a few places in the US where you can get it done well. I live in Houston and there are none here. My Uro will begin training on it in January and will need 30+ surgeries to know what he is doing. He will only do HoLep on very large prostates where open surgery is the only option. Button hardly hurts at all, I was expecting far more pain. Button which is likely all you can get unless you are willing to drive/fly to Indianapolis or one of the few Mayo Clinics that does it, heals very fast, a week or so and I was doing reasonably well. I don't care what anyone tells you, if they remove most of your prostate you will have some discomfort and you will need some time to recuperate. Any prostate removing surgery is surgery and requires healing time, for instance the lining of your urethra will have to grow again. Regarding doing it again in 10-15 years that is all current science has to offer, you have little choice. A poster here states that his HoLep removed 85% of his prostate and that his Uro told him that he has a 1% chance of needing it again. That is because he is 76 and at his age his life expectancy is not what yours is. My Button removed 80-90% according to my Uro, about the same as HoLep and about as good as a conventional TURP. A regular TURP has far more risk of complications and takes far longer to recuperate. At your age it is very unlikely that any procedure will last you 30 years. It is possible but not likely - my father had a regular TURP in his 70s with no complications other than some incontinence for about a month. He died this year at age 98 and did not need anything else again (he was on Finasteride at the end). So his lasted 20 years, it is a matter of how much is left behind (hard to remove more than 80 to 90% unless you have a radical open surgery) and also genetics (you may be lucky or maybe not) but needing another Button for me 15 years from now would be ok, after the first one I see it as not a big a deal.

Your are very welcome or as the young guys say these days, no problem....

 

Cs, I see you are still disputing my posts. I resent your saying that my posts "must be taken with a grain of salt" as I have never stated anything regarding my HOLEP procedure that was not exactly true.

   

I'm sure that not all Holep surgeries may be as successful as mine has been. I was an ideal candidate due to my excellent vital signs and physical condition despite my age. Patients with complicating conditions  may have a different outcome. But no one could have been more surprised than I that I had no pain, a bit of discomfort was all. How that is possible with a very large raw area with salty urine flowing through it is amazing to me, but that's how it was. I had pink urine for seven days and none since. As far as "healing time" is concerned, all I have seen is that my flow after the surgery was not as strong as a week later and any mild discomfort ended at about the same time. I never took any pain pills, not even over the counter types. I had some incontinence due to the third lobe stretching out the bladder neck but that's been over for awhile. As of about eight days after surgery I was otherwise completely normal. As of now, I sleep through the night,  I can knock the bark off a tree and have no remaining issues of any kind.   

When Dr Humphrey stated that there has been only 1% of Holep patients who have required another procedure, I assume he was referring to the hundreds of Holeps he has performed. I doubt he would know the results of all other procedures worldwide. He was not talking about me and the liklihood that I will die of old age before I need another procedure. That was really uncalled-for, CS, I will probably out-live you, given my health, life-style and family history. 

I know that there are many times more Button TURPS performed than Holep and that no doubt this contributes to the many posts in these threads about unsuccessful TURP procedures. But it is simple facts that manyTURPS are performed by surgeons in other than large regional University hospitals and that the training curve for TURP is far less than that for the HOLEP procedure. You have stated as much.

I am willing to admit that a TURP procedure performed in a state of the art facility by a very experienced surgeon, as yours was, will likely have  successful results. And I am willing to bet that most of the posters referring to their unsuccessful TURPS were not performed under optimal conditions as HOLEP always is performed, just because of the difficult nature of the HOLEP procedure. Also, many of the posters referring to their unsuccesful TURPS have complications that I didn't have. 

I base a lot of how strongly I feel about where and by whom any surgery is performed by the statistics concerning the number of injury and deaths by infection, erroneous procedures, improper anesthesia and medication that occurs far too often in our country. I have recounted before a statement somewhere in these forums by a healthcare professional, an MD I think,  that he would never have any surgery of any kind in any other than one of the large regional University Hospitals by a surgeon on the staff. It's simply a matter of combining funding, training, experience and accountability for setting the stage for a successful outcome.  

There are definite drawbacks to the HOLEP procedure; you will probably have to travel to find a surgeon as the procedure is done in only a dozen or so locations in the US, every one of them the finist facilities in their area, It's also expensive, my procedure at the MAYO cost in excess of $19,000 plus the cost of travel and hotel. I still don't know for sure how much Medicare and my supplement will cover but I think I will pay $1000+ out of pocket, plus close to twice that for travel, etc. That was a great investment in proper health for the rest of my life, in my opinion.  As of now, I'm 76 and I have not one single health issue, I am truly blessed, I know.

There are good reasons why the Mayos are top-rated in the US. I have never been so  coddled and pampered in my life and have never been surrounded by so many bright  young faces among the staff of interns, surgeons, anesthesiologists and nurses. Competence and professionalism is just standard procedure. My son and l came away in awe. Even the cafeteria is gourmet and we ate nowhere else

I wish I had known a year ago what I know now.  A friend of mine from high school died this year due to complications after a TURP procedure. He was not a good candidate, 76 years old, like me, overweight and out of shape, with advanced diabetes, was in a wheelchair at our last reunion, etc. The procedure was not performed in a University Hospital. Probably his surgeon was adequately experienced but I don't know for sure.

I can't help wondering what would have happened if i could have convinced him to go to the Mayo for HOLEP. I'll never know but I know this; our lives are driven by the information we have available for decision-making in any endeavor.  Prior to the internet you just nodded at your Doctor's infallibility and did as he said. That's no longer necessary or advisable,  there is no source anywhere for the real-world experience that is found in these forums and others.  I benefited greatly by reading these posts. I was led to HOLEP in these forums and I regard it as one of the best decisions of my life. We have a responsibility to recount accurately the whole story as it occurs to us and I have done that to the letter.  I wish I had known enough to take my friend to the Mayo, I'm always going to regret that I didn't know what I know now, Maybe he would still be with us.       

I stand ready for you rebuttal CS, but I would rather declare a truce. We both have a lot to add to these forums. And Happy New Year.

Ron. 

Jon, at your age I doubt that your prostate is as large as mine was. My long-term urologist would not do TURP on mine as it was 114 mg in size with a third lobe. He recommended a supra-pubic simple prostatectomy by a colleage. Through a large incision below the navel, into the bladder and then through the bladder neck to clean out the prostate. That's why I looked for an alternative and found HOLEP. It would be interesting to know what your Doc says about HOLep, I'll bet it will be like what another urologist said when I told him I was headed to the Mayo for HOLEP. He said, oh that's an old laser technique that we don't do anywhere in this area. We do the state-of-the-art-here. My long-term urologist knew nothing about HOLep, when I told him no one does it in Texas he said, well doesn't that tell you something? I replied yes, the procedure is difficult, takes longer to perform, expensive, requiring extensive experience and is done only in regional university hospitals. His only reply was that TURP is not easy either.

If your Doc doesn't dp HOLep then he certainly will have nothing good to say about it. I have found that Docs in other fields guard their accepted practices very jealously, recently experiencing an unbelievable reaction in nuerology. The truth is that most Doctors, like all of us, get set in their ways, accustomed to doing things in certain way. Insurance coverage and liability lawyers enter into every decision as well. That's just the human condition, we all do that. 

Another poster said that Holep is far riskier than other procedures but I have fouind no evidence of worse outcomes, They call that "morbidity". I have no doubt that morbidity following Holep would be worse than for  some other procedures as it is more difficult, takes longer to perform, if not for the super-experienced and motivated surgeons, the more-precise instruments and the support staff found in the major Hospitals.

These factors mitigate the risk and make Holep a very succesful procedure.

All of that being said it also costs more and not everyone is willing to travel around the country, especially getting back after surgery. I was very concerned about that but I could have driven back to Texas two dfays later. It was really that easy. Maybe not advisable, though, probably.

I cannot get away from my belief that the most important factor is where the procedure is performed more than anything else. Only the best surgeons with the

best equipment and the best support staff are going to be on the staff of a major University hospital.  That would be the over-riding consideration to me whether I was doing minor surgery or major, such as what you are facing.

At any rate, best wishes, the chances are good that you'll be a new man soon. Good luck!!

Ron   

Ron; What is considered the "average size" of a normal prostate???

Hi Ron,

I appreciate your and JimJames contributions to the forum. But I think it is appropriate to comment that each of you is a sample of just one. From what I've read on various forums, the holep and the button turp appear to be the best procedures for reducing the prostate size and eliminating retention of urine. I've read the results of a couple of posters who had holeps, one in the UK and one in Australia, and both had 5 or 6 weeks of pain, bleeding and discomfort following the procedure, not too different than my Greenlight experience. I've also read glowing reports, like yours, of patients who have had standard turps and greenlight lasers.  In all honesty, there's really no way to know how one will react to any of these procedures, or to anaesthetic.

In my case, it took a greenlight, the removal of scar tissue, the removal of bladder stones and a resection of the bladder neck to get satisfactory results the past year. And 3-1/2 months ago I started having all night episodes of nocturia twice a week. Thank God these episodes stopped two weeks ago, as mysteriously as they started.

In regard to prostate size, mine was more than 120G with a very prominent median lobe protruding into the bladder. My uro used up two Greenlight XPS 180 watt tips and removed 70g.and left the median lobe mostly in tact. For some reason this hasn't caused me a problem, even though that lobe takes up about 1/4 of my bladder.  I guess what I am trying to convey, based on my own research and personal experiences this past 4 years, is that the best procedure is the one that works for you. There's no guarantees and everyone is different. 

Well, of course you are right, but I will say this, I have read nothing about any instance of any procedure that was as painless and trouble-free as my Holep procedure was. That has to stand for something as my prostate was 114 mg, protruding into the bladder with a third lobe and I am 76 years old. I was told by a TURP uro that I considered that he would have to remove the middle lobe as it would just drop down and stop up the urethra that was opened by TURP on the other two. He no doubt had a reason for leaving it. Maybe because he knows that if he removes that lobe you will have a gaping bladder neck and will be incontinent until you can get the  bladder sphincter tightened up. I was incontinent for awhile after my Holep but I'm good now after doing the kegel exercises and just letting healing occur. That lobe is taking the place of a sphincter valve for now but that thing will continue to grow. I have a bad feeling about leaving it to get larger while protruding into the bladder. A quarter of your bladder would be 150 mg or so?

  

As I have said numerous times lately, I have come to the belief that the facility and the surgeon and his support staff are as important or moreso than the type of surgery, at least between TURP and Holep. In your case, you have had so much difficulty that i would get a second or third opinion from renowned surgeons on the staff of one of the regional University Hospitals or one of the Mayo or Johns Hopkins Clinics.  I think you need to start from scratch with the best University Hospital in your region. Your problems are just beyond the pale.

I haven't seen the posts you mention about Holep mortality examples. I'll look them up.

As always, my sympathy and best wishes.

Ron  

Well, I think that a normal prostate is around 40mg-50mg or so, a large one is 75-90 mg, and anything over a 100 or so is getting really large even though I have heard of a HOlep surgeon operating on at least one over 240mg. Another surgeon said he filled up two beakers with prostate tissue. So, they grow at different rates and we all tolerate different sizes, apparently. If there are any medical professionals out there that would correct me if I am wrong then I would welcome that input. Happy New Year, Chuck,  and all readers of this post, you too, CS..   

Chuck,

According to Wikipedia a "normal" prostate is on average 11 grams, ranging in size from 7 to 16.  Just do a Google search of "Prostate" and the Wikipedia page will come up.  My own prostate (age 68) was considered large, it was about 60-70 gms.  The doctor never meassured it with an Ultrasound or MRI (no need) but that is his estimate based on a rectal exam and looking at the tissue during the surgery.

As I have stated before I had a procedure called Plasma Button Vaporization of the Prostate (PBVP) which unfortunately is often called a Button TURP.  A Button TURP is nothing like a conventional TURP, it is totally different.  Some posters here refer to what I had as a TURP but I did not have a TURP, I had a Button TURP.  Repeating myself, there is little comparison between the two in both risks and side effects.  The only common feature is that they both remove prostate tissue, but they do so by very different means and with very different profiles.  I am saying this not to upset anyone but to make sure that those considering options know that a Button TURP and a conventional TURP are two totally different procedures.

 

Bob,

You mentioned that some posters in the UK and Australia had HoLep with bad outcomes. The moderator here does not allow links to competing sites but if you Google "SteadyHealth" and then "Prostate Surgery, HoLEP" and go to page 8 you can read "daduff001" posts. He nearly died due to HoLep in California, ended up in ER with massive bleeding and clots. His Uro had 15 years of experience with HoLEP and had done "hundreds", the patient was told.

There are risks with any surgery of course but there are two major ones with HoLEP, the capsule can be damaged since the Uro cuts large chunks of tissue in one motion and secondly these large chunks end up in your bladder and have to be morcillated and then irrigated out. In the patient above some residual tissue was apparently left behind even though the had what appeared to be a very experienced Uro.

A PBVP (Button) does not pose those risks as the vaporization removes small amounts of tissue at a time and vaporizes it completely thus no "chunks" left behind. There is always a bleeding risk but usually not weeks afterwards like the patient above. There is also the risk that the Uro, if not highly experienced, will damage the sphincter and and leave one incontinent for a while. The most important aspect of any surgery is the skill of the surgeon, that cannot be over emphasized.

Hi CS123,

I don't know if the holep posters I mentioned had "Bad" outcomes. It just took several weeks for them to recuperate, as it did me for both the TUMT and the Greenlight. I honestly don't know how they were 6 months to a year or more later.

I read the HOLEP post by daduff001 about his gross hematuria. Actually he is guessing the surgeon did something wrong but ironically this same thing happened to me last December, a year and a half after my Greenlight. I had gross hematuria, my bladder was completely covered in clots. I needed emergency surgery to clean out the clots and cauterize two bleeders in my prostate and one  on my bladder neck. While he was in my bladder my uro found and removed bladder stones and also resectioned my bladder neck. That was a year ago and things have been OK this year.  Gross hematuria is due to unknown causes 25% of the time. My uro said it could have been caused by weakened veins during the Greenlight, or the stones or even self cathing which I did. But no conclusive cause was found. I was in the hospital 4 days while they tried to clean me out with a three way cath to irrigate the bladder. They never checked my hemoglobin which was wahing out. When I passed out they found I needed 8 pints of whole blood and had the surgery the next day. I continued to get the blood for two days. I was in a very good hospital but no one checked if my hemoglobin was dropping. With the irrigation, the blood was basically invisible.  I entered the hospital with a Hemoglobin count of 15 and it was a little over 5 when I passed out.

I've heard over and over about the skill of the surgeon. Mine is very skilled, has been doing loads of GL's for more than 6 years. He even does kidney transplants and is a combat surgeon in the reserves, serving 6 weeks a year in Afghanistan. But I almost died too.

Hi Ron,

My bladder capacity is only about 350 cc until I have to go. I think my median lobe is about 40g, but it only partially protrudes into the bladder. The protrusion is about an inch away from the bladder neck. When I saw it on the sonogram it looked like it extended across the lower quarter of the bladder, but that is a narrower part of the bladder, near the mouth, so it probably only takes up 10% or less of the bladder volume. At present I have no reason to seek any treatment until I have a problem. Especially knowing what can go wrong. Just as an aside, medical treatment gone wrong is the third leading cause of death in the US, right after cancer and heart disease. Estimates run from 200,000 to 400,000 deaths a year caused by FAULTY medical treatment or prescriptions or avoidable infections.

Bob, what happened to you would scare the dickens out of me, a fast dropping hemoglobin count and no one at the hospital noticing it until you passed out. Like you have mentioned in the past, it is a crap shoot no matter where you go or what surgeon you use. All we can do is go for the best and pray!!! Glad that you came out ok.

Hi CS123 and others, I have studied the 3 main procedures available to us; the BPVP ButtonPlasma  Vaporization, the HoLEP, and the Greenlight. But, I still do not know all that I need to know, yet.  My Uro is leaning on the BPVP and although I do not like the idea of burning (Vaporizing) tissue, I think that it may be a better direction than HoLEP for a smaller prostrate.  I do not like the idea of the surgon needing to fish out the pieces of tissue he has cut away with the laser, with the possibility of leaving a piece that would block the bladder neck or get infected.  I do understand and I can see where HoLEP would be a better procedure for a large prostrate. I would think it might cut down on the procedure time, by being able for the surgon to take out bigger pieces faster than the Button that vaporizes the tissue at a slower rate, but not leaving tissue behind to possibly get into the bladder.  I am in the Memphis, TN area and my Uro's clinic is one of the biggest in this area and they seem to be very successful. At least I have not found any bad reviews from anyone about this practice or my Uro. I would like to hear from more that have had the Button Plasma Vaproization procedure and how they are doing post procedure. I cannot remember who posted it, but I have only seen one that has had the Button and that was a really good outcome.  If there are any more that are willing to shair their experences with the Button BPVP, then I would welcome your comments.

Thanks,

Happy New Year,

Jon

 

Actually John, a HoLEP takes longer than a PBVP. While HoLEP cuts tissue in larger chunks all that tissue goes into the bladder and needs to be morcillated. This is what takes extra time.

One advantage that did not find a mention in most of the posts that in Holep the tissue that is extracted can be sent for a Biopsy. In any of the vaporization techniques the tissue is vaporized and hence you may need to do biopsy separately. That is why I am opting for Holep. 

True but why would that sway you into a more challenging procedure that is harder to perform? Is your PSA high? If not why worry about it.

CS123,  Yes, I understand this is what takes the extra time. One of the advantages of removing the tissue during the HoLEP procedure is to do a biopsy on it looking for cancer, as samedlhi has noted.  My Uro has said, he does not think or suppect cancer in my prostrate. 

Thanks, Jon

Yes my PSA is high around 4.5.  But PSA is not a Cancer  marker.  High psa does not imply positive for cancer and low PSA does not preclude it.   So as a rule of thumb it is good to perform a biopsy if I am subjecting myself to a such an elaborate procedure.  I want to get it out of my mind.

Sam, a PSA higher than 4 warrants further testing. This is especially true if your PSA was much lower before. There are many reasons why someone would have a high PSA, a prostate infection for instance, so as you mentioned it is not a definitive marker for cancer. As I recall from your earlier posts you are young, in your 50s if I am not mistaken. If I were you I would not wait until a BPH procedure to test for cancer, I would have a biopsy right away just in case. Catching cancer early is key to the success of treatment.

Well, I'm glad to hear someone agrees with me as to the importance of the facility, the surgeon and his staff.  It's all--important to me, fortunately I'm good for now.  Happy new year to all posters and lurkers. Ron

Jon, you're taking the right path, study the choices and make an educated decision. I have to say from the last seven months of posts I have read that Green Light seems to be the worst choice and is becoming less-recommended by urologists.   Good luck whatever your choice. Ron

Good for you Sam. I hope your Holep is as successful as mine has been. There is another factor if you want to test for cancer. The usual way is to take two dozen or so samples of the prostate through the wall of the rectum via needles. This procedure is suspected of spreading cancer in some cases if cancer exists and in other cases causes infections. For these reasons i have refused to ever have the procedure done. My psa has always been fine and my uro never suspected cancer but he wanted to do this procedure anyway!

If the cancer test can be done with the Holep residue then that sounds like the way to go to me. 

If you are having Holep done, then almost by definition it's being done in the fineist facility in the area, by a super-qualified surgeon. That would satisfy my concerns about the facility and the staff. 

Good luck and let us know how it goes. Ron

Jon, in almost every case related in these forums patients post-op have had to pass blood clots which were painful in some cases and always scary. With my Holep I had pink urine for 7 days and not one blood clot or any tissue appeared from the procedure. If my case is typical then youir concern about pieces blocking the urethra or getting infected is unfounded. The surgeon must almost liquify the prostate tissue as the tube is very small. As far as Holep being riskier I don't know where CS gets this. I think the quality of the regional medical center facilities, the support staff where Holep is performed and the experience of the surgeon will greatlly reduce all risk factors as they would for any procedure, even for simpler procedures like urolift for example..

As another poster stated today, medical errors are now the third largest cause of death in the US. I think I got that right, correct me if I'm wrong, but to me that is really scary. 

Thanks Ron. I have similar notion on regular biopsy and hence I have been avoiding it also.    I will keep this forum posted and I am 3-4 weeks away from the procedure. 

Thanks CS for all the posts and inputs.  I have been using secondary tests and indicators and avoiding biopsy which is the only deterministic test for cancer. The reason is that it can aggravate the situation at times.  So I want to use this opportunity for getting it tested. I am 49 and I waited for 4 years and after reading the posts and discussions on the forum I believe it is not worth waiting any longer.  I was fearing RE more than anything else but I am past that stage because there are bigger things at stake.  These discussions have helped me cross that line. 

Very good attitude, Sam. I hope all goes well for you and I anticipate that it will.

I have already posted the reasons why HoLEP is riskier than PBVP but you are unwilling to accept them which is OK with me. You can believe anything you like!!!

For others my initial reply is waiting to be moderated since it contained a link to an NIH article (National Institute of Health). I have edited the link and hopefully this one will fly.

HoLEP has three major differences in comparison to a PBVP. First, as has been well reported here there is a steep learning curve for HoLEP and the reason is that it is difficult to learn and perform. The surgeon is cutting large chunks of the prostate at a time and there is a risk of getting too close to the capsule and damaging it. This risk is essentially nonexistent with PBVP as the Button vaporizes small amounts of tissue at a time. Experience helps but the risk is still there.

Secondly, the pieces or chunks that are cut in a HoLEP end up in the bladder and they have to be morcellated out. This takes time and presents risks which are also non-existent in PBVP since the tissue is vaporized. If anyone wants to read about morcellation and a new procedure for doing so Google “holep morcellation of the prostate”. The third item that appears is a reference to an NIH study which may be of interest to some.

Thirdly, if these “chunks” are not all removed properly a person can get an obstruction or even gross hematuria as reported by “daduff001” in SteadyHealth.  He had a very experienced surgeon, 15+ years doing HoLEPs and “hundreds” of procedures as “daduff001” stated but he ended up in the ER in a life and death situation. So even with an experienced surgeon problems can occur.  Again with a PBVP there are no “chunks” to be removed from the bladder, all tissue is vaporized. This is good and bad, the bad is that there is no material irrigated out to do a biopsy with. For those with low PSA this is not an issue.

There are common risks with any BPH procedure, infection, bleeding, incontinence, etc. Infection can occur with any procedure, depends more on the hospital than the surgeon. Bleeding is possible with PBVP but less likely as the Button cauterizes the tissue. The main risk of PBVP is incontinence. The Button probe has to be moved back and forth (in and out) and an inexperienced or careless surgeon can go too far in and/or too far out damaging the sphincters that control continence. My Uro guaranteed me that I would have no incontinence (his words) as he had done hundreds of this procedure and not a single patient had had incontinence. I had none, not even for a single day. This risk exits with HoLEP also, a surgeon can certainly damage the sphincters during the enucleation. The risk is also there with a conventional TURP.

Everyone agrees that the learning curve for HoLEP is steep.  What this means is pretty simple folks, the procedure is difficult to learn and perform. Again experience helps but the risks are still there. The harder any procedure is to master the higher the risks, this is elementary. HoLEP has one major advantage over PBVP, it can be performed on a prostate of any size, even the very large ones. This procedure is best reserved for those individuals whose only option is open prostatectomy. It is also a fact that there are only a few places in the US where one can get a HoLEP by experienced surgeons. It is just not that available even though the procedure has been around for a long time, far longer than PBVP.

And again just so there is no confusion, a PBVP (Plasma Button Vaporization of the Prostate) is often called a Button TURP but that is unfortunate as it is nothing like a conventional TURP, the two are very different procedures. Also so there is no confusion either, I am a retired engineer, worked for an oil company in Houston for 32 years, do not and have never had an interest in any BPH or for that matter any medical procedure whatsoever.

 

Hope this helps... Good luck to all.

For whatever it is worth the NIH study I referenced above states the following under the Discussion section:

"The usage of morcellation is not without complications. Kuo et al reported four cases of residual tissue arising from problems with morcellation. One case of residual tissue with a firm texture resulted in successful suction only after the adenoma was incised with a laser into more manageable pieces. Problems with dull blades occurred in another two cases. A fourth case required open cystotomy due to an extremely large prostate. A similar case of open cystotomy due to hard tissue and a large prostate was reported by Krambeck et al. Conversely, medium and small glands have also caused problems. Shah et al used two methods to cope with morcellation failure (sectioning of the tissue with a serrated loop and retrieving medium- and small-sized tissue with the alligator forceps)."

Those of you who are interested can read the whole article as I referenced above.  Again, I hope this helps in making decisions.

It was strange. All day I felt like I was in a dream state. When I passed out I could hear my wife yelling at me but couldn't respond. They put me on the crash cart and tested me and started the transfusions. Had no time to be scared. A miss is as good as a mile. I've had a few close calls before, just another one of my 9 lives used up.

I have deleted the 2 original posts above as they were the same as the one that was posted but I have added the direct link below. I am aware there is a continuing disagreement in this thread but as previously discussed each user's posts are their own opinion and we will not get involved in "who is right or wrong" disputes. If a reminder is needed please read the FAQ in the second link below.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3521131/

http://patient.uservoice.com/knowledgebase/articles/398318-alternative-medicines-opinions-etc

Yes unfortunately we have to do out homework the doctors are not. I would 100 percent go after the true minimal invasive which means that no full anesthesia and if something for some reason is not working then remove it in an easy way and no damage whatsoever had not been done. It's a shame that Memokath is still not in the US. Hope you will find the best solution.