Which is the best surgical treatment for benign prostatic hyperplasia?
Posted , 19 users are following.
I'm sixty two years old and have been catheterized (for now just over six weeks ) after being hospitalized for urosepsis following a cystoscopy. I'm waiting for the TURP procedure on the NHS although I believe there may be better surgical procedures and I am prepared to pay privately to get the best result. Any thoughts, information and/or weblinks would be most welcome. Thanks. P
0 likes, 103 replies
doug04815 PetW
Posted
JerryR had a HoLAP procedure done 5 weeks ago: https://patient.info/forums/discuss/i-just-had-a-holap-for-my-bph-708123
From what I see from internet research HoLEP has a 70%+ chance of RE and HoLAP in one study showed a 36% chance.
"Retrograde ejaculation of sexually active patients was reported in 36.3% of the HoLAP "
"Patients after HoLEP and TURP reported retograde ejaculation in 75% and 62%, respectively "
HoLAP appears better for small prostates with less likelihood of tissue regrowth and another operation, whereas HoLEP is better for large prostates, presumably because more tissue is removed.
Maybe someone who knows more than I can weigh in the difference between HoLAP and HoLEP.
hank1953 doug04815
Posted
This is from Mayo clinic:
There are several different types of prostate laser surgery, including:
Photoselective vaporization of the prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel.
Holmium laser ablation of the prostate (HoLAP). This procedure is similar to PVP but uses a different type of laser.
Holmium laser enucleation of the prostate (HoLEP). A laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate.
PetW hank1953
Posted
Yes I've never been told exactly how much my prostate is enlarged. An oversight on my part - perhaps being too trusting of the clinician - I need to find out exactly what the situation is regarding MY prostate. On the cystoscopy it looked like the camera was approaching an anus - a crinkly dark thing with a tiny aperture in the middle.
PetW doug04815
Posted
Thanks for comparisons on retrograde ejaculation - I'm surprised HoLEP came out worse than TURP
derek76 PetW
Posted
Size is always the first thing I've been told and is surely the most important. When having a cystoscopy I have always seen the prostate as a large pink thing with a mass of blood vessels and then the interior of the bladder. The last one also showed a nodule on the median lobe that they said was not suspicious.
derek76 PetW
Posted
As they say lies, damn lies and statistics.
Bobcats PetW
Posted
Well, I AM one of the miracles on this forum.
I am 54 years old and very FIT and active at the gym and yoga. I don't know why the PAE procedure worked so well for me, but it has. I am back to my normal self without taking any medication. My car and travel kit still have emergency catheters at the ready because of old fears, but thank God I have not even come close to needing since my procedure.
Before PAE, my daily nightmare was EXTREME urgency followed by dribble, dribble, and 3 times full retention. I would be driving my car and the urgency would hit, if I was in traffic sometimes I would use a pee bottle...but that took a lot of practice to not p**s myself! When on a plane, the urgency would hit and the fasten seatbelt sign came up, I would dance in my seat with impending doom! A living hell as many here have experienced!
Now, I can hold it in for several hours if need be. The urgency has completely vanished. All BPH symptoms have vanished. I am my normal self. I have zero side effects, retro, etc. I had started to "leak" before the procedure and that is gone! I am very LUCKY!
I wish the best of luck to you and all.
Here is my experience https://patient.info/forums/discuss/my-pae-at-ucla-april-2019-700378
PetW Bobcats
Posted
Thanks for this Bobcats. Much appreciated!
doug04815 Bobcats
Posted
Maybe PAE will become the new gold standard for BPH surgery. The following article was published in 2014 and was therefore a bit optimistic about the timeline, since I don't see it happening by 2021.
Cut and paste into Google: "PAE May Become Standard of Care for BPH within 3-7 Years"
PetW doug04815
Posted
Thanks doug will have a look
derek76 doug04815
Posted
I assume that with PAE the radiologist has no control over how much the prostate will shrink.
I really only favour laser procedures where the Uro can precisely take away tissue causing the obstruction and seal blood vessels as he goes along. It has worked twice for me so I'm a believer.
lester90053 PetW
Posted
The best procedure for everyone has not yet been invented so doctors tend to choose what is best for themselves not the patient. Suggest you get as many opinions as you can. Prior to any procedure you will be asked to sign a waiver of liability which gives you no recourse.
PetW lester90053
Posted
Yes this sounds about right lester. I'm in the process of getting as many opinions as I can. Thanks. P
derek76 lester90053
Posted
Difficult for we Brits to get multiple opinions as an NHS patient and a private consultation costs around two hundred pounds without tests.
In America do you have to pay for every consultant you see or does your insurance cover it ?
lester90053 derek76
Posted
Good question. It's always best to ask the insurance providers.
derek76 PetW
Posted
All privately ?
Which area do you live in ?
derek76
Posted
PS. To get opinions they all need to do a series of tests. How many cystoscopies and DRE's do you want? My last DRE in 2015 stimulated my vagus nerve and put me into permanent atrial fibrilation. A cardioversion will not work due to the size of my right atrium.
dan25410 derek76
Posted
That depends on what type of insurance your employer provides, and then depends on which option that you choose (it's rather complicated). If you choose to go the HMO route, then you are locked into their system, and will have to go through a little hassle to change doctors in order to get some alternative opinions. After that, you can get some extra opinions/consultations for a low co-payment fee ($10 for me), but since they are part of the same HMO, i'm not sure how many alternative procedures the other doctors will be able to use.
I'm guessing that even if the doctor has both the recent education and training in the latest techniques, he/she may be limited by the facilities and technology available within that HMO.
If i want to go "out of my network" of HMO doctors, then i would have to pay $100 to $200 per consultation, which would be like paying without having any health insurance coverage. OTOH, if i choose the PPO option (we get to choose every November for the following year), then i can see Any doctor, but the co-payment for all office visits and procedures is now 20% out of pocket. This will obviously cost me more than if i were to remain with my current HMO, but in the case of someone doing invasive surgery with my prostate, and all that this implies, then it might be worth paying out of pocket.