Hi everyone,
I live in Seattle, I have had BPH issue since 2 years, nigh time I have 3-5 trips, and especially at night I start and stop to urinate with little a mount, and dribbling. I plan to have a surgery, there are 3 euros in my area perform 3 different procedures: Bipolar Turp, Greenlight, and HoLEP, but I have no idea which one suits me well. So I would like you guys to advise or share your experiences and successful outcome.
Thank you in advance..
Hi Tanak:
I live in Seattle as well. Would you mind sharing the name of the urologist that performs HOLEP?
With regards to your question, from what I’ve read and heard it seems that Greenlight has gone out of favor. Also, I believe that Greenlight does not afford the opportunity to have the removed prostate tissue checked for prostate cancer.
HOLEP and bi-polar TURP seem to be the choices short of prostate removal. Between the two it would seem to rest with the urologist’s ability. I may need a procedure in the next couple of years and one of the big questions I would have is: does the urologist try to spare the bladder neck (thus reducing the possibility of incontinence). Retrograde ejaculation is pretty much a given, but I would want to avoid incontinence at all costs. I’ve read some posters say that their urologists were able to “spare” the bladder neck. I’ve only seen one poster define what this meant. It was a HOLEP procedure where the urologist leaves some prostate tissue remain around the bladder neck so as to avoid damaging the bladder neck.
Don’t get any of those. Find a doc that does Rezum. It works fine for most, requires no anesthesia, has a very low incidence of RE (5-10%) and virtually no chance of incontinence or impotence.
Well said, rde. HoLep is also the best in longevity, with 1% redo after 20 years.
" ..Several studies have followed HoLEP patients for between 5 and 10 years, with a re-operation rate of less than 1%. Note this is in stark contrast to TURP with a reported average re-operation rate of 7.4% and PVP with a re-operation rate of 5-6% [5].Apr 25, 2015.."
Hank:
Did they state a reason why the redo rate was higher for TURP? I would’ve thought that a redo would mostly be a result of prostate tissue growing back. Why would TURP be higher? Does HOLEP remove significantly more tissue?
Why do people ask strangers and possibly even Trolls for what is best for them rather than trust the opinion of the Uro’s who have done their tests and know what needs to be done. Remember Forums like this attract those who have had problems with their procedures or who left their condition for so long that they were less likely to get a good outcome.
GL has been around for at least seventeen years ( I had mine in 2004 ) and the equipment is now on its third generation and from my experience was a quick procedure, about an hour for my 75 grm prostate and from day two people were surprised that I was out and about as usual. My prostate regrew to 135 grms and in 2013 I had Thulium/Holmium laser similar to HoLep and saves tissue again with a good outcome. If tests have shown no indication of prostate cancer It does not matter if tissue is saved. That procedure took around three and a half hours.
That procedure reduced my prostate by 80 grms with 35 grms saved for histology. Incidentally my PSA came down from about 7.8 to 0.70.
HolEp has not been around for anything like 20 years. Even GL has not been around that long.
HoLEP, or Holmium Laser Enucleation of the Prostate was developed in New Zealand in the late 1990’s. It is normally done under general anaesthetic. The prostate is approached internally (endoscopically), through the urethra, without any cuts on the skin. The Holmium laser is used to peel out the obstructive core of the prostate in its entirety. This leads to maximal relief of prostate obstruction and a man will usually only require 1 HoLEP procedure in his lifetime. It is very unlikely that the prostate will regrow after HoLEP (0.7% need a re-operation up to 10yr after HoLEP compared to 10-15% after TURP, and more after green light laser surgery).
After HoLEP, the area of the prostate that is removed is sent for microscopic analysis. Cancer that would otherwise be undetected is found in 8%.
HoLEP is one of the most extensively researched procedures for BPH. 16 HoLEP randomised trials (the highest quality of clinical trial) have been published up to Dec 2014. The clinical trials comparing it to the previous “gold standard” of TURP, consistently show advantages for HoLEP that include: Less bleeding, fewer blood transfusions, shorter time with a catheter in place after surgery, and shorter hospital stay (90% of men having HoLEP are able to leave the hospital without a catheter the day after surgery, and in some cases there is no need to stay in hospital overnight). Meta-analyses which are studies analysing the results of large numbers of randomised trials, suggest that HoLEP relieves urinary symptoms and improves urinary flow rates more effectively than all other endoscopic procedures for BPH. The average symptom score improvement after HoLEP is 70-80% and flow rate improvements of up to 600% have been reported. Recent studies have shown that HoLEP is extremely effective at treating men in urinary retention. 98% of men with catheters before surgery are freed from their catheter dependence after HoLEP. This compares to 70% with green light laser and TURP surgery. Unlike all other endoscopic procedures for BPH, HoLEP is suitable for men with any size prostate.
If HoLEP is the best procedure for everyone as you say it is then why is everyone looking for other newer procedures which have not stood the test of time only to be largely disappointed and have to be done over? Would it not be better if more research is done as to prostate growth so that prevention can be instilled?
I don’t think I said for everyone. People always look for something better and in the case of our NHS for cheaper options. That’s why REZUM is now their flavour of the month. They want a cheap procedure and quick turn round.
Research on prostate growth is on going.
I had a UROLIFT in March that has not helped my flow. I wish now that I had discovered this forum so I would have known about failures and the side effects of the many procedures.
I SUGGEST you read everything you can in this forum about the patient experiences and use the web to get more information about all the procedures out there.
I personally have changed Urologist and have been trying various drugs with success for my bladder and some blockage. Some drugs just have too many side effects and I will not use them.
Why do people ask strangers and possibly even Trolls for what is best for them rather than trust the opinion of the Uro’s who have done their tests and know what needs to be done.
A question for the ages! I have asked the same question on this forum many times. I suppose our UK friends dealing with NHS don’t have the options those of us in the US have, especially us old farts on Medicare. One of the problems with internet forums is that they tend to attract complainers. The only reason I’m still participating is because I had a very successful TURP and I feel a responsibility to counteract the people who badmouth it (usually those who have not had one.)
The other thing to keep in mind (for those considering a procedure) is that this forum is populated by mostly old men. If someone has post-op issues, we have no way of knowing if the patient’s other health issues may be contributing factors to a less successful outcome or a slow recovery. I think one of the reasons my TURP outcome was good is that I’m in excellent physical condition (for a 70 year old). I am not overweight and exercise 6 days/week (running or lifting weights.) Someone who has other health issues might not have the same outcome.
I also stick around as do a few other regulars to try to be of help to newcomers but we all have a 'best procedure that worked for us and friends. I have difficulty in understanding some of the really bad outcomes from any of the well tried procedures. I do honestly believe that UK procedures done in hospitals with a team of urologists and full back up are preferable to some of the American procedures.
I was 70 when I had my GL and 79 when my Thuluium/Holmium procedure.
My first Uro did GL on a man of over 90 as he described it as a very gentle procedure.
People come to this group because they seek information. Based on the posts here, it would seem that many don’t get good info from their docs. I’ve seen everything from out and out lies, to misguided direction based on what procedures they’re trained to do, not which one is best for a particular patient. Of course most people here are old - BPH isn’t a young man’s disease. Some have health issues that could impact recovery or which procedures are optimal, some don’t. Some are done with sex, some aren’t. All that should be factored into what is the best first course of treatment for someone.
Also, many impute their results from a particular procedure to everyone else who might be looking for some insight. That’s also misleading. Just because there are millions of men who are really happy with the old fashioned TURP, doesn’t mean that in this day and age, it should be a first line treatment for most men. Nor do the Rezum failures imply that its a flawed or poor first choice for many men - in fact, its probably ideal for most with simple BPH - particularly if health problems create increased risk with anesthesia, or men who want to preserve their ejaculations.
Further, NO ONE SHOULD EVER use comments here to compute success or failure rates for any procedure. Everything here is anecdotal and very few men who had any procedure go as promised and got the relief they sought find their way here. What this forum will help with are introducing things like self cathing - which for many men is a godsend while they decide what to do next or wait for something better. It will also inform about how some procedures aren’t right for certain physiologies - Urolift and PAE are not so good with enlarged median lobes for instance.
Men should so their homework, research real statistics and use this forum as one of many tools available to help guide them through the morass that is BPH treatment IMO.
Basic information is readily available on the internet and you don’t need to come here to find out what GL, HOLEP or bipolar TURP are. Once a man has a basic understanding of the procedures/methods used to combat BPH, then he needs to know the questions to ask. Uros will usually respond to your questions - but they don’t necessarily provide information on questions that a man doesn’t know to ask. This is true of many aspects in life.
Because blogs like this have posters who have actually gone through procedures they can help OPs determine what questions they need to ask. To me this is the most important contribution blogs like this make.
Well said, Derek.
rde, maybe you can find out why hoLep has better redo rate than Turp, and let us know. 
A later study showed hoLep redo rate is 1.4 % after 18 years. Talk about meeting the test of time.
Rezum is the best choice right now, if retro ejaculation is a big concern.