I have BPH, symptoms being urinary retention and recurrent UTIs. My urologist recommends surgery, and has ruled out a Urolift due to my having an enlarged median lobe. That leaves me with a choice between TURP and GreenLight laser, and he’s really pushing TURP. From everything I’m reading however, the Greenlight procedure seems just as effective, and has lower risk of side effects and a much shorter recovery time. Above all, I’m seriously concerned about sexual side effects above all. I’m 57 years old, and I’m not ready to “cash in my chips” just yet. I already have ED issues, and the thought of further sexual diminishment is leaving me quite depressed. Is my doc pushing TURP because he’s more experienced with it? Are there other options? I’m wondering if a second opinion is advised. Any feedback from guys who have been through this?
If your American he might be pushing TURP because he earns out of it. Prostate Artery Embolisation (PAE) is something you should investigate. As this I performed by an Interventional Radiologist Urologists are a little reluctant to refer you. It may still not be right for you but as your fears are well founded this much less invasive procedure could be just what you are looking for.
Hi Chuck ,
I made really detailed and long investigation about treatment of similar signs of BPH as you have. My prostate is just 50 ml (grams) , but big median lobe ,which blocks bladder neck. This causes nearly full retention, sleep shortage, nocturia, and in time the neccessity of CIC- self cathing. Pls note PAE in case of big median lobe has small effects. I passed it last April . After few months of symptoms relief, the problems returned with bigger intensity. So I lost one year time. Yes you have some options : TURP, GL, HOLEP, open prostatectomy ...new methods as Urolift, REZUM and FLA. It seems that for big median lobe is best REZUM and FLA . This is based on my long investigation and consultations with many patients and some doctors. REZUM is cheaper, probably covered by your insurance , but still more random method in comparision with FLA.
After detailed analyses of my problem - detailed MRi scannes, PSA, PVR, e.t.c. I decided for FLA. Living in Europe I'm flying to USA early April for FLA procedure. If you need more details pls PM to me. Have a Nice Day, Stan
Hi, I reported extensively on my experience since my problem was the big median lobe as well. I spent several months investigating and looking around. Being in the Houston area I found a great doctor whom I trusted and did GL. Turned out perfect for me with both recovery and results. FLA is a very good option. I would not do TURP which my first doctor wanted to perform. You can always PM me if you can’t find my previous responses. Good luck to you!
TURP is barbaric given the alternatives i.e. Greenlight and HoLEP.
HoLEP, in and out in the same day with no catheter. No experience of GL but would expect the same as HoLEP.
Minimal incontinence but that may be because I carried out pelvic floor muscle exercises for a month prior to the procedure and after but more gently. Dribbles had cleared up within a few days.
At 57 with some existing ED issues, I would not even consider ANY of the surgeries (TURP, Holep, Greenlight) before trying one of the less invasive ones. Your large median lobe rules out Urolift and PAE, butr Rezum and FLA are both options you should try. If your doc only does TURP and Greenlight he's way behind the times and you should find another doc.
TURP, Holep and greenlight all can have long recoveries, all can leave you temporarily incontinent and all (much lower chance in a good surgeon's hands but still there) have a somewhere between a high likelihood and guarantee of leaving you with dry ejaculations (RE) for life.
FLA has shown real promise but isn't as thoroughly vetted as Rezum - both are options and the overwhelming majority of men who pare diagnosed properly and have Rezum are very happy with the results. No anesthesia (although I recommend being twilighted as it can hurt), low incidence of RE (they claim 3%, its probably more like 10, but Greenlight is 50 and HOlep and TURP are close to 100) and almost no chance of permanent devastating side effects like incontinence and impotence. This forum is filled with horror stories after Greenlight and TURP, but only one that I know of regarding Rezum and that was with a 79 year old post stroke patient. The chance of a horror story is low even with the surgeries, but its virtually none with Rezum and FLA and at 57 I wouldn't even consider TURP or Greenlight before trying one or both of them.
IMO, find a new doc, get a full workup (scope and urodynamics) if you haven't had one and assuming your prostate is most or all of your problem, try REzum and/or FLA with a doc who performs them.
I've had a PAE which was a huge success. It causes no changes in the function of the prostate and therefore should be a first option even with a large median lobe. It is covered by medicare and most insurance companies. If it doesn't work you can then proceed to more invasive procedures. FLA sounds good as does Rezum. Both tend to be better with prostate size under 80. Over 80 if PAE doesn't work the first time I would try it again. 90% success rate with no side effects.
Hi David, did you have a large median lobe ? Thanks. Hank
This Forum is littered with failures because the people who have problems post and those without need not. We also have the same people posting the same message time after time. I post that GL worked for me in 2004 and Thulium/Holmium similar to Holep did in 2013 but I am practically a voice in the wilderness. I am also sure that procedures done in hospitals in the UK have a much higher success rate than ones in America.
Did none on the Forum ever subscribe to the NG for BPH. I read it from 1995, it still exists but is now seldom used. GL was the wonder cure from 2003 and few posters had problems. I have over 13,000 old posts on file. The First ever GL patient posted there and few days after his procedure flew from America to Japan without any problem. Like Victor Kiam of razor fame he was so impressed he bought shares in the company.
In my case it was life back to normal on day three.
I'm with you on this Derek.
I only post to advise people of how it was for me and for only that reason which will hopefully allow them to make the right judgement call for them and not forgetting we are all individuals who react differently to treatments, procedures and the condition itself. There's lots of learned publications online giving all the details, statistics and info on trials of all the procedures and treatments for BPH and I wish people would use these facilities to research the best options for them rather than rely on sometimes quite spurious information that some regular posters persist in rehashing on here.
The best advice I can ever give is get a second or if need be third opinion if you have any doubts.
Most do well with all of the procedures, including TURP and the failure reports here shouldnt be used for statistical purposes, just as a cautionary tale as to what can go wrong - however rarely. Some of the newer, less invasive procedures have almost NO horror stories - meaning worst case scenario is less scary with them. Unless someone's physiology dictates a more invasive surgery, it usually makes sense not to opt for greenlight or Holep first (TURP never IMO) , given what could happen in rare cases (incontinence and/or impotence) or what is likely to happen (retro ejacualtion/longer recovery).
TURP never as it is an older procedure.GL, HoLep and other laser procedures do the same thing much better. Is there any reason now for TURP apart for Uros who do not want to learn or spend money on new equipment.
If the options are to shrink it, tuck it away or remove tissue I go for removing it.
I don't know if I did or not. I asked the IR what happens if I do. He said if it doesn't work the first time they are successful 50% of the time on the second try, and that a prostate larger than 80 usually have the entire prostate enlarged. As IR's do more of these I would guess they are finding out what embolization techniques to use on large median lobes. So 80% plus half of the 20% equals 90% with no side effects. Urologists hate this procedure since they don't do it. I used to communicate with a urologist who when I emailed about PAE wouldn't email me back. I believe many of the posts on this site who criticize PAE are disgruntled uros, who see their surgery money going away. Who wouldn't try something with no side effects with a 90% success rate.
I'm not sure about extra opinions as Uro's tend to advise on the procedures they specialise in and have the equipment for. They are unlikely to send you in America particularly to a competitor. In the UK your NHS area heath authority pays for your NHS treatment in another area but no doubt they are reluctant to pay more than for the cost of their own favoured procedure. It took me eight months from requesting the GL that my area did not do to actually having the procedure. In theory if a procedure is not available in the UK we can ask to be to referred to a hospital in Europe. A few French and German hospitals are actually touting for business.
This is a 2012 description of PAE from Southampton Hospital in England that will need to be passed by the moderator.
I no longer have the first post from Patrick who was the first ever GL PVP patient but this was one of his later updates.
Just a short note to say the I am now 15 months post-PVP and I feel great. Strong flow, no freq, no urgency, no residual, no retro. After 15 months, my bladder seems to have regained the elasticity lost to years of bladder outlet obstruction caused by BPH. AUA score = 0 Quality of Life Score = Delighted PSA = 1.6 Peak Flow > 50 ml/sec capacity without urgency > 800 ml residual 0 ml I want to mention secondary improvements that I attribute to Laserscope PVP. Prior to PVP, I could not run or bike longer than 20 or 30 minutes because of BPH. I literally timed my runs to be between mens' rooms. Now I am running 5 miles in under 40 minutes (something I haven't done since age 23) and biking over 50 miles without the need to stop. As a result of this, I am in better physical shape now at age 45 than I was at age 25. I attribute this directly to having the PVP done. Seems like many others both on and outside this newsgroup have had excellent results as well. Laserscope tells me that over 5000 PVPs have been done so far this year. This is a significant number given that there are about 150,000 TURPs done per year. I estimate that within 3 years PVP with overtake TURPs inthe United States as the most used and the perferred surgical procedure for the treatment of BPH. I heard that Dr. Te is now running two machines and is fully booked until December. He was inundated with inquiries after the WNBC TV segment that ran in June. It seems like the dialog here has been very positive as well. To those here who are plagued by BPH and are still on the fence. Go have it done. The sooner the better. You will regain freedom over BPH that you don't fully realize how much you have lost. Take care and best wishes for good health, Patrick
So what's the point? Posting something 6 years old? Da! There are much better current descriptions on the web including videos. The tiny risk of the hazards are strictly theoretical and if you have an experienced IR are almost zero. How about the risks of Turp, Holep, etc that the uros do. The screw up the lives of many men. You might be a urologist in danger of having your livlihood endangered. Whatever happened to the ethics in medicine? If you put all the procedures side by side PAE is the lowest risk and least invasive, and importantly doesn't impact doing any other procedure if it doesn't work.
What's the point? Has the basics of the preparation or the procedure changed since then ? Obviously Southampton hospital have not felt the need to update it and they were the first UK hospital to do trials of it.
Calm down you seem to have a bee in your bonnet about fake news from endangered urologists:-)
Chuck I would not give up on your sex life. GL and Turp would get rid of it more Turp they GL but it take sometimes up to a year to get anything back. This doctor he he the one that is telling you that Urolift will not work. I would see a doctor that does Urolift for a second opinion. There have been very good results on median lopes in the trails. They just pull it to one side. I did not have a median lobe issue but my prostate was closed and the size of a large lemon. Been over 3 years and still wide open. No side effects at all. With GL and Turp you will get sexual problems and retro is a given. Good luck Ken
Ken, you are actually not right on all your assertions. I had median lobe, two urologists said Urolift was not an option. I decided for GL and Vaporization. Results are good for me. Can pee again and forward ejaculation. Urologist warned that 30% chance of retro exists. I guess I’m one of the lucky 70%.