So I've finally found a doctor I like. I dropped the creepy female uro who wanted really wanted to do a 12-needle biopsy for no damn reason. I got a doctor who came recommended by a friend, He operated on him and got a good result. The guy is a professor of Uro. Anyway, he wanted to do a Greelight or Acquablation. I asked which one he thought I should have, which one has a better result, etc., and he said the Acqualbation because "it's cooler" cuz it uses a robot. But now my insurance has declined it. My insurance will pay for a Greenlight Lazer. Should I fight the insurance for the acquablation? His office is telling me they are both equal and in fact there's less bleeding with the lazer. Anyone have any thoughts? Thanks.
GL is tried and tested having been around for about 15 years and he is probably very experienced in them. If your median lobe is not the problem area and he does a bladder neck sparing version you will avoid RE.
I've read that Dr. Miller at Vanderbilt also uses a "bladder neck" sparing version of HOLEP. Why can't all doctors do this? I thought the basic idea is that when they get near the bladder neck, they limit the ablation so that there is still a small amount of prostate material around the bladder neck. This would then spare the bladder neck. Is that your understanding, derek?
A study was just published a few weeks ago comparing Aquablation to TURP for guys with fairly large prostates (50-80g), and having a large middle lobe. They found aquablation beat TURP for results, plus the rate of retro ejaculation was 41% after TURP, versus only 2% for aquablation.
Don't know how that compares to Greenlight, but it certainly seemed like it's no contest against a TURP.
Pretty much the same results. Both have the same complication rate (incontinence, impotence, less RE with aquablation). Both will damage the nerve bundles on the sides of the prostate by elevating the temperature of the prostate. One use laser to ablate, the other steam. Thermal damage is comparable. Go for the Urolift or PAE if you want to preserve these functions. Obviously everybody's anatomy, age, URO operator is different, so are the results. BTW in the previous postings somebody asked me if the Alprosadil is the right medicine to produce strong erections. To those who are strong proponents of removing the most part of the prostate inside the capsule, Alprostadin was first found inside the prostate, before it became an ED remedy. So, prostate inner mass does influence the erection by producing vasodilators. That might explain why BPH sufferers and postoperative patients after TURP and SRP suffer ED. Of course, there are other places where vasodilator is produced, but the inner prostate is an important organ for the erection and play an important role in ED.
Of course, again, everybody's arterial system is different.
Gene: Look up aquablation again. They do not use steam; you are thinking of Rezum.
Acquablation is newer procedure and is not yet approved by FDA, so there very little hope that your insurance would cover it. Results do sound promising compared to other procedure. Have you checked how much would be a out of pocket cost?
I dropped the creepy female uro who wanted really wanted to do a 12-needle biopsy for no damn reason. You didn't say but your PSA must be elevated and the reason to do a 12 core biopsy is to check for prostate cancer. You could also do a 3T MRI, but you might have to pay out of pocket for that. I had a 12 core biopsy in 2012 and it came back positive for cancer. A second biopsy a year and a half later showed that the cancer was growing, so I had it treated with radiation - now gone.
Yes, it generated less heat than TURP or laser enucleation of large prostates but required TRUS and intraurethral cystoscope inserted, mean stricture is possible. Still destroys some important area of prostate, less probability of impotence and incontinence but more of bleeding after surgery. requires overnight stay and perceived experimental by most insurances and Medicare. Any robotical procedure is expensive by nature of expensive instrumentation and software. I will still chose PAE as the safest option.
I don't agree with most of this. Results aren't the same and Aquablation has the longest recovery of ANY BPH treatment. Many are still bleeding months after Aquablation.
Greenlight is an older procedure and in experienced hands it works well. Recovery can be messy - urgency is bad enough that many wear diapers for 1-4 weeks post op. Long term, the main problem with Greenlight is RE (dry orgasms). There is a 50/50 chance of it - almost no one does the bladder neck sparing procedure, so I wouldn't factor that in. If you don't care about RE, Greenlight is a good choice. In the wrong hands Greelight can do permanent damage and leave you incontinent. Make sure your doc has done hundreds of these if you opt for it.
Also covered by insurance is Rezum. RE is 5-10% and the worst case scenario is it doesn't work - although in about 90% of the cases it does. They don't put you under and it works fine with enlarged median lobes. Downside vxs Greenlight is most of the benefit comes weeks 6-12. while Greenlight works within a day or two. I would opt for Rezum first and if you aren't happy wiht the results, do Greenlight.
What exactly you disagree with in my brief statement. I mentioned possibility of bleeding. There is not always bleeding for aquablation. It's just a waterpeak knife. Fast and sharp. Allows precision due to the robotic drive and ultrasound imaging control of he stream by a special software that calculates the process in advance. The main difference is that both, TURP and RESUM, GL including, generate plenty of heat inside the prostate, heat is transferred to the surface of the capsule, where the bundles of critical nerves responsible for the erection and ejaculation are located. Damage to some nerves impairs erection and causes frequent ED up to three years after surgery. Nerves has the tendency to restore themselves sometimes and erections return, but not always. Any method works with enlarged median lobe because during any of the surgeries most of the body of the gland is resected or destroyed (ablated) one way or another. We are speaking about different level of thermal damage to the critical nerves. Not very well studied area. Mostly hypothesis.
My Uro is a big FAN of aquablation here in Los Angeles. There is some big wig Uro at USC , Dr. Mihir M. Desai, MD ( my uros mentor ) who is teaching the procedure to other uros, however, insurance companies don't like to pay for it so he offered me a TUVP, as opposed to TURP. I am not even sure of what the difference is because I tuned him out!
I asked him about PAE and he said , there is not much benefit to it... I went with PAE :)
Unless/until they can modify aquablation to lessen the bleeding/recovery time, my guess is that it will never catch on.
PAE seems to work best when no enlarged median lobe is present. Along with Rezum, FLA and Urolift, worth doing (which one depends on each case) before considering going under for a full blown surgery.
and? how was it? results?
please stop peddling your misinformed prejudices. i had aquablation 3 weeks ago and no bleeding after a couple of days and really quick recovery
I'm glad you had a good result. My info came from the top urologist at the Cleveland Clinic who said it's a less risky procedure than TURP but typically has an even longer recovery.
And how are your symptoms now?
So do you think I should try Resum first before the GL? It's less intrusive? If it doesn't work, I can get the GL. Or maybe my insurance will cover aquablation at that time.
What you're saying about the burning tissue and heat makes a lot of sense. You're saying that happens with Resum as well? Do men retain their sex lives better after Resum?
I also like the idea of Resum being outpatient, not full blown surgery.
This makes a lot of sense to me. I think you've changed my mind. I'm going see a resum doctor first. My GL doctor doesn't do reszum.
I don't regard GL as full blown surgery as there is no cutting or stitches involved. I travelled home by train on the second day and went to the races the next day. People were surprised to see me and asked if my operation had been cancelled :-)