GreenLight Vs Urolift

Hi

I live in Toronto, Canada. I have been suffering with BPH for the past five years. I am 54 years old with no children and don't expect to have children. I am faced with two options. Take the greenlight surgery which is completely free and is paid by the government health insurance. The other option is to do the Urolift, but it will cost me $10000 which is not covered by insurance and has to come out of my own pocket. $10000 is a lot of money for me. I am not sure how long the urolift will last and if my prosate will keep on growing even with the urolift in place.I really don't know what to do. Hoping that you'll can give me some suggestions.

Hi Daniel,

Difficult choice. Sorry to read that. In the end, of course, only you can decide.

My view is that it would be worth shelling out for the UroLift. Three reasons to my knowledge:

1: there is less chance of erectile disfunction;

2: of lengthy (tho' not painful, if my experience is anything to go by) healing (leukocytes and blood in the urine) - mine is still happening after 3 months of HoLEP surgery (a supposed improved version of green light surgery); and

no external ejactulant (seems the latter part of the urethra is lost, resulting in the ejcaulate gong straight into the bladder) - perhaps not a biggy, but, for me, a bit disconcerting.

I couldn't have the UroLift, else I would have done it. The surgeons I talked to did say that as it is new, there is some uncertainty about how long it would last, but they thought it ought to be little worse than any prostateactomy. Plus there are somethings that are supposed to slow/halt prostate growth.

Best wishes, Ian

I had GL PVP (75 gr prostate) in 2005 and was happy with the instant recovery but not a terrific flow. I did not have retro. My prostate regrew to 125 gr.and last year I had Thulium laser surgery with a slightly slower recovery. Someone here said that his Uro told him that prostates continue to grow like weeds.

Urolift seems to be effective but I cannot see what is going to stop it from continuing to grow as nothing has been taken away and ten Grand is a lot of money.

While I was happy with PVP last years surgeon was very much against it saying that it is a commercial procedure and not a cure. Much of the cost for PVP is for the use once laser rod.

Tough choice. My previous Urologist said that there was a problem with Greenlight and that he had to do all his patients all over again, with the TURP. He said that the Greenlight caused abrasions [or something like that]  in the Urethra. I didn't want either the Greenlight or the TURP so I waited until the Urolift came along. I'm 86 and I figured that this new Urolift made more sense than any other.

I had it done about 3 weeks ago and my initial reaction was very positive but now with each following week it seems to be going back to my original symptoms that prompted me to get the Urolift. It's still a "little better" than before the treatment but I thought it would improve more with each week. That hasn't happened BUT it may be too early to judge the results. Here's another possible suggestion. I have a 77 year old frined who decided that his solution was to do a selt-catherization.

Each night he inserts the catheter [along with a bag for the urine} and he sleeps like a baby, then wakes up wiith a bag of urine. Does anyone else in this group know anyone who does self-catherization? If my Urolift doesn't give good results, I may end up with doing the self-catherization.

One of the first UK Uro's to do Green Light (not my one) later told me that they initially thought that GL was a quick and easy procedure but they later realised that they needed to to do it slowly and with more care.  

Well, first of all you can have Urolift done in San Antonio, Texas for $2500, total cost and fly home the next day. Check with Dr Nadeen Kella in San Antonio. I thought that was the best solution for me but I didn't qualify as my prostate was too large, 114mg, and had a third lobe protruding into the bladder. Either condition would have disqualified me. So, if your urologist is considering urolift he/she must know that the size and configuration is compatible with urolift, right? The only way they could know would be by viewing with a cystoscope and by ultrasound through the rectum. Don't be afraid of these if you have not had them done. They are nothing to dread. Patient reports in these forums indicate that urolift appears to be a reasonable stop-gap procedure which usually works for a few years, then the prostate has grown larger and you are once again facing surgery. There are cases where it didn't work at all, probably with inadequately trained surgeons, I suppose.

A multitude of patient reports in these forums reflect negatively on Green light laser surgery. For myself  I would never consider it, there are much better options such as Button Turp and Holmium Laser enucleation of the prostate; HOlep. My urologist's usual method is Button turp and he recommended it to me until it was discovered that my prostate was too large for Turp also. So my only options were supra-pubic simple prostatectomy (incision below the navel, into the bladder and core out the prostate via the bladder neck, HORRORS) or Holep which accesses the prostate thru the urethra, like Green Light or Turp, except Holep uses a much more precise, more controllable laser than Green light with highly-experienced surgeons and performed only in large University Hospitals or Clinics such as the Mayos. It is much less dangerous and invasive and almost always has very satisfactory results. It may be difficult to find a Holep surgeon but they I'm sure that they exist somewhere in Canada. 

If Holep is not a possibility then I would insist on Button Turp. Canada will have many thousands of surgeons performing that procedure. It is widely known to be easier on the patient than Green Light and I would be suspicious of any surgeon still using green light nowadays.  

I was very fortunate in finding a Holep surgeon at the Mayo Clinic in Phoenix who could slot me into his schedule in about 30 days. I had the procedure done on October 31st. I never had any actual pain only pink urine and mild discomfort for about a week. It has been thirty eight days now and I am enjoying a new life. I get urges to urinate every three or four hours and can wait for half an hour or so before finding a bathroom. I completely empty my bladder every time. My stream would knock the bark off of a tree. I'm 76 and I don't recall, even as a teenager, having a stream like now. I find that I'm taking a lot more liquids, drinking beer usually instead of wine or liquor, than I used to since urinating was always such a problem. I sometimes get up once every night if I took a lot of liquids the day before. In short, I'm more normal than I have been in at least thirty years and I'm really enjoying my new life.

I have said many times in these forums that if I could go back ten years I would never take any of the meds, such as Flomax. It works fine for awhile but sooner or later it won't be enough and they will prescribe more meds which will effectively castrate you, maybe permanently. 

Rather than taking any of the Meds I would first try to have Holep done. If that isn't possible I would have Button Turp, not Green Light Laser. If I were having Urolift done it would be by a surgeon who has done at least a few dozen of the procedures. It's a minimal learning curve but still ............................!

Learning what we have in the last six months of participating in these forums every day I think I would just gut up and have either Holep or Button Turp done and skip Urolift. It 's a stop-gap measure at best and the Prostate will continue to grow. That's another factor about Holep, though, it's a once and done routine, only one percent of Holep patients have another procedure later on. 

Whatever you decide (or is decided for you), post your results here and continue to update. Many thousands of BPH patients will read these posts. I first learned about Urolift on the web and here in these forums. I then learned about Holep in these forums. My urologist recommended against both of them. Actual patients, not medical professionals, have given me the information to help me gain a new life and I intend to give back. I am very grateful to the posters who revealed options I never knew existed. I hope you will offer the benefit of your experience as so many others do every day.

Best of luck to you and Merry Christmas!

Ron

Hi IanC. I'm just curious as to where your Holep was performed. I had it done at the Mayo Clinic in Phoenix. I couldn't have Urolift either, but now I'm glad I didn't

Best wishes,  Ron 

There are a number of posters in the BPH threads who do self-cathing. Many have perfected the technique and just insert the catheter and go every four or five hours, completely emptying the bladder. I was afraid that I was approaching full retention a couple of months ago when the meds quit working and I had to find some way to last until my Holep appointment on Oct 31st. So I tried self-cathing and couldn't get the thing in. My urologist provided a thinner one and I was able to insert that one, completely emptying my bladder for the first time in at least ten years. I have to say that going for four hours or so after years of going every 45 minutes in the day and four or five times at night was an amazing feeling of relief. Fortunately, the meds did kick in, sort-of, and I was able to make it to my Holep surgery without further emergency.

After having done it once I know I could do it again, it's a learning process like anything else. I was extremely careful to be immaculate and careful, maybe unnecessarily so. I say go for it, I used the  reddish-brown one with the turned-up tip to help get through the prostate. It also had a little button where you grasp it to indicate the position of the turned-up tip. It was very thin and I would definitely use that one again. 

I expect to be through with prostate problems as my Holep was an amazing, off-the-chart success and my surgeon tells me that only one percent of his Holep surgeries ever require another procedure.

There cannot be a procedure less-painful or troublesome than my experience has been. I'm literally overwhelmed.

But try the self-cathing. Like me, you may come to a point where you need to know if you can do it. Knowing that you can avoid the emergency room is an enormous plus and you may find that you can do it indefinitely. There is one caution; one of the posters I read developed a minor pain and ignored it. it was an infection which got much worse causing him to lose a testicle. So, if it hurts get to the doc for antibiotics immediately.   

Good luck and keep us posted.

Ron

Hi Ron,

Mine was performed in Brentwood, a place to the East of London, UK.

Best wishes, Ian

I just want to complement Ron for your incisive approach to our BPH problems. Your last posting should be saved by everyone. You have convinced me to investigate the Holep procedure if my Urolift doesn't work out. I am with an HMO in Miami and the Urolift cost me only $100 for the hospital stay. I have a hunch that my HMO won't pay for the Holep. Can you give us an idea of what the Holep procedure will cost? Also, does anyone know of a doctor that does the Holep in South Florida? Again, thank you, Ron.

Thanks for your kind words. Holep is done at all of the Mayo Clinics and I know there's one in Florida. I would recommend the Mayos over any other Hospital no matter how minor the surgery.

I still don't know for sure the cost of Holep after Medicare and Medicare supplement but the total is somewhere north of $16,000 at the Mayo.  Ouch!  I may have to pay a bit out of pocket but not much. The trip to Phoenix and all that for me and for my son to come help me get back (turned out to be unnecessary) was close to $2000 though. 

When I tried to have Urolift done just a few months ago Medicare had approved it but the word had not filtered down to the surgeons so it was being done out of pocket but the surgeons assured me that I would be reimbursed by Medicare within a year or so. Your experience shows that HMO's, at least, have caught up.

I know that the Mayos do not accept Medicare Advantage Plans only regular Medicare. A supplement policy will cover anything that Medicare covers. So, if you are considering Holep at the Mayos be sure you have regular Medicare. 

There are other locations for Holep other than the Mayos, such as Indianapolis, Nashville, Boston and others, all huge regional University Hospitals. It is done in these Hospitals because of funding the very extensive training and equipment necessary for Holep.  

So, my advice, get your insurance in order, then go to the Mayo and have Holep done.

My experience has been that Holep is no more invasive than urolift with one exception; with Holep, Turp, Green Light or any of the procedures that remove prostate tissue you will almost certainly have retrograde (dry) ejaculation. Since the meds gave that to me years ago Holep didn't make it any worse and my sex life is now improving. I don't miss the wet part at all. .

Urolift will not cause retrograde ejaculation so if that's absolutely crucial to you then Urolift may be the right ticket. Just be aware that with urolift there will be another procedure in your future as the prostate continues to grow. 

Best of luck to you and be sure to post your results here, good or bad, patients need actual experiences not Dr. BS. Thousands (millions?) of patients worldwide can benefit from your experience.

Ron   

The hospital in England where I had my GL PVP used it for years along with TURP and then started to trial HoLep. Eventually after a split decision they decided that HoLep was the way to go and dropped GL.

There are lots of medical reviews/comparisons of the different procedures online that I will not post as the moderator may not like the commecial aspects of them.

Hi Ron

Thanks for your input. I am very surprised that it costs only $2500 to do the urolift. I wonder if the price is also for Non US Citizens. I have written to  them and lets see what they say. My only problem is that I don't want to have the retrogade ejaculation.I did go on Rapaflo for abouta month and experienced Retro and hated it. I have been on hytrin(Terazozin) for the past three years. But  think it is not working as it should. I keep on getting unirary infections. That is why I am looking  for the surgery. I don't mind doing the Urolift, even if it works out for me for the next five years so long as I don't get the retro. Who knows in the next five years what will be available. Ron what do you know about PEA? I heard that there is a urologist in Portugal who is very successful in curing BPH using this method.

I spoke to my urologist about your view of Holep vs Greenlight(From your previous posts I have been reading your post for the past few weeks), he told me that it is nonsense. It is the same cutting, whether you use a green light laser or red light laser. He told me that he could cut my prostate in such a way with teh green light laser that I may not get retro, but no guarantee. But I don't want to take the chance. So thank you so much your your input, I really do appreciate it.

I wish you a Merry Christmas and Happy New Year 2015 to you and your family.

Dan

My GL PVP was the bladder neck sparing version and no retro. My Thulium Laser one resulted in zero output. Why is it a problem if you don't intend to become a father? 

I priced urolift in San Antonio about five months ago and his price may be different now.  I don't know why it would matter if you are a US citizen or not, I don't think so.  With PEA I think you mean PAE, Prostatic Arterial Embolism. As I understand the process it's done by an artery specialist rather than an Urologist. They use a chemical to stop the blood flow through individual arteries to the prostate to starve the prostate and cause reduction in size. Obviously the surgeon must stop the correct arteries and leave the others alone.  I have heard reports from only two patients who had this procedure and neither was very successful. There may be thousands that are successful though.

This is an area where we really need to hear actual results of PAE. If it's a wonder cure we are not hearing about it here. How about it guys? Speak up,  there are thousands of sufferers who want to know about PAE!

I certainly don't know much about the procedure so if others can add to my assessment, feel free to do so.

As far as urologist's opinions of procedures other than the ones they prefer, let me say this; Holep is a laser, true but a very precise laser compared with others, allowing the surgeon to approach the capsule more closely without damaging the capsule or the nerves on the capsul surface. He is able to remove a larger proportion of the prostate tissue in some cases leaving only the empty capsule. Other lasers will not do that. That's exactly the same sort of response I got from two urologists concerning urolift and Holep.  My long-term uro who is head of urology in a very well-respected hospital had never heard of urolift when I expressed an interest in it about five months ago. He also had never heard of the current version of Holep which is much-improved over the previous version. When I told him that I would have to go out of state to get the Holep done his reply was "doesn't that make you feel in your gut that if no one here is doing it there must be a reason"? I replied, yes but the reason is that Holep has a very high learning curve, each surgeon trains with a mentor for dozens of procedures and only practices in the huge regional University teaching hospitals with every facility at hand to perform a difficult but very beneficial procedure. He replied, well TURP is not easy either. Maybe not, but I think it's a whole lot easier on the surgeon than on many patients.

Surgeons are just human beings like the rest of us, they have to find a sweet spot between liability attorneys and satisfied patients. They are constrained by liability concerns that overshadow everything they do. A surgeon who sticks his neck out on an unaccepted procedure is looking for big trouble. They thus find a routine, Button Turp usually, that works most of the time, is accepted by Medicare and Medicaide, private insurance, is quickly and fairly easily done, is peer-supported universally, who can blame them?  So, Button Turp is the gold standard and thousands of these procedures are done compared to much fewer others. I don't believe Green Light is well-accepted anymore and I would not consider it.  Best of luck and keep us posted on what you do.

Merry Christmas to all posters!!       

Hi Daniel,

I had the Gat-Goren procedure in May 2011, and I'm happy with it.  No retro, my prostate shrunk back a lot, and symptoms were greately eased.  I posted a long reply in the "CPPS / BPH / Chronic Non Bacterial Prostatitis - My Sad Story" discussion.  I'm active on the HealingWell Gat-Goren forum, where PAE is also sometimes discussed.  GG is a boutique procedure:  high cost, no insurance reimbursement, uneven outcomes and not successful for some patients such as those with large midlobes.   Still, I'm happy with mine. 

BTW One PAE patient posted a month ago on HW that they were happy with their results. Another PAE patient never posted his follow-up results. PAE and GG are performed by Interventional Radiologists but are otherwise totally different procedures.

Best of luck.

Hi 

I have never heard of the Gat-Goren Procedure. It is quite interesting. Do they do the procedure in the US? Do you have to go to Israel to do it? How much does it cost?

Thanks

Dan

Yes, you have to go to Israel or thereabouts.  I went to Tel Aviv for my operation in 2011, but now patients go to a hospital in Crete, and the doctors fly from Israel to meet you there.  It's not done anywhere else, though there are similar procedures that are sometimes done.  There is an occasional discussion on this very technical topic on the HW forum I mentioned; I need to refer you to that forum for more information.

As for price, I don't know.  The price has gone up since I had it, and there are exchange rate issues.  You can contact the clinic for the most recent price.  It will be between US $20K and $30K.  I realize that this puts it out of the reach of most guys, especially since insurance won't cover it.  I'm not proseletyzing for it; I'm merely recounting my experiences as an option for some men. 

The HW forum and the clinic web site have covered the theory behind the procedure, so I won't go into that here except to say that the prostate itself is not directly targeted.  Which sounds strange, I know.

Best of luck whichever route you take.

 

Sorry to sound dumb. Can you please direct me to the HW forum? I don't know what HW stands for.

Thanks

Dan

Dan, I don't want to intrude on this forum by starting a long discussion about Gat-Goren. I'm content just to mention that it exists, and anyone so inclined can begin to research it.  It's an experimental treatment, not accepted by mainstream medicine, so many guys will not feel comfortable with it.  I've been directing folks to the HW forum. (Just Google "Healing Well" and "Gat-Goren".)  "A word to the wise..." and all that.