I am on a trajectory toward needing one of the available BPH treatments, with REZUM and HOLEP at the top of the heap. There is a wonderful thread here on this forum regarding REZUM, but I am not seeing much on HOLEP.
Anyone here have experiences they want to share with HOLEP?
I’ve been following this blog for about 7 months and have heard a lot about cathing, drugs, and the various BPH procedures including PAE, Rezum, Urolift, TURP, Green Light Laser and HoLEP. The following summarizes what I’ve read as best I can.
Bottom line: drugs may work for a while (for me it was about 3 years), but they are not a long term solution and can also result in damage the bladder from constantly being over extended/full. Some procedures seem to work for some but not all. Worse yet, some have reported total incontinence after their surgical procedures. It’s hard to tell if it was a botched job or not.
The real answer imho is surgery, specifically HoLEP. I did the research on all the procedures (except PAE….had not heard of it), and chose HoLEP. It is the best surgical procedure because; 1) less time in the hospital and a on catheter (less than 24 hours), 2) less bleeding, 3) very small chance of needing a repeat procedure, and 4) they remove prostate tissue (instead of burning or otherwise destroying it), so they can biopsy it for cancer. I have heard no reports of anyone having HoLEP and needing a second procedure or experiencing incontinence or needing to continue cathing. I’ve heard way too many horror stories on this blog about TURP & GL. My uro explained that they both burn the tissue out, and therefore leave scar tissue. That tends to shrink over time, and hence the need for a repeat procedure. With HoLEP, they cut the tissue away, grind it up with a ‘morcellator’, push it into the bladder, and then wash it out.
Yes, you the have retro ejac, but sex drive returns, and since I don’t plan to have any more children (age 68), it’s not a problem for me. I was retaining close to 800ml, and my prostate was 85 grams, PSA 3.8. After it was 46 grams, PSA 0.2. I had my surgery in January, and after two to three months had no problems at all. I did have leakage for 3 or 4 weeks. Some in the UK report they were told to do Kegel exercises for a few months before surgery to avoid this.
I have heard some good reports on PAE which is done by interventional radiologists. It is an outpatient procedure and far less invasive. If I had it to do over again, I might do that first.
Lastly, the experience & ability of the doc is critical, and often difficult to determine. Hospital ratings for various specialties can be found in the US News & World Report evaluations. Bios for docs may or may not be available. For example, the Mayo Clinic was rated best in the nation, and they have the education and publications of their docs listed…… very helpful. Best of luck!
Thanks a million Paul. Great info!
It's people like you that make it possible for people like me to make the most informed decisions.
Paul did a good summary, which I agree with. I had HoLEP nearly 2 years ago. There was more hiccups than my over-optimist urologist said, but I'm now mostly good - get up at least once a night, sometimes twice, but less than the 3-5 times before. More importantly, my retention is minimal - 20-50mL v. sometimes over 1L before and causing problems with my ureters.
I too checked out many of the alternatives (but not PAE) and decided HoLEP was best.
Good Morning Bill Sorry for your problem. I myself am not a fan of any of the procedures that take anything away from a man ( Retro ). There are good thing on Holep and bad. If that is the way you what to go. With Holep the surgery does help sometimes but it can cause many side effect so your getting rid of one problem for manymore. Leaking, incontinence some bleeding and retro if you can. Sometime they get to close and you may not lose your sex drive. It does not always happen. but it can. Rezum is new and they have had good thiings with it. It is not done by a urologist it is done by a radiologist that is why a urologist will not tell you about it. This procedure will make the prostate smaller with no cutting. And it perserves your sex life. What ever you do get as much information you can before you pick anything. Look at the pro and cons. If you can if you pick Holep have your doctor give you a pill that will cause retro so you can see if you can live with it. Some men can't because it does not feel the same and stop sex all together. I can tell you myself. I was on a pill that cause it. And the orgasm was not as good. You get the built up and it just goes flat. Some there is no change but at 61 I am not giving up anything just to pee better. My orgasm are very intense and I ejaculate more now then I did when I was younger. I don't care if I am not having kids anymore I still enjoy it And the clean up can be fun for both. It makes me feel like I'm still alive. Also I think any man that is having any procedure should watch the video of the procedure and see what is going to be done to them. Take care and my god help you in your pick Ken ( I had a Uro-lift in 2014 and I'm great )
Good Morning Bill Sorry for your problem. I myself am not a fan of any of the procedures that take anything away from a man ( Retro ). There are good thing on Holep and bad. If that is the way you what to go. With Holep the surgery does help sometimes but it can cause many side effect so your getting rid of one problem for manymore. Leaking, incontinence some bleeding and retro if you can. Sometime they get to close and you may not lose your sex drive. It does not always happen. but it can. Rezum is new and they have had good thiings with it. It is not done by a urologist it is done by a radiologist that is why a urologist will not tell you about it. This procedure will make the prostate smaller with no cutting. And it perserves your sex life. What ever you do get as much information you can before you pick anything. Look at the pro and cons. If you can if you pick Holep have your doctor give you a pill that will cause retro so you can see if you can live with it. Some men can't because it does not feel the same and stop sex all together. I can tell you myself. I was on a pill that cause it. And the orgasm was not as good. You get the built up and it just goes flat. Some there is no change but at 61 I am not giving up anything just to pee better. My orgasm are very intense and I ejaculate more now then I did when I was younger. I don't care if I am not having kids anymore I still enjoy it And the clean up can be fun for both. It makes me feel like I'm still alive. Also I think any man that is having any procedure should watch the video of the procedure and see what is going to be done to them. Take care and my god help you in your pick Ken ( I had a Uro-lift in 2014 and I'm great )
Good Morning Bill Sorry for your problem. I myself am not a fan of any of the procedures that take anything away from a man ( Retro ). There are good thing on Holep and bad. If that is the way you what to go. With Holep the surgery does help sometimes but it can cause many side effect so your getting rid of one problem for manymore. Leaking, incontinence some bleeding and retro if you can. Sometime they get to close and you may not lose your sex drive. It does not always happen. but it can. Rezum is new and they have had good thiings with it. It is not done by a urologist it is done by a radiologist that is why a urologist will not tell you about it. This procedure will make the prostate smaller with no cutting. And it perserves your sex life. What ever you do get as much information you can before you pick anything. Look at the pro and cons. If you can if you pick Holep have your doctor give you a pill that will cause retro so you can see if you can live with it. Some men can't because it does not feel the same and stop sex all together. I can tell you myself. I was on a pill that cause it. And the orgasm was not as good. You get the built up and it just goes flat. Some there is no change but at 61 I am not giving up anything just to pee better. My orgasm are very intense and I ejaculate more now then I did when I was younger. I don't care if I am not having kids anymore I still enjoy it And the clean up can be fun for both. It makes me feel like I'm still alive. Also I think any man that is having any procedure should watch the video of the procedure and see what is going to be done to them. Take care and my god help you in your pick Ken ( I had a Uro-lift in 2014 and I'm great )
Bill I am sorry I got it wrong I was talking about PAE REZUM They have good outcome with that procedure to Ken
I'll share my experience with HoLEP. Keep in mind, your experience might be very different from my experience. I am not going to cover reasons for choosing HoLEP – there is enough information on this site to form an informed opinion.
I am 44 yo. Prostate was intruding into bladder creating flap that severely impeded flow. Bladder was distended, there was a bladder stone.
I had HoLEP at IU Methodist by J.Lingeman on 7/11/2016. 40g of prostatic tissue removed, bladder stone removed, bladder neck resected, tissue pathology was negative. Out of hospital next day. On elliptical trainer 7/14. Last time seeing anything strange in urine – 7/15. Some discomfort in urethra, managed with phenazopyridine for one day, no narcotics. Swelling around prostate started coming down ~7-10 days after procedure. Sex two weeks later, retrograde ejaculation. At this point, I could not tell you that orgasms, except for being dry, are any different than from the before surgery.
Flow is really good, voiding volumes ~300ml, no issues with incontinence. Can sleep for 4-5 hours, urinate, and go back to sleep. Takes seconds to urinate while it was minutes previously.
According to medical literature, two months is the expected time frame for things to readjust to baseline.
Do you know if there is a urologist, that can do this procedure in Hawaii?
By any chance, did your uro tell you that you have weak bladder muscles, and that's the reason that you could not empty your bladder?
Dennis If your doctor told you that you have a weak bladder then it not your prostate Get help with your bladder..Ken
Your very lucky. That there is no change in your orgasm But that is not all ways the case. Everyman is diffrent. That is one thing they will never take away from me.....I don't care if I'm not having any kids. At 61 I still enjoy my ejaculation Have a good day..Ken
I am not aware of any surgeons performing this procedure in Hawaii - this procedure is not widely available in the US, fortunately for us, it is spreading slowly. Your best bet would be to contact surgeons directly, explain what your personal circumstances are and see if they will be willing to work with you. Dr. Humphreys is in Scottsdale, AZ, he is most likely to be the closest for you. It is not inconceivable to manage everything – tests, surgery, in one trip. The list, obviously not full - Dr. Lingeman, Dr. Humphreys, Dr. Miller, Dr. Lerner, Dr. Kuo.
I believe, in my case, strength of bladder muscles was not an issue.
I had what I expected to be HoLEP on Thursday June 30 and was informed moments before surgery that the laser used was Thulium not Holmium and that it was a step up in quality. You can Google both for comparison. At that point I did not question and proceeded. Three hour surgery, prostate noted as "massive" 80 grams of morsulated material submitted for examination. No cancer. I was out of the hospital on Friday July 1 and due to weekend plus Monday holiday had catheter until July 6th. No fun with that schedule. Had some bleeding issues in the beginning and that has subsided. Now dealing with leakage and am told could last for months. After checking with other HoLEP patients this also is in the relm of "normal" outcome. Of course some are better, all heal differently. As has been mentioned the key is to find a Doctor that has done this procedure hundreds of times. If I can be of further help let me know.
I notice that "kenneth" has posted no less than three (all the same) lenghthy anti surgery rants as usual. Note that Urolift is not for all especially large prostates and the outcome is not 100% rosey.
I had leakage as well but only for 2 or 3 weeks. The UK guys report being told to do Kegel exercises as a way to stop that..... they were even told to do it months before the surgery. It did help me (just stop the urine mid-stream several times for 15 seconds, repeat, etc.).
And I will do that till the day I die. There are many other procedures that do a better job and less truma to a mans body. You went through a 3 hour surgery and you may all way have a problem with leaking. There have been men on here that still have a problem after up to a year and have to do CIC after a surgery that was suppose to fix the problem. Uro-lift...PAE...RAZUM are just as good and do not cause the truma that the others do. I can give my opinion to anyone but they pick what they will have. And have to deal with the side effect after the surgery. I will never give up anything just to pee better. And if I have cancer there are other ways to deal with it they having your prostate cut out Ken
As a eneral rule, I recommend starting with the procedures that are least invasive with the fewest side effects first. They are, PAE, Urolift and ReZum. Permanent side effects are rare with all three and most who are good candidates get considerable, acceptable relief from them. Its my feeling that you can always go for more invasive surgical options if those three don't work or you aren't a good candidate.
HoLep seems to be the best of the surgical options, but it will leave you with RE, which many feel makes sex permanently enjoyable. Recovery is long, often with weeks to months of leakage. It's way better than TURP, but I suggest that you investigate/try all of the three less invasive options before going under the knife.
Very good advice.You can always go forward but you can't go back with the knife. Take care Ken
I had my Holep carried out 2 years ago in Cambridge. It was done privately but is available on the NHS in Cambridge by the same excellent consultant. I have to say it has been a total success for me. The only after-effect and expected was retrograde ejaculation but as I was producing very little anyway it has made no difference. I had very little pain after the first couple of days apart from urination stinging for the first week. My flow rate remains excellent with no dribbling. For a few months I had very occasional spontaneous spotting but that stopped a year ago. My prostate produced some blood for 5 weeks despite the hospital saying it would last a few days. So, choose a good consultant with a lot of experience and go for it. I am so pleased with the operation and the surgeon. BTW my prostate was around 130gm.