Holep vs. Green Light vs. TURP

Men's health
1

Good Afternoon Gentlemen & Ladies,

I just left my New Urologist's office (Stanford Med Center) yesterday at 5 pm. Long story short...
I am now narrowing down my final decision for seeking a resolution to my many years of BPH. I know we are All Different and have to find our own "Best Choice" to our own issues.
To give a bit of insight into my particular situation: - I'm over 60, very physically active, 35 years marriage, 2 adult kids, a relatively small prostate size, 38 grams, which is apparently growing inward and squeezing the urethra, more than it's growing outward. The CT Scan with & without contrast dye shows the prostrate is also pushing in on the bladder. No median lobe, strictures, or other side issues. Have been using CIC twice a week to keep my PVR's down from 100 to about 40-50 ml. I sought out PAE, both at San Diego State University Medical Center and Stanford University Medical Center. I was informed by an IR Doctor whom I respect, that I am not an "excellent" candidate for PAE, due to their preference to utilize PAE on sizes of 50 -100. Can NOT afford FLA, have ruled out Rezum, Mono TURP, and Urolift.

After much reading/research, having many DRE's, Ultrasounds, Cystoscopy, Flow Tests, trying various "Medications", and seeing 3 different Urologists and one Interventional Radiologist, I have come to the the conclusion that I want to cease battling this affliction and move forward with my Life and will likely get one of the following procedures in the next month or so.

Holep - Green Light (PVP) - TURP (button) -

At this time I would appreciate your valued thoughts, experiences, and rationale opinions on which procedure you believe has the Best Overall results. Feel free to include negative aspects of each, but please limit them to personal experiences, not third/fourth hand stories.

Thank you all in advance. And rest assured, I will keep you All updated as my procedure progresses, for other folks who follow and have yet to make their "Choice".

Respectfully,

Chuck

.

2

As you describe your situation why do you need a surgery at all? Do you have any symptoms? Do your urologists told you you need a surgery? My urologist told me that 300ml PVR is OK. Of course it might be because my bladder is very much stretched.

3

Chuck, Why have you ruled out REZUM? I had it at the end of June. I can pee, and no nasty side effects. Worth looking into IMHO. You can PM me if you want more info. Also 100ml PVR is low. Why the concern? Best, Fred

4

Just wondering what your other symptoms are. A PVR of 100 is not huge. And did you mean to say you cath 'twice a day' rather than twice a week. I cannot understand how cathing twice a week would keep PVRs down for long. Please clarify, and somebody may be able to help. Regards Dermot

5

I'm 78, have had BPH as long as I can remember. I have had all three, beginning with the green light and followed by TURP ending with the HOLEP. Had so much scar tissue from biopsies and the other procedures not much choice was left. Finally had the HOLEP last year. You might want to consider the holep if you're going to end up there.

6

Yes my Symptom rating scale is 29. Basically can't get much sleep due to getting up to pee, and then can't pee much, then can't go back to sleep, then getting up again to do the same thing about every 2-3 hours. Lack of sleep ruins one's Life. Also... if I was not CIC-ing, the PVR's seem to snowball and get higher, as the pressure builds. I do NOT want to stretch my bladder, by waiting too long and then have problems with that AFTER having a procedure.

7

Thanks for your thoughts on Rezum. I just know of too many complications that I do not want to risk. As far as PVR's...
Basically I can't get much sleep due to getting up to pee, and then can't pee much, then can't go back to sleep, then getting up again to do the same thing about every 2-3 hours. Lack of sleep ruins one's Life. Also... if I was not CIC-ing, the PVR's seem to snowball and get higher, as the pressure builds. I do NOT want to stretch my bladder, by waiting too long and then have problems with that AFTER having a procedure.

8

I can only report my experience of button TURP. After many years of struggling on Tamsulosin and Dutasteride I finally reluctantly opted for the operation just over a year ago. The procedure caused me no problems and resolved my symptoms completely.

9

Which ever surgery you elect, make sure the surgeon is well trained and experienced in doing that procedure. Ask how many of that procedure they have done in the last 6 months.I had a Greenlight procedure in 2016 and didn't ask those questions. It was a disaster for me, leaving me totally incontinent and with strictures in the external sphincter. It was a major FUBAR .

Glenn

10

In this case you are absolutely right to look for the solution. Good luck!

11

Dermot,

I do indeed mean twice a week. By cutting off my liquids 4-6 hours before bed, and doing natural voids a few times before bed. And then every 3 or 4 days following that routine with CIC-ing, I have been able to seriously reduce the "pressures" on my bladder and subsequently my regular PVR's. Apparently I have the bladder capacity of a humming bird. Although it was not always this way, and seems to have only become an issue since having BPH. My flow has been measured several times and is about 4.9 . And going years without much deep sleep has cause me serious side "issues" and difficulties, as well as sunken dark circles around my eyes. I am very ready to move past this BPH challenge.

Chuck

12

I agree about Rezum. There have been a few who reported problems on this site. But for me and thousands of others, it worked very well with no side effects.

13

LOL... I hear ya Brother. . I have read many of your posts and understand what you have endured. My hat's off to you for your valiant fight sir. Holep is what I am leaning towards, because it does sound advantageous to my individual situation.

14

Mike,

Thank you sir for your information. Was there any recommendation on prep for the buton TURP or during recovery, that you can share ?

I too suffered the trials/tribulations of the "chemical" methods. Both caused me bad problems; one almost cost me my 30+ year married. It made me not care about anything or anybody... including myself. I woke up every day the same. No good days, no bad days, just days.... Nothing seem important. Nothing seemed to matter. * I was subsequently told that Alpha blockers can have psychotropic effects on people. HECKA--DOODLE ! - One would think the Doctors might wanna mention that little tid-bit of important information to their Patients. Best to you sir.

Decorously,

Chuck

15

Chuck,

HoLEP is top of the list, but it normally used on larger prostates. You would have to speak with a urologist who does HoLEP to see if they are willing to work on a prostate of your size - probably, yes. You would have to go to either Southern California or the Mayo Clinic in Arizona - no HoLEP done in Northern California.

Plasma Button TURP or bipolar TURP would work out well for you, but might cause retro ejaculation. There are techniques used with the newer TURP techniques that might spare you this side effect. I had a bipolar TURP in April with excellent results - no pain, very easy, home after 4.5 hours, done at my local hospital 2 miles from my house, fully covered under my insurance.

Greenlight is not as effective as TURP, according to my urologist, and has some proponents here, but also some poor results.

Some questions you need answers to from the urologists you interview: is the procedure covered by my insurance will I have to travel far to have this done will I have to stay in a hospital overnight or can I just go home after the surgery for TURP do I want general or spinal anesthesia what about catheters after the surgery (I had a Foley in for three days after)

Hope this helps your decision process,

Tom

16

Glenn, Thank you for sharing that with me sir. I hope you are able to find help to deal with those strictures in the external sphincter and / or a possible resolution to the incontinence. I will indeed take your recommendation to heart and inquire about the Surgeon's level of training and recent experience. That does sound very crucial to whatever procedure we choose. Although having said that, due to monetary considerations, I like many other people, have financial constraints and insurance limitations I must work within.

With your FUBAR descriptor, it sounds like your Surgeon may have been VA related. If that's the case, my heart goes out to you even more. I have many Family and Friends dealing with the VA healthcare "system".
Chuck

17

Hi Chuck,

I like you have fought BPH for years. Now 68 years old. Had two Biopsies, one blind and one 3D, both negative. PSA before Green Light (PVP) was 6.6. After Green Light (December 2018) it jumped to 9.9. Urologist puzzled to say the least. Will return next month for another PSA and flow test. On the plus side no more meds for me. able to sleep all night and can now empty bladder. No urge to go. Was rough at first, didn't like the catheter at all and passed blood for weeks. Would I do it again? Yes, definitely. Just wish my PSA would go down. By the way, no more biopsy for me. Too Invasive. Was awake for both of the them, just a local. Not Fun!

18

Chuck,

A couple of additional points: with HoLEP and TURP the tissue samples are sent to the lab so you get checked for prostate cancer at the same time - a two for one situation. Also, you and I had/have the identical sleep issues. My retention was causing me to get up at night and go to the bathroom 6-10x, severely disrupting my sleep. My TURP greatly improved my frequently/urgency issues as my bladder is now "calming down", but the sleep is still not resolved. I am thinking this has become a very bad habit. So, the longer you get used to getting up frequently at night the longer it will take you to break that habit. This is another reason you need to get some form of treatment once your questions have been answered.

Tom

19

Tom, where's in Southern California that one can get hoLEP ? Thanks.

20

Chuck, I hate to tell you this but you are a poor candidate for surgery, with your very small bladder and very low PVR. I don't see how CIC twice a week helping either. However, if you decide to have one, hoLEP is the best. Theoretically, it can be done on any size prostate, with the largest one was about 900g. I would look into non surgery options if I were you. I suspect that