Buscando ayuda de hombres que ya han tenido HoLEP

Salud del hombre
1

I met with Dr. Lingeman, considered the pioneer of HoLEP in the States. Fellows under him have gone on to institutions like Mayo Clinic-Rochester.

Unfortunately, I drove 200 miles to see him and did not get much time with him, despite being on a wait list for an office consult that was nearly 16 weeks long.

My PVR on the day of the consult was nearly 400 cc. It's never been remotely that high. A week later my urologist's nurse measured my PVR and it was essentially zero at 8:45 am - after peeing 900 cc over three bathroom visits the night before and hardly having anything to drink that morning.

So, I am having a pelvic US and PVR this week along with the nurse rechecking my PVR the following week - all to see if my 400 cc PVR was a fluke.

To be honest, it was enough to scare me into agreeing to surgery (HoLEP) 10 minutes after meeting Dr. Lingeman.

Lingeman is warm and personable. He has good bedside manner, to be sure. He is extremely skilled at HoLEP and is a highly regarded doctor overall. But, I didn't nearly have as much time with him as I had hoped -- and especially given the apparent need for near immediate intervention.

To the guys who've had HoLEP (with Lingeman or anyone else), how long were you in pads for incontinence?

Does the incontinence mean absolutely no control and filling a diaper completely (like an infant) or does it mean if you feel the urge to go, you only have seconds to reach the toilet or risk making a mess or leaking if you sneeze or laugh or even fart?

Did anyone have complications such as a stricture or bladder outlet obstruction (BOO) that required subsequent surgery?

How long was the catheter in?

How quickly did you notice improvement in flow? Has that improvement lasted?

Has anyone not had RE after HoLEP?

Finally, would you do it all over again?

I've weighed all my options and for various reasons, Rezum and PAE are not good choices for me. Perhaps PAE was a year ago and Rezum two years ago (when my prostate was 90 cc), but at over 130 cc with a median lobe, my choices are now limited. I'm looking at GL (PVP) and HoLEP. The thing that attracts me to HoLEP is long-term effectiveness and more than 30 clinical trials proving just that.

Your input can help put my mind to rest.

Many thanks in advance, Michael

2

You seem to have more worries than hopes. There are a lot of UK HoLep success stories on the Forum.
Try this link an also look for his later update to 18 months on. It is an old link in a closed conversation so if it does not open for you I will copy and paste it for you.

My GL and Thulium/Holmium experiences in 2004 and 2013 were even easier. My GL was also at Newcastle when they were doing trials on GL. and I was my Uro’s 8th patient.

3

No people are the same, no doctors are the same, no procedures are the same. You take your chances and hope for the best. Good luck.

4

Lester,

I understand. I was simply hoping to find out what to expect from guys who have had HoLEP.

The doctor just said to expect to wear pads for 3 months. Nothing more.

I don’t know if wearing pads = changing diapers at work every 3-4 hours or if wearing pads = having a little protection for incidental leaks.

Obviously, that’s a substantial difference: does the pad collect 300 cc or 20 cc?

Just looking for something helpful from the guys who’ve been through it. If I had a friend who’s had HoLEP and could tell me about it, I wouldn’t need to start this thread.

5

Derek,

I look at it as, I seem to have more questions than answers.

I’m an engineer. I do a lot of research. Perhaps being so analytical is detrimental; perhaps I’ve spent too much time on this forum because if there’s one thing that one finds here is conflicting information. What works for one man fails for another, and one can see a myriad of experiences on this forum, both good and bad, for any and all BPH treatment options.

Thanks for your link. I appreciate that.

I sought out the no. 1 HoLEP practitioner in the U.S., and undoubtedly one of the best in the world. Unfortunately, I drove 4 hours and didn’t get to ask half my questions because he was backed up with patients in the waiting room.

A good friend of mine is have a robotic radical prostatectomy for Gleason 8 cancer next week. He will be in pads for several months. I can ask him after his surgery what that means, and assume the results will be similar. After tall, HoLEP is in essence a intra-urethral partial prostatectomy.

6

Good discussion. I am thinking hoLEP, and nothing else, so I hope to benefit as well.
Re incontinence, I agree with Lee that everyone can have different outcomes. However, from what I’ve read, the 3 months incontinence is mostly leakage since hopefully you external sphincter can still hold urine in.
Re retention, how much you drink is the main factor, because your bladder is a pump, and it can only pump so much volume. I you drink little, your retention will be very low. But you may have many other problems.

7

I would avoid a Uro who tells his patients that. Even the original TURP patients did not need that that. .

8

As you must realise people who post after procedures are the minority who have problems others are out playing golf or like me were at the races on day three.

9

I see that no one is answering your specific questions.

I had the procedure in India last year. The catheter was removed the next day. There was no bleeding from the prostate, but the bladder and the urethra were inflamed because of the laser and the catheter, so there was blood in the urine for about a week. I wore a diaper only for clothes protection. I didn’t have incontinence. My flow is like a pitcher of liquid pouring out. I have RE from the procedure. I was 80 when I had I had it and I would do it all over again. I had Rezum and PAE, both failed probably because my medium lobe was out morphed out of shape.
I hope that I answered your questions.

10

I read many years ago that there are massive urology hospitals in India dealing with hundreds of patients a day. Was yours one like that ?

11

You can say that. The way I did it is that I corresponded with the urologist before I made an appointment so I was all set up when I got there.

12

UK links to NICE prostate procedures:
If it does not pass the moderator I’ll PM it to you.

13

A few months ago I went to the Mayo Clinic in Jacksonville Florida requesting HoLEP. I met a great surgeon, Dr. Chandler Dora, who advised me my prostate was too small for HoLEP (was 40 gms). He said the risk of sphincter damage was too great with a 40 gm prostate. So, instead, I had HoLAP. A = Ablation. E = Enucleation. Had the surgery July 18th and am doing great. Very satisfied and impressed with Dr. Dora and the Mayo Clinic Hospital. If you want to see HoLEP performed google: HoLEP Dora youtube. Best of luck to you whatever procedure you have.

14

Thanks Joseph

That was helpful. I am doing Kegels now. Sounds more like pads are for leaks, not full bladder emptying.

I should educate myself further on bladder and prostate anatomy

Glad to read you’re doing well
Michael